25th Anniversary International Scientific Conference-2016
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/12769
Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine
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Item How important is blood glucose control in diabetes?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Patel, A.Diabetes is now a common condition, with rapidly increasing prevalence globally. Individuals with diabetes have a two to three-fold increased risk of developing macrovascular complications such myocardial infarction and stroke, compared with those without diabetes. Premature morbidity and mortality in people with diabetes is also associated with microvascular complications, including retinopathy and kidney disease. In 2008, the results of three large-scale randomised trials of intensive blood glucose control failed to provide evidence in the reduction of macrovascular disease in people with type 2 diabetes; indeed in one trial, intensive glucose control was associated with poorer outcomes. These findings were unexpected, in light of the epidemiological associations between blood glucose levels and both microvascular and macrovascular disease. Some proposed that the absence of benefits (or presence of harm) from intensive blood glucose lowering might reflect adverse effects of excess severe hypoglycaemia, or the concept of “metabolic memory”, whereby any beneficial effects may be observed only several years after the onset of tight blood glucose control. In this presentation I will provide an overview of the trial evidence relating to blood glucose control in people with type 2 diabetes, including recently reported data on long-term follow-up in the pivotal trials, ostensibly addressing the issue of “metabolic memory”.Item Hypertension – what’s in a name?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Patel, A.Medical students worldwide are still taught that “hypertension” is a disease, and that if a person develops this disease, they now have a major risk factor for cardiovascular diseases (CVD). However, in countless epidemiological studies, the association between blood pressure and vascular diseases has been shown to be continuous and log-linear, and that this association persists well below traditional cut-points that have historically been used to define “hypertension”. Utilising threshold blood pressure values to define the presence or absence of a disease state is a false dichotomy that has resulted in the definition of “hypertension” being a moving target over the past 50 years. Exposing and eliminating this false dichotomy is not just an intellectual exercise or a matter of semantics. While more and more guidelines for CVD prevention adopt the “absolute risk” approach, hypertension guidelines also still persist in most countries, which is detrimental to clinical and public health approaches to CVD control. In this presentation, I will challenge the very notion of hypertension and make the case that until this term is eradicated from the medical vocabulary, huge numbers of high risk individuals will be denied treatment that has the potential to substantially impact on their disease risk. At the same time, many individuals at low risk who may have little to gain will be preferentially treated. This is particularly an issue in resource-constrained environments, where prioritising treatment for those who are likely to benefit the most is critically important. Key to addressing this issue is shifting from a paradigm of hypertension control to one of blood pressure lowering.