Fitness Fights High Blood Pressure, Even With Family History

Although people with a family history of high blood pressure (hypertension) are at much greater risk of developing the condition themselves, regular exercise and physical fitness may significantly lower that risk, according to a new study.

"The results of this study send a very practical message, which is that even a very realistic, moderate amount of exercise -- which we define as brisk walking for 150 minutes per week -- can provide a huge health benefit, particularly to people predisposed to hypertension because of their family history," study author Robin Shook said in an American Heart Association news release.

The researchers followed nearly 6,300 highly fit people ranging in age from 20 to 80 for nearly five years. Of this group, one-third had at least one parent with high blood pressure. These people had a 34 percent lower risk of developing hypertension than other people who also had a family history of the disease but were not as physically fit.

Overall, more than 1,500 of the participants developed hypertension during the course of the study. High levels of fitness, however, were associated with a 42 percent lower risk for high blood pressure -- regardless of family history. Moderately fit people had a 26 percent lower risk.

In contrast, the study, published May 14 in the journal Hypertension, showed that people with a low level of fitness and a family history of hypertension had a 70 percent higher risk for high blood pressure than highly fit people.

Moreover, among fit people, having a family history of hypertension increased the risk for the condition by only 16 percent.

"The correlation between fitness levels, parental history and risk are impossible to ignore," said Shook, a doctoral candidate in the Arnold School of Public Health at the University of South Carolina in Columbia. "This awareness can serve the clinician and the patient as they work together to find effective and reasonable ways to avoid the diseases that have affected their family members, in some cases for generations."

The American Heart Association recommends at least 30 minutes of moderately intense physical activity, such as brisk walking, five days a week.

Because the majority of participants in this study were white, well-educated men with higher incomes, the new findings may not apply to all people.

More information

The U.S. National Institutes of Health has more about hypertension.

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ADJUVANT CHEMOTHERAPY BENEFICIAL IN HIGH RISK CHOLANGIOCARCINOMA

A systematic review and meta-analysis provides "reasonable" support for the current practice of giving adjuvant therapy to patients with resected biliary tract cancer with high-risk features, researchers conclude.

"We found from our review that adjuvant therapy, mainly chemotherapy, appears to offer a survival advantage to those patients with biliary cancer with the highest risk of recurrence after surgery," Dr. Jennifer J. Knox, a medical oncologist at Princess Margaret Hospital in Toronto, Ontario, Canada, told Reuters Health.

"These are the ones with positive lymph nodes or cases where the resection margins are not clear of cancer cells. However, our review did not suggest a clear benefit to adjuvant therapy over surgery alone in the lower recurrence risk patients (earlier stage)," she added.

There is a "striking lack" of prospective randomized studies on adjuvant therapy in this setting and such studies are "needed to provide better rationale for this commonly used strategy," the study team notes in a report online April 23 in the Journal of Clinical Oncology.

Tumors of gallbladder and bile ducts are rare - about 9,760 new cases diagnosed each year in the United States - and aggressive. They typically have a poor prognosis, with five-year survival rates ranging from 5% to 15%. Surgical resection offers the only potential for cure, yet fewer than 35% of biliary tract tumors are resectable at presentation, and even after seemingly satisfactory resection, relapse rates are high.

Postoperative radiation, chemotherapy or both may improve outcomes, but the literature consists mainly of uncontrolled institutional series and registry analyses. Based on these data, an adjuvant approach is "favored and used in up to 70% of centers worldwide," the authors note.

"Our review attempts to combine multiple small studies that do not answer the question properly on their own but can contribute to the statistical power of a combined meta-analysis on the topic," Dr. Knox said.

The researchers searched for studies published from 1960 through 2010 that evaluated adjuvant chemotherapy, radiotherapy or both compared with curative-intent surgery alone for biliary tract cancer.

They identified and included in their analyses 20 studies involving 6,712 patients. The 20 studies included one randomized trial of chemotherapy alone, two registry analyses (Surveillance Epidemiology and End Results database), and 17 institutional series. Patients were treated with both chemotherapy and radiation in eight studies, chemotherapy alone in three studies and radiation alone in nine studies.

In the overall population, the pooled data showed that any adjuvant therapy was associated with a nonsignificant improvement in overall survival, compared with surgery alone (odds ratio 0.74; p=0.06). There was no difference between gallbladder and bile duct tumors (p=0.68). The association became significant when the two registry analyses (the studies with the largest weight) were excluded (OR 0.53; p<0.001).

In a sensitivity analysis, patients who received chemotherapy or chemotherapy plus radiation derived statistically greater benefit than their peers who received only radiation (OR 0.39, 0.61, and 0.98, respectively; p=0.02). The greatest benefit for adjuvant therapy was in those with lymph node positive disease (OR 0.49; p=0.004) or microscopic positive margins (R1 disease) after resection (OR 0.36; p=0.002).

"Our results suggest adjuvant chemotherapy, radiotherapy, or chemoradiotherapy for both high-risk gallbladder and bile duct cancers is warranted or should be considered in prospective studies," the authors say. This mirrors in part the results of the only phase III randomized trial performed to date, which was published in the journal Cancer in 2002.

Guidelines from the National Comprehensive Cancer Network suggest adjuvant concurrent fluorouracil-based chemoradiotherapy in patients with positive margins, carcinoma in situ at the margins, or positive lymph nodes after resection for cholangiocarcinoma.

"These recommendations are somewhat expert-opinion driven," the researchers note. "Our data now lend stronger support to these practices and recommendations, having analyzed nearly 2,000 patients receiving adjuvant therapy," they write.

Still, Dr. Knox told Reuters Health, a proper clinical trial comparing different adjuvant approaches is needed in higher-risk biliary cancer patients "and the outcome would define a new optimal treatment approach."

"This will take considerable collaboration from multiple institutions across several countries. The data from this current paper should help promote the planning of and support the completion of such an important clinical trial," Dr. Knox added.

Based on their analysis, the researchers say those studies should involve two active comparators rather than a no-treatment arm among patients with lymph node-positive or R1 disease. In patients, with low-risk disease (node-negative and R0 resections), a prospective randomized study with a nontreatment arm still seems justified, they say.

The authors have no relevant financial disclosures.

Tips & Tricks for Delivery Day

As expecting moms are set to welcome their new bundle of joy into the world, being prepared can make delivery go more smoothly than you would have otherwise imagined. Below are some tips for ensuring your delivery day is as smooth as can be.

Birth Plan & Patience

It is always good to have discussed a birth plan with your medical team prior to delivery. It’s helpful to have thought about whether or not you will deliver naturally or with the help of pain medication. It is also important to identify who will be in the delivery room with you and who should stay in the waiting area. When outlining your birth plan it is also a good time to consider optional procedures like cord blood banking, since mostdecisions, like cord blood bankingneed to be made well in advance of birth. All of these items should be outlined in your birth plan. The catch, however, is that it is not always possible to follow a birth plan to the letter. Therefore, don't forget to pack your patience on delivery day. Go with the flow and trust that your doctors and others who are caring for you will do the right thing for both you and your new baby.

Pack a Bag

Depending on whether your labor was a surprise or you are induced, you will still need to be prepared up to 3 weeks in advance of your due date, as labor can come at anytime. Go ahead and pack a bag for your hospital stay and be sure to include pajamas, toiletries, any comfort items, along with activities to keep you busy if you are in for a long wait. This bag should be by the door and ready to go at a moment's notice.

Prepare Your Notification List

Childbirth can be stressful, but at the end, you also end up with a great bundle of joy about whom you want to tell the whole world! Therefore, do some pre-work and identify who all should hear the news when your baby arrives. If you are planning to send out an email or text message to those people, be sure you have built your list and have the email addresses or phone numbers ready. Be sure your phone or computer are charged up and ready for some notifying of the happy news!

Water & Vitamins

Just as you have done throughout your pregnancy, do not forget to continue drinking lots of water and taking your pre-natal vitamins. This will help ensure that your baby is as healthy as possible and that your amniotic fluid level is maintained throughout the crucial last few weeks of your incubation period. Be sure to hydrate yourself and keep the baby fed with nutrients.

As you can see, there are many things you can do to help ensure a great experience on delivery day. Following these tips will make sure that you and your family or friends are prepared for one of the most important days of your life. Good luck!

This article was written by Katie Moore. Katie is an active writer within the blogging community who discusses maternity, motherhood, prenatal health, childbirth and other topics within this niche. If you have any questions or would like to connect with Katie please contact by visiting her blog, Moore From Katie or her twitter @moorekm26.

BREAST CANCER AT LEAST 1O DISEASES-THE DEATH OF "LUMINAL" SUBTYPE

A "new map" of breast cancer, which identifies 10 distinct disease subtypes based on gene activity, will revolutionize the diagnosis and treatment of this disease, say researchers.

The findings, published online April 18 in Nature, come from the largest global gene study of breast cancer tissue ever performed.

"This research is 'ground-breaking' indeed," said world-renowned breast cancer expert Martine Piccart, MD, PhD, from the Jules Bordet Institut in Brussels, Belgium. "The current classification of breast cancer is overly simplistic and results in suboptimal treatment selections for our patients," she told Medscape Medical News.

"I am not at all surprised that breast cancer is not 4 diseases but at least 10…and I do believe that this discovery will lead to the better management of patients…although this will probably take another 10 years," Dr. Piccart said.

Researchers in the United Kingdom and Canada analyzed nearly 2000 tumor samples taken from women diagnosed with breast cancer 5 to 10 years ago. They integrated tumor-sample copy numbers and gene expression with data on long-term clinical outcomes. They concluded that the samples could be divided into at least 10 distinct subtypes on the basis of common genetic features that correlate with survival.

The next step is validation in clinical trials, but the ultimate aim is to target treatment to the precise "genetic fingerprint" of each tumor type, said colead author Carlos Caldas, MD, FMedSci, from the Department of Oncology at Cambridge University, United Kingdom, and senior group leader at Cancer Research UK's Cambridge Research Institute.

"Our results will pave the way for doctors in the future to diagnose the type of breast cancer a woman has, the type of drugs that will work, and those that won't, in a much more precise way than is currently possible," he said.

"This landmark study will completely change the way we look at breast cancer," according to Cancer Research UK, which provided much of the funding for the study. The charity highlighted the study at a press conference held in London, United Kingdom.

Current Pathology Subtypes

Currently, breast cancer is classified by pathologists into 4 subtypes, Dr. Caldas explained. This is based on testing for the estrogen receptor (ER), which if positive indicates responsiveness to hormonal therapies, and for HER2, which if positive indicates responsiveness to trastuzumab (Herceptin).

By far the largest proportion of breast cancers (70%) are ER-positive/HER2-negative, about 7.5% are ER-positive/HER2-positive, and about 7.5% are ER-negative/HER2-positive. The remainder are the so-called triple-negative breast cancers (ER-negative/progesterone-receptor-negative/HER2-negative), which are aggressive, do not benefit from any targeted therapy, and are treated with chemotherapy, he said.

However, in the 70% of breast cancers that are classified as ER-positive/HER2-negative, there is a tremendous heterogeneity, Dr. Caldas explained, with some patients having a much better prognosis than others.

The researchers found that 7 of the 10 newly identified disease subtypes are in this category. There is a wide variation in prognosis by subtype; at 15 years, the best shows 80% survival and the worst shows less than 40% survival. "We are getting more separation in this largest subgroup of breast cancer. This is very important. We have been on a quest to find better markers in this group of patients," Dr. Caldas said at the press briefing.

The new classification identifies very robust HER2-positive tumors, whether they are ER-positive or ER-negative, he noted. "All previous molecular tests have failed to do this properly," he added. This might increase the number of patients classified as HER2-positive, who could benefit from treatment with trastuzumab, the researchers write.

Another of the new subtypes, known as cluster 10, coincides fairly closely with the triple-negative subtype, although not exactly, Dr. Caldas said.

The largest of the new subtypes identified, known as cluster 4, accounts for about 16% of the total and is "very interesting," he continued. This subtype has fewer copy number gains and losses, and shows a significant infiltration of inflammatory cells, suggesting an activation of the immune system. This subtype comprises patients with ER-positive, with ER-negative, and with triple-negative tumors, and "would be missed in any other classification system that relies on sequencing," he said.

The researchers also discovered several new genes. Some of these, such as kinases and phosphatases, are very attractive targets for new drug development, he said.

"We have produced a completely new way of looking at breast cancer," Dr. Caldas said. "It is very robust because of the number of samples that we looked at," he explained.

When asked by Medscape Medical News how this novel molecular stratification of breast cancer fits with other tests that are already available, such as Oncotype DX and MammaPrint, Dr. Caldas explained that the evidence suggests that neither of those tests add much to the subtypes that are identified by high-quality pathology. "The United Kingdom leads the world with regard to pathology, especially in breast cancer," he said. In this setting, neither Oncotype DX nor MammaPrint add much information, he said. In fact, the National Institute of Clinical Excellence deemed that both are not cost effective, he added.

Another expert told Medscape Medical News that this work is in its early stages. "This is very exciting work that will significantly advance the field of personalized medicine and could potentially have important therapeutic implications. However, I would caution that the findings are not ready for prime time yet, and need validation in prospective clinical studies before they can be incorporated into clinical practice," said Aditya Bardia, MD, MPH, from the Massachusetts General Hospital Cancer Center in Boston.