Beta-blockers have long being used as first-line therapy for hypertension as their use had resulted in a reduction in cardiovascular morbidity and mortality in controlled clinical trials. A recent meta-analysis comparing beta-blockers to all other anti-hypertensive drugs taken together has found that stroke reduction was sub-optimal. Specifically, atenolol was associated with a 26% higher risk of stroke compared with other drugs. Several reasons may explain the less favourable outcomes with beta-blocker therapy. These include some adverse metabolic abnormalities such as dyslipidaemia and new-onset diabetes, and less effective reduction of central aortic compared with brachial blood pressure. Newer beta-blockers such as carvedilol or nebivolol are better tolerated. These beta-blockers have a vasodilating effect, which may beneficially affect systolic blood pressure in the aorta. Their long-term cardiovascular outcome in hypertension is still not known. Further studies would be required to show that stroke is adequately reduced by these newer beta-blockers. In conclusion, beta-blockers should not be the first drugs of choice in the management of uncomplicated hypertension. They may be used in addition to other antihypertensive agents to achieve blood pressure goals. However, in patients with angina pectoris, a previous myocardial infarction, heart failure and certain dysrhythmias, beta-blockers still play an important role.
Adrenergic beta-Antagonists ; therapeutic use ; Antihypertensive Agents ; therapeutic use ; Contraindications ; Humans ; Hypertension ; drug therapy ; Meta-Analysis as Topic ; Singapore ; Stroke ; chemically induced

Objective: To analyze changes in physique change among children and adolescents in Japan from 1900 to 2015, and to provide the scientific basis for national constitution development strategy in China. Methods: Data on height and weight of Japanese children and adolescents aged 6-17 years provided by the Ministry of Foreign Affairs. Cluster analysis was performed to analyze the data. Results: The 5 time periods of highest physique growth rate of Japanese boy and girls were 1948-1950, 1950-1955, 1955-1960, 1960-1965, 1965-1970, and the 5 time periods of lowest growth rate were 1939-1948, 2005-2010, 2000-2005, 1900-1905, 2010-2015, 1995-2000. Physique growth of Japanese children and adolescents showed a relatively constant increasing trend before World War II and the late 20th century, and a rapid increasing trend during 20 years after World War II and a decreasing trend during and short period after World War II. In the cluster analysis, the lower half of male students fell into a single time period (1939-1948) showing the highest rate of decline. Conclusion Physical changes of Japanese children and adolescents are closely related to the socio-economic environment, and rapid increasing trend is observed during 20 years after World War II. Based on experiences from Japan, rapid socio-economic growth in China provides an important opportunity to promote physical development of children and adolescents. Cautions should be paid to the risk of overweight and obesity accompanied by economic growth.

Objective: This paper analyses the secular trend in physical growth among Japanese children and adolescents from 1900 to 2016, and to provide scientific reference for growth and development in Chinese adolescents. Methods: Data of height and weight of Japanese children and adolescents aged 6-17 years from 1900 to 2016 included in the Survey of School Health Care were used to illustrate growth rate and range of height, weight and BMI during different periods by using one-way ANOVA. Longitudinal correlation between height, weight and BMI was analyzed by using longitudinal analysis method. Results: During 1900 to 2016, height growth ranged between 9.5-19.9 cm in boys and 10.8-18.9 cm in girls aged 6-17 years and the weight growth ranged between 4.0-15.9 kg in boys and 3.9-14.2 kg in girls, with males significantly higher than females; Peak height and weight growth rate of Japanese children and adolescents occurred between 1950 and 1960 (boys: 4.8 cm and 2.7 kg; girls: 3.9 cm and 2.4 kg). On the contrary, from 1939 to 1950, height and weight of Japanese children and adolescents showed a significant decreasing trend (boys: -1.8 cm and -1.2 kg per 10 years; girls: -0.8 cm and -0.4 kg per 10 years); During 2000-2016, the growth rates of height of boys and girls in all age groups in Japan were -0.2 to 0 cm in boys and -0.2 to -0.1 cm in girls per 10 years, respectively. Conclusion The long-term growth trend of Japanese children and adolescents shows an increasing trend before and after World War II; During World War II and the early post-war period, Japanese children and adolescents showed long-term decreasing trend. In the 21st century, the slow decreasing trend in growth among Japanese children and adolescents is observed, which might associate with absence of favorable environment.

Objective:The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach.Methods:Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis.Results:A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score ( r = 0.47, P = 0.002), albumin-bilirubin score ( r = 0.37, P = 0.001), Lok index ( r = 0.36, P = 0.02), liver stiffness ( r = 0.58, P = 0.01), and spleen stiffness ( r = 0.77, P = 0.01), while negatively correlated with albumin ( r = -0.42, P = 0.006). Conclusion:The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

The Ministry of Health (MOH) has updated the clinical practice guidelines on hypertension to provide doctors and patients in Singapore with evidence-based treatment for hypertension. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on hypertension, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Antihypertensive Agents ; therapeutic use ; Blood Pressure ; Evidence-Based Medicine ; Health Promotion ; Humans ; Hypertension ; diagnosis ; therapy ; Life Style ; Risk Factors ; Singapore