Synopsis “I don’t need medication; my blood pressure is only high because of my stressful job.” How should you respond? This team of researchers observed more than 6,000 white-collar workers (men and women) for 7.5 years (84% follow-up). They excluded anyone who had known cardiovascular disease and hypertension at baseline. The participants completed a series of scales to assess job stress and other psychological demands of work. Additionally, the study team assessed each participant’s vital signs, body mass index, tobacco use, exercise patterns, and so forth. Women had no difference in their BP whether exposed to stress at baseline, at follow-up, both, or neither. Men who experienced no work stress at baseline or at follow-up also showed no change in BP. The authors, however, point out a graded response: Stress levels present only at baseline were less important than stress levels only at follow-up, and when men’s stress levels were present at both baseline and follow-up, the systolic blood pressure increased 1.8 mm Hg.

Most women quickly stop taking bisphosphonates

Clinical question Do women continue osteoporosis therapy for a meaningful period?

Bottom line Approximately half the women initially prescribed a bisphosphonate—daily or weekly treatment—will not be taking it after 3 months, and only one in five will be taking it after a year. Since this short duration is unlikely to provide them with meaningful benefit, the money spent on bone mineral density testing and the rest of the diagnostic work-up and follow-up, along with the cost of the initial drug therapy, is essentially wasted on four of five women diagnosed with osteoporosis. (Level of evidence = 1b)

Downey TW, Foltz SH, Boccuzzi SJ, et al. Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. South Med J. 2006;99:570-575.