NURSING STANDARD

Clinical digestLower blood pressureachieved with agedgarlic capsules

Aged garlic extract is superiorto placebo in lowering systolicblood pressure, similarly to first line medications in patients with treated butuncontrolled hypertension.

Australian researchers assessedthe effect and tolerability of agedgarlic extract as an adjunctivetreatment to existingantihypertensive medication.Their study involved patientswho had hypertension that wastreated but not controlled.

They undertook a doubleblind, parallel, randomised,placebo controlled trialinvolving 50 patients whoseroutine clinical records ingeneral practice documentedtreated but uncontrolledhypertension. The activetreatment group received fourcapsules of aged garlic extract(960mg containing 2.4mg S-allylcysteine) daily for 12weeks, while the control groupreceived matching placebos.The primary outcome measureswere systolic and diastolicblood pressure at baseline, four,eight and 12 weeks, and changeover time. Tolerability wasassessed during the trial andacceptability at 12 weeks.

In patients with uncontrolledhypertension (systolic bloodpressure >140mmHg atbaseline), systolic blood pressurewas on average 10.2mmHg

Older womenwho drink fruitjuices can putthemselves atgreater riskof gout

Sweetened drinks are associatedwith an increased risk of gout in women, although thecontribution of these drinks is likely to be modest.

Gout, a painful form ofarthritis, has been linked to men historically, but evidencesuggests it is becoming moreprevalent among older women.

Sugar-sweetened soft fruitjuices and fructose-rich drinkswere linked to an increased riskof gout in men. Researchers in the United States analysed datafrom the Nurses’ Health Studyfrom 78,906 participants with nohistory of gout at baseline. Theywere followed up over 22 years,during which time there were778 confirmed cases of gout.

A rise in the intake of sugar-sweetened

soft drinks wasindependently

associated withincreased riskof gout.

Compared with consumptionof less than one serving permonth of sugar-sweetened softdrinks, the multivariate relativerisk of gout for one serving perday was 1.74. For consumption oftwo servings per day or more, therelative risk was 2.39 (P<0.001for trend). The correspondingrelative risks for orange juicewere 1.41 and 2.42 (P=0.02 fortrend). The absolute differencescorresponding to these relativerisks were 36 and 68 cases ofgout per 100,000 person-yearsfor sugar-sweetened soft drinksand 14 and 47 cases per 100,000person-years for orange juicerespectively. Diet soft drinkswere not linked to gout (P=0.72 for trend). Comparedwith the lowest quintile offructose intake, the multivariaterelative risk of gout in the topquintile was 1.62 (P=0.004 fortrend) giving a risk difference of 28 cases per 100,000 person-years. The authors saythat healthcare professionalsshould be aware of the potentialeffect of these drinks.

Choi HK et al (2010) Fructose-richbeverages and risk of gout in women.Journal of the American Medical

Association.doi:10.1001/jama.2010.1638

Sugary beverages can raiserisk of gout in older womenResearchers call forhealthcare workersto be aware of theeffects of soft drinks

ISTO

CK

PHO

TO

GET

TY I

MA

GES

p16-17w19_CLINICAL DIGEST 10/01/2011 11:38 Page 16

january 12 :: vol 25 no 19 :: 2011 17NURSING STANDARD

lower in the garlic groupcompared with controls over the 12-week treatment period(P=0.03). Changes in bloodpressure between the groupswere not significant in patientswith a systolic blood pressure<140mmHg at baseline.

Aged garlic was generally welltolerated and acceptability of thetrial treatment was 92 per cent.

Ried K et al (2010) Aged garlic extractlowers blood pressure in patients withtreated but uncontrolled hypertension: a randomised controlled trial. Maturitas.67, 2, 144-150.

Young women morelikely than men torelapse with depressionWhile almost all adolescentsrecover from major depression,recurrence occurs in almosthalf, with a higher probabilityamong females in this age range.

Major depressive disorder in adolescence is common and impairing. Efficacioustreatments have been developed,but little was known aboutlonger-term outcomes.

Researchers in the UnitedStates investigated whetheradolescents who responded toshort-term treatment wouldhave lower recurrence rates andidentified predictors of recoveryand recurrence. A total of 196adolescents (86 male) took partin the follow-up. They wererandomised to one of fourshort-term interventions

(fluoxetine, cognitivebehavioural therapy, theircombination, or placebo) andwere monitored for five years.

Almost all participants (96.4 per cent) recovered fromtheir original episode during thefollow-up period. Recovery bytwo years was more likely forshort-term treatment responders(96.2 per cent) than for partial ornonresponders (79.1 per cent,P<0.001), but was not linked to having received the mostefficacious short-term treatment(fluoxetine combined withcognitive behavioural therapy).

Of the 189 participants whorecovered, 88 (46.6 per cent) had a recurrence. Recurrence wasnot predicted by full short-termtreatment response or byoriginal treatment. But full orpartial responders were lesslikely to have a recurrence (42.9per cent) than nonresponders(67.6 per cent, P=0.03). Genderpredicted recurrence (57 percent among females versus 32.9per cent among males, P=0.02).

Curry J et al (2010) Recovery andrecurrence following treatment foradolescent major depression. Archives ofGeneral Psychiatry. doi:10.1001/archgenpsychiatry.2010.150.

Good and bad weatherincrease hospitaladmissions for traumaThere are strong seasonal trends in trauma admissions toA&E departments for childrenand adults.

A UK team of researchersassessed the relationshipbetween daily trauma admissionand observed weather variablesusing data from the TraumaAudit and Research Network of England and Wales and theMeteorological Office. Datawere obtained for 21 A&E unitsin England. All patients arriving

at A&E with a subsequent death, inpatient stay of morethan three days, interhospitaltransfer, or requirement forcritical care between January 11996 and December 31 2006were included.

Analysis indicated that therewere strong seasonal trends inpaediatric admissions (P<0.001)and adult (P=0.016) traumaadmissions. For adults, each riseof 5ºC in the maximum dailytemperature caused a rise intrauma admissions of 1.8 per cent, while eachadditional two hours of sunshineprompted a 1.9 per cent rise.

For children, a similar rise in temperature and hours ofsunshine saw increases in traumaadmissions of 10 and 6 per cent.

Each drop of 5ºC in theminimum daily temperaturecaused adult trauma admissionsto increase by 3.2 per cent. There was no similar increase inpaediatric admissions. Snow orsleet increased adult traumaadmissions by 7.9 per cent andevery 10mm of rainfall increasedadmissions by 2.2 per cent. Anapproximate 20mph increase inmean wind speed was estimatedto cause a decline in paediatricadmissions of 13 per cent.

Parsons N et al (2010) Modelling theeffects of the weather on admissions to UKtrauma units: a cross-sectional study.Emergency Medicine Journal.doi:10.1136/emj.2010.091058.

Extra sunshineand a rise intemperature affectboth adult andpaediatricadmissions for trauma

Adolescent boys are less likely to havea recurrence of depression

ISTO

CK

PHO

TO

REX

FEA

TUR

ES

p16-17w19_CLINICAL DIGEST 10/01/2011 11:38 Page 17

Copyright of Nursing Standard is the property of RCN Publishing Company and its content may not be copied

or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission.

However, users may print, download, or email articles for individual use.