Dr. Jud Fisher of Healthcare Partners of Nevada Discusses Men’s Health

I just found this health related video on YouTube … and thought you might enjoy it!

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Dr. Jud Fisher, a renown family practitioner, talks with the Las Vegas Morning Blend channel 13 about men’s health during Men’s Health Week.

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Whole Grains May Reduce Hypertension in Men ~ Nutrition & Health Tip

I just found this health related video on YouTube … and thought you might enjoy it!

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Visit savantmd.com formore health tips and videos or follow us on http Here’s another good reason to eat breakfast and to include a whole grain cereal. A preliminary report of a study presented at an American Heart Association’s meeting suggested that eating a whole grain cereal at least twice a week resulted in an 11% reduction in risk for hypertension in men. Eating cereal everyday had a 19% reduction. These results came from a review of the data from the long-running Physicians Health study that had over 13000 participants. As you know, having hypertension increases a person’s risk for heart attack, stroke, and kidney disease. The researchers could only give the results for men since there was not enough data for women, although previous studies have shown that whole grains also benefit a woman’s heart health. A key point to remember is that the cereals were whole grains and not refined grains. Make sure you keep that in mind when choosing your next breakfast cereal. Dr. Mark Savant is a General Internist. He has been in practice for over 12 years. received his medical degree from the Medical College of Wisconsin www.savantmd.com www.savantmd.com This video was produced by SavantMD Inc. © Copyright 2009 -2013 SavantMD Inc. All Rights Reserved.

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Your choice: chocolate bar vs lycopene capsule for your BP

What about a daily dose of chocolate for your hypertension? Sounds like a dream, right?

When I was growing up in a third world country, chocolates were only available as treats for special occasions such as Christmas and birthdays. As a child, I always dreamed of one day eating as much chocolate as I could. Decades later, I found myself living in a country famous for its chocolates – Belgium – and now in another country equally as famous for the same reason – Switzerland. Theoretically, I can now have all the chocolates I want. But you know what? Chocolate lost its appeal – not to mention mystic – as soon as I started seeing it every day.

In recent years, chocolate has reinvented itself from a high-sugar, high-fat, and high-calorie junk food to a healthy gourmet snack. The junk food versions are still around but there are now the dark (70% cacao or more) low-sugar types that even those with diabetes can enjoy. Studies have shown dark chocolate is beneficial to cardiovascular health especially in lowering blood pressure.

So you’d think it is a dream come true for those with hypertension to be prescribed with a daily portion of chocolate to keep their blood pressure under control. Well, an Australian study reported some surprising results. The study participants with prephypertension were assigned to take either a lycopene-rich tomato extract capsule or 50 g (about half a bar) of dark chocolate each day for hypertension for 12 weeks. Surprisingly enough, half of those assigned to eat chocolate found the treatment not so palatable. All participants found it easier to take the lycopene capsule each day than eat dark chocolate.

The authors speculate as to the reasons why and author Dr. Karin Ried of the University of Adelaide states:

…there is a difference between “consuming a food item voluntarily or having to eat it on a daily basis for 12 weeks.”

…[the chocolate group] reported strong taste and concerns about fat/sugar content as reasons for unacceptability of chocolate as a long-term treatment option.”

The study results indicate a lack of preference for chocolate. On the other hand, is it really the chocolate itself that is not acceptable or is it the mode of delivery? What if the tomato extract were to be taken fresh each day (and not in a capsule)? Would the participants still prefer tomato juice to chocolate?

People always try to take the easy way and swallowing multivitamin pills and supplements each day are usually preferable to shopping, preparing and eating fresh produce. It is called convenience.

I am not saying that chocolate is the answer to your blood pressure problems. Despite the research studies on this topic, experts think that it is “too soon yet to advocate chocolate as a treatment for high BP.”

According to Dr Brent M Egan (Medical University of South Carolina in Charleston:

“Clearly more research is needed; we don’t think the state of the art is there yet. The number of studies is relatively small, few people have been studied, and the number of products that have been investigated is also too small to be making general health recommendations for the world.”

Patient-doctor encounter is important in hypertension control

Hypertension patients: How often do you talk to your doctor about your blood pressure? Current guidelines recommend that patients with “uncomplicated hypertension” should consult their doctor at once a month. That’s the theory. In practice, it is more like every 3 or 4 months.

Well, a recent study shows that talking to your doctor regularly, say, every 2 weeks or even more frequently, can actually help keep your blood pressure under control.

According to lead author Dr Alexander Turchin of Brigham and Women’s Hospital in Boston, MA (source: heartwire):

“Patients’ blood pressure normalized much faster if they saw their physician frequently. [This] may be common sense, there have been no data to prove this. Ours is the first large study to really show that there might be an association.”

The study looked at 502 diabetic patienst with hypertension and analyzed their doctor encounter frequency. Those who had encounter frequency of once a month or less had their BP normalized faster (median of 1.5 months at the rate of 28.7 mm Hg/month). Those whose encounter was less frequency took longer to have their BP normalized.

“Shorter encounter intervals are associated with faster decrease in BP and earlier BP normalization. Greatest benefits were observed at encounter intervals of two weeks or less, shorter than what is currently recommended.”

The authors believe that there is a lot to improve when it comes to adherence to the frequency of patient-doctor contact. For those with more complication condition and comorbidities (e.g. hypertensive diabetic patients), this is especially crucial in keeping BP in control.

Ok, so it is such a hassle to visit the doctor very often. The authors point out that there are more “creative ways” of improving care and increasing compliance. Patient-doctor encounter need not be face-to-face

Dr. Turchin points out:

“All healthcare systems need to become more creative in terms of their approach. And this is not just a message to physicians put also to patients.”

Nowadays, technology is available for remote consulting such as by phone or using the Internet. Both doctors and patients should make use of this technology.

As the National High Blood Pressure Education Month in the US come to a close, we bring some more resources:

Mission Possible: Prevent and Control America’s High Blood Pressure

Your Guide to Lowering High Blood Pressure

National High Blood Pressure Education Program

Yoga-like relaxation therapy lowers BP

Ok, so practicing yoga is associated with female intellectuals with leanings towards spirituality and alternative medicine and blue-collar males would never have anything to do with it. But what if it really works in lowering blood pressure? How do motivate the machos to give it a try?

To avoid preconceptions that their patients– mainly working-age workmen undergoing cardiac rehabilitation – have about yoga, the researchers simply called it relaxation/stress reduction therapy and compared to the standard therapy in this patient population called progressive muscle relaxation (PMR). Thus, the patients were actually “blinded” to the therapy they were randomized to, simply called relaxation 1 (yoga) and relaxation 2 (PMR).

PMR is “a technique based on alternate tensing and relaxing of muscles … used to reduce stress and anxiety.” The yoga practice used was Vinyoga.

A total of 340 male patients undergoing cardiac rehabilitation and suffering from hypertension were randomly assigned to either relaxation 1 or relaxation 2 therapies 5 times weekly for 3 weeks at a rehabilitation center. Most of the patients were taking several antihypertensive drugs. After 3 weeks, the patients were asked to continue the relaxation practice at home.

After 3 weeks, decrease in systolic blood pressure levels was significantly more in the yoga group than in the PMR group. The blood pressure-lowering effect of yoga was especially pronounced among those with the highest systolic blood pressure at baseline.

However, adherence to the relaxation therapy in the home setting proved to be difficult. After 6 months, only 50% of the PMR group was practicing relaxation therapy once a week. Adherence is even lower in the yoga group, at 30% after 6 months. Despite these seemingly high drop out rates, the authors claim these adherence rates are actually higher than those reported by previous studies using standard rehab programs.

The Vinyoga seems to be especially promising in fighting hypertension if only the patients will be motivated enough to continue the practice beyond the rehab center setting. Ways of motivating these patients – men expected to return to their manual and usually physically taxing jobs – need to be explored. Calling the practice yoga would definitely dampen the enthusiasm rather quickly.

According to lead researcher Dr Wolfgang Mayer-Berger,

“[It is] too early to make yoga a part of usual cardiac-rehabilitation therapy [but] maybe this is really an everyday therapy we can use.”

Follow-up studies are being planned to confirm the blood pressure lowering effects of yoga.

Pregnant and smoking? Read this!

Pregnant, yet still smoking? Well, this latest report from the experts might motivate you to quit.

Swedish researchers compared the blood pressure of babies of moms show smoked during pregnancy, and babies of moms who did not. The results are really bad news for smoking moms and even worse news for their babies. Why bad news? Because these babies tend to suffer from a so-called circulatory dysfunction which results in abnormal control of the blood pressure during repositioning.

When we stand up, the heart rate normally increases, blood vessels constrict to keep the blood supply to the organs of the upper part of the body especially the brain and the heart, the blood pressure increases slightly.

In the first few months of their lives, babies are not able to change positions or sit/stand upright and have to be lifted for repositioning. During repositioning, the baby’s body, too, has to cope with the change in position with change in blood pressure.

The study involved 19 babies of non-smoking couples and 17 babies of moms who smoked 15 sticks of cigarettes per day on average. Both groups of babies were of normal weight at birth and were breastfed. A test for blood pressure control is by tilting the babies upright during sleep.

In this research, the babies were tilted up to an angle of 60 degrees and then returned to their lying position again. Blood pressure and heart rates were then measured during sleeping, during tilting, and after returning to the original lying position. The tilting test and the measurements were performed when the babies were aged 1 week, 3 months, and 1 year. The results of the study show:

• Babies at age one week who were not exposed experience a 2% increase in blood pressure when tilted. At age one year, this increase in blood pressure is up to 10%, a normal increase correlated to the increase in size and mobility of the baby.
• Babies who were exposed to tobacco in utero exhibit the opposite trend in blood pressure during tilting. A 10% increase was observed during the first week, which decreases down to 4% at age 12 months.
• The researchers also observed that the heart rates of the exposed babies were abnormal and highly exaggerated in response to tilting at ages 3 months and one year.
• When sleeping undisturbed, diastolic blood pressures of exposed babies were higher at 3 months, and the heart rates were 20% slower at 1 year compared to non-exposed babies.
• When upright babies were returned abruptly to their lying position, blood pressure in non-exposed babies goes back to normal; blood pressure of tobacco-exposed babies goes up.

According to lead author Dr. Gary Cohen, senior research scientist in the Department of Women and Child Health at the Karolinska Institute in Stockholm, Sweden:

“Tobacco-exposed infants have a different profile. It’s surprising how early in life these functional abnormalities can be detected in the babies of smokers. The re-programming of the cardiovascular function is present at birth and is still present and even more dramatic at one year.”

In other words, the circulatory system of tobacco-exposed babies is not functioning properly and is hyperreactive in the first days of life, but becomes underreactive and less effective with time. The circulatory dysfunction and poor blood pressure control have some consequences later in life, including susceptibility to hypertension and other cardiovascular problems.

Blood pressure monitoring and sleep

Which one would it be – blood pressure problems or a good night’s sleep?

The so-called ambulatory blood pressure (BP) monitoring technique measures BP 24 hours a day. It assesses the variations in BP during daytime and at night. Sleeping BP, i.e. BP measured during sleep is a good indicator of risk for heart attack and stroke. Normally, BP is lower at night compared to that measured at daytime. When sleeping BP doesn’t “take a dip”, then the risk for cardiovascular problems is much greater. To continuously measure BP, patients are equipped with adevice called actiwatch or a wristwatch actigraph, which is the size of a wristwatch and is worn like one.

However, how do this widely used test and the device affect the sleep of the patients? A recent study reveals that the BP monitoring device can actually disturb the patients’ nighttime rest, thus questioning the validity of the measurements.

According to Dr. Rajiv Agarwal of the Indiana University and Veterans Affairs Medical Center in Indianapolis

“Blood pressure (BP), measured during sleep correlates better with heart attacks and strokes compared to blood pressure measured in the doctor’s office. However, if blood pressure measurement disturbs sleep, then it may weaken the relationship between ‘sleeping BP’ and these cardiovascular events.”

The study followed up 103 elderly patients with kidney disease equipped with actiwatches. The results revealed that

• the BP monitoring device disturbed most of the patients
• the participants spent, on average, 90 minutes less time in bed
• the participants spent less time sleeping and slept less efficiently
• some participants awoke at night

According to the researchers, the dip in night time BP measurements is due to sleep. However, if a patient cannot sleep due to whatever disturbance, then night time BP may be abnormally high.

The researchers are therefore warning about jumping into conclusions about interpreting the results of ambulatory BP monitoring.

Dr. Agarwal continues

“Thus sleep quality should be taken into account when interpreting blood pressure during sleep… Whether similar results will be obtained in younger people remains to be seen.”

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Traffic noise and your blood pressure

For those thousands who are on the road every week day, have you ever wondered about how traffic affects your cardiovascular health? I already have tackled several aspects of traffic before in this blog and how they affect health. Here’s an update and another aspect of traffic we haven’t thought about yet – noise pollution.

Air pollution

Vehicular traffic generates air pollution. Environmental problems aside, many studies have shown that air pollution affects the heart, the brain, and the immune system, leading to chronic physical health problems such as asthma and heart disease as well as cognitive problems in children. See previous posts for a comprehensive of the global air pollution problems.

Stress

You cannot deny it. Driving to and from work and getting stuck in the traffic jam generates stress. Researchers have linked increased incidence of heart attack to heavy traffic and have found indication os synergy between stress and air pollution.

Noise pollution

It’s not only what you smell and what you feel – it’s also what you hear. In a recent study by Swedish researchers, traffic noise is also associated with cardiovascular effects that lead to increased blood pressure. According to lead author Theo Bodin of the Lund University Hospital,

“Road traffic is the most important source of community noise. Non-auditory physical health effects that are biologically plausible in relation to noise exposure include changes in blood pressure, heart rate, and levels of stress hormones. We found that exposure above 60 decibels was associated with high blood pressure among the relatively young and middle-aged, an important risk factor for cardiovascular diseases such as heart attack and stroke.”

The researchers looked at 27,963 residents of Scania, Sweden and the effects of road traffic on their health. Results of the survey showed:

• Exposure above 60 dBA (decibels) led to changes in cardiovascular parameters, most especially elevated blood pressure.
• All age groups were exposed to traffic noise levels below 60 dBA, a level which is considered moderate.
• Effects of traffic noise were more noticeable in young- and middle-aged members of the population and less in older age groups (e.g. 60 to 80-year olds).

The authors hypothesize on the reason for the different responses between age groups:

“The effect of noise may become less important, or harder to detect, relative to other risk factors with increasing age. Alternatively, it could be that noise annoyance varies with age”.

Sweden is comparably sparsely populated relative to many other developed countries. Scania is also a relatively small city by European standards. Can you imagine the amount of traffic noise that residents of large cities like Mexico, Sao Paolo, London, or Bangkok are exposed to? In the European Union alone, 30% of the population are exposed to day-night traffic average noise of 55dB(A). So next time you are tempted to press the accelerator or the horn, think about your health and that of others. Think about heart and your blood pressure.

Music for the heart and the vascular system

Music can have power over us. The slow lullaby puts babies to sleep. The fast number perks us up to dance, and perform better during work out.

A research study by Italian researchers shows that music has a strong effect not only on our moods and emotions but on our cardiovascular system. In fact, our heart seems to go in sync with the music we are listening to.

The researchers looked at healthy whites aged 24 to 26 years old with and without previous musical training. The participants had to wear headphones and listened to the following:

Five random tracks of classical music were played – including selections from Beethoven’s Ninth Symphony; an aria from Puccini’s Turandot; a Bach cantata (BMW 169); Va Pensiero from Nabucco; Libiam Nei Lieti Calici from La Traviata – as well as two minutes of silence.

While listening, electrocardiogram (ECG), blood pressure, cerebral artery flow, respiration and narrowing of blood vessels on the skin of the study participants were monitored and recorded.

The effect of crescendos and descrescendos was especially monitored. Don’t worry. I am not music-literate myself so I looked it up. A crescendo is a gradual volume increase, and a decrescendo is a gradual volume decrease.

So here is how the volume changes the function of our cardiovascular system:

• A crescendo results in vasoconstriction, e.g. narrowing of blood vessels under the skin, increased blood pressure and heart rate and increased respiration rate. Crescendos induce moderate arousal.
• During the descrescendos down to the silent pause, the opposite effects were observed, e.g. vasodilation, lower blood pressure, heart and respiration rate. Descrescendos generally induce relaxation.

The effect of the volume change was proportional to the change in music profile.

According to lead researcher Dr. Luciano Bernardi, professor of Internal Medicine at Pavia University in Pavia, Italy.

“Music induces a continuous, dynamic – and to some extent predictable – change in the cardiovascular system. It is not only the emotion that creates the cardiovascular changes, but this study suggests that also the opposite might be possible, that cardiovascular changes may be the substrate for emotions, likely in a bi-directional way.”

So what does this tell us about music?

Music could be a potential therapeutic tool for cardiovascular diseases, e.g. blood pressure control, correction of abnormal rhythms (arrhythmias) and even rehabilitation of stroke patients.

Music therapy is used in many conditions including neurological impairments such as autism. In healthy people, studies have shown that music reduces stress and enhance athletic performance.

“The profile of music (crescendo or decrescendo) is continuously tracked by the cardiovascular and respiratory systems. This is particularly evident when music is rich in emphasis, like in operatic music. These findings increase our understanding of how music could be used in rehabilitative medicine.”

Anti-hypertensive pills for everyone?

How about anti-hypertensive drugs as part of your daily routine? British researchers recommend that hypertensive drugs (not one but a combination) be given to everybody starting at a certain age regardless of the fact whether they actually have high blood pressure or not. The logic behind this recommended generalized prophylactic treatment is to avoid cardiovascular events caused by hypertension.

According to Dr Malcolm  Law and Dr Nicholas Wald of the Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London,

“Guidelines on the use of blood-pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure. Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”

This means that we should swallow a daily cocktail of anti-hypertensive drugs just like we are swallowing vitamins or nutritional supplements.

The researchers based their recommendations on a meta-analysis of 147 randomized trials that included a total of 958,000 people. The same researchers also supported the so-called polypill which contains 5 different cardiovascular drugs that include:

• a statin
• three anti-hypertensive drugs
• aspirin

The results of the meta-analysis showed that:

• People aged 60 to 69 benefit from taking hypertensive drugs regardless of blood pressure measurements.
• A combination of three drugs at half standard dose (as in the polypill) reduced the risk of coronary heart disease by approximately 46% and of stroke by 62%.
• A single antihypertensive agent at standard dose had about half the effect of the polypill

Currently, there are five main classes of blood-pressure-lowering drugs, namely:

• beta blockers
• thiazides
• ACE inhibitors
• angiotensin-receptor blockers
• calcium-channel blockers

All drugs except calcium-channel blockers were similarly effective in preventing cardiac events and strokes. The calcium-channel blockers seem to have a greater preventive effect against stroke compared to the other drugs.

Other health experts, however, are not so convinced about the arguments and the results of the meta-analysis. They question a lot of assumptions and as well as analytical methods that may not be valid. According to Dr. Franz Messerli of St Luke’s-Roosevelt Hospital Center, New York City

“A meta-analysis is like a sausage; only God and the butcher know what goes in it, and neither would ever eat any.”

Indeed, the idea of prescribing anti-hypertensives for everybody is hard to sell. It is true that hypertension can lead to cardiac events and strokes but there are factors aside from blood pressure play a role as well. Besides, many of the risk factors for cardiovascular disease are lifestyle, and therefore, modifiable factors.

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R-I-N-G-G-G: your blood pressure, please?

It’s not your normal phone call. It is just like having your own assistant who reminds you to check your blood pressure and refill your prescriptions except that this is all fully automated and computerized. Researchers at the University of Montreal tried a computer-based telephone program which automatically calls hypertension patients a couple of times a week to inquire for blood pressure measurements. The readings are then recorded and passed on to the patient’s health care provider who will then analyze the data and modify the treatment regime if deemed necessary.

The study included 223 hypertension patients from different primary care clinics in Laval, Quebec. 111 of the participants were assigned to the intervention group who received “an educational booklet, a digital home blood pressure monitor, a log book and access to the telephone-linked management system.” The remaining 112 received only the booklet in addition to their usual medical care program.

The study results showed that this “simple, automated feedback system made hypertension patients more aware of their potentially fatal or disabling disease and helped them significantly lower their high blood pressure.”

The reductions in blood pressure measurements in the intervention group are:

• 11.9 millimeters of mercury (mm Hg) in systolic blood pressure
• 6.6 mm Hg in diastolic pressure

The reductions in the control group are:

• 7.1 mm Hg systolic blood pressure
• 4.5 mm Hg diastolic

The success of this computer-based phone call program can be attributed to its ease and convenience but also due to the fact that there is always someone reminding the patients what to do and as well as give feedback on how well they are doing.

In addition, this is a helpful service for those patients who aren’t too mobile and tend to be forgetful.

The next step is to find out how cost-effective is this automated intervention.

According to lead author Dr. Pavel Hamet,

“The automated blood-pressure control system could be widely accepted if it is cost-effective. The healthcare system doesn’t want to increase the cost without some benefit.”

Automated services are usually more cost-effective than manned services. In addition, if further studies can confirm that this automated phone call reminder service can prevent complications of hypertension such as stroke and kidney failure that can add to health care costs, then the health authorities might just be convinced of the system’s benefits.

Why African Americans are prone to hypertension

African Americans are more susceptible to stroke and other cardiovascular diseases than any other ethnic group in the US.  According to recent statistics from the American Stroke Association

• Blacks have almost twice the risk of first-ever strokes compared to whites.
• Blacks have higher death rates for stroke compared to whites.
• The prevalence of high blood pressure in African Americans in the United States is the highest in the world.
• Among non-Hispanic blacks age 20 and older, 62.9 percent of men and 77.2 percent of women are overweight or obese.
• In 2001, 27.7 percent of black or African-Americans only, used any tobacco product. Heavy cigarette smoking approximately doubles a person’s risk for stroke when compared to light smokers.
• Black women have higher prevalence rates of high blood pressure, obesity, physical inactivity, and diabetes than white women.

This recent research at the Medical College of Georgia may give us a clue to this ethnic group’s susceptibility. It seems that a natural mechanism that regulates blood pressure is missing in many African Americans who are otherwise perfectly healthy. High blood pressure is a major risk factor for cardiovascular disease. Blood pressure can be increased by stress. However, the human body has a built-in mechanism that brings down the blood pressure. This system works by excreting more salt into the urine.

According to researcher Dr. Matthew Diamond

“The way it’s supposed to work is the higher your blood pressure goes, the system is supposed to be suppressed so you urinate out more sodium and the blood pressure goes down in response.”… The renin-angiotensin-aldosterone system helps regulate blood pressure, prompting the kidneys to hold onto more salt – and fluid – if it’s too low and to get rid of salt when it’s high.

However this mechanism that regulates blood pressure does not seem to work properly in about 1 in 3 adolescent African Americans. The study looked at 168 participants aged 15 to 18 years of age. The participants were healthy, non-obese, with normal blood pressure, and were placed on diets with controlled sodium and potassium. The researchers monitored their blood pressure, urine and blood samples while the participants were exposed to environmental stress through playing video games. The results showed that the renin-angiotensin-aldosterone system worked perfectly well in adolescents who were white but was improperly suppressed in about a third of black participants.

The reason for this dysfunction cannot be easily explained but may have some genetic explanation. The researchers are now planning to “screen participants for a genetic mutation that has been linked to hypertensive kidney disease to see if that’s a factor that can be used to help identify those at risk for hypertension and kidney disease.”

May is National High Blood Pressure Education Month in the US. The results of this study may just be the key understanding why African Americans are prone to hypertension and cardiovascular disease.

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Depressed? Check your blood pressure!

The link between depression and cardiovascular health is well-known although the mechanism behind the relationship is not well-understood.

A study by Dutch researchers may just give us an idea of the complexity of that link. For one thing, contrary to the common perception that depression can lead to hypertension, depression, is, in fact, associated with low blood pressure. However, medications against depression – the so-called anti-depressants can increase blood pressure. In particular, tricyclic antidepressants (TCAs) can increase the risk for hypertension.

According lead author Carmilla Licht

“Doctors should at least be aware of a potential blood-pressure rise that could be linked to TCA use, especially for patients with cardiovascular disease or high blood pressure or others who are at risk for hypertension…They may consider meticulously monitoring these patients’ blood pressure when they prescribe one of these antidepressants or consider prescribing another antidepressant medication.”

The results of the study are somewhat controversial because they contradict the current “depression-hypertension theory.”

The study was part of the Netherlands Study of Depression and Anxiety, and followed up 2618 participants aged 18 to 65 years old. The study participants were divided into 3 groups:

• Control group without history of anxiety or depression
• Patient group with a major depressive disorder (MDD) but not on antidepressants
• Patients with MDD and on antidepressants

Patients were monitored for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and distinction was made between different types of antidepressants, e.g. selective serotonin-reuptake inhibitors (SSRIs) vs tricyclic antidepressants (TCAs).

The study also observed that a typical patient with psychiatric disorder “were a little older, more likely to be female, less educated, less physically active, smoked more, and had a higher body-mass index and more diseases.”

The study results showed that compared with health controls, MDD patients have significantly lower blood pressure. However, MDD patients on TCA had significant higher blood pressure. The use of SSRIs doesn’t seem to be associated with blood pressure measurements.

So the next question is

Is it the depression that lowers the blood pressure or is it the low blood pressure that causes the depression?

The authors speculate that three things might influence the depression-low blood pressure link.

• Use of anti-hypertensive drugs
• Common causes of depression and low blood pressure, e.g. fluctuations in metabolites, hormones or neurotransmitters
• Low blood pressure can cause depressive symptoms, e.g. fatigue, dizziness, low tolerance to cold temperatures, and concentration problems.

While depression is associated with low blood pressure, the study shows that anxiety is linked to high blood pressure. This, the authors say, might be due to continuous stress associated with anxiety.

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When relationships go bad, women’s heart suffer most

Tension. Stress. Anger. Anxiety. These are what you get in a relationship gone bad. Unfortunately, the emotional distress that comes with a strained relationship can translate into physiological problems that in turn lead to conditions like high blood pressure, heart problems, and obesity.

These health problems have been reported for both men and women although the latter seems to be more susceptible to health issues caused by bad relationships, according to a study by researchers at the University of Utah.

For the study, [the researchers] recruited 276 couples married an average of two decades, in which men and women were between 40 and 70 years old. Participants filled out questionnaires that covered positives, such as emotional warmth and mutual support; and areas of tension, such as frequency of arguments and extent of disagreements over issues like sex, kids, and money. (Source: WebMD).

The participants were also monitored for blood chemistry, blood pressure and waist circumference.

The study showed that the health effects of a discordant relationship on women’s health include:

• Depressive symptoms, more likely to be reported by women.
• Metabolic syndrome symptoms (which would include increased blood sugar levels, increased levels of bad cholesterol and triglycerides) more likely to be reported by women.
• Weight gain and increased waist circumference, also more likely to be reported by women.
• Depressive symptoms reported by men not related to metabolic syndrome.

This is not the first study to explore the effect of relationships on health outcomes.

A large body of research shows that divorce is associated with coronary calcification in both men and women. However, the current study clearly indicates that the relationship between emotional distress caused by a bad relationship and cardiovascular health is stronger in men than women.

In another study, researchers found out that the quality of a marriage relationship can have an influence on recovery rates of women with breast cancer.

Corollary to this, another study on stroke victims and their spouses showed that, depending on coping skills, caregiving can cause depression and put a strain on relationships.

But why are women more susceptible? According to the researchers:

“Women seem to be more relationship oriented. We know by research that women tend to base their self-concept on relationships, how they are doing, how things are going for them. And we think that’s the reason we’ve shown that negative relationship issues seem to take a greater toll on women emotionally and physically.”

High BP trends among America’s children

The latest statistics from the US National Health and Nutrition Examination Surveys (NHANES) are out and the numbers do not look too good for American children and teenagers.

NHANES are surveys conducted by National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) which provide “cross-sectional, nationally representative health examination data on the US civilian, noninstitutionalized population.”

CDC researchers, in collaboration with colleagues from Wake Forest University School of Medicine Department of Epidemiology and Prevention, North Carolina, conducted an analysis of NHANES data from the following years: 1988 to 1994, 1999 to 2002, and 2003 to 2006. These are data of children and adolescents in the age range of 8 to 17 years old. The researchers specifically looked at the elevated blood pressure (BP) and estimates of BP before reaching elevated levels.

BP was measured and classified based on the update guidelines in the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. The results of the data analysis showed that overweight and obese children and adolescents are more likely to suffer from elevated BP.

Hypertension or above normal BP is common among adults. However, there is increasing indication that elevated BP is also becoming a problem among children as well. This is troubling because other research studies have shown that high BP tracks through life, and that “BP levels measured in childhood and adolescence are also associated with elevated BP in adulthood.”

Hypertension is well-known risk factor for chronic health conditions such as cardiovascular disorders (e.g. heart attack, heart failure, stroke) and kidney disease. However, hypertension can be managed with lifestyle change strategies.

High BP in children has been also linked to other health conditions.

Sleep breathing disorder is a condition “characterized by short periods of upper airway obstructions that are complete (apnea) or partial (hypopnea), or a longer period of insufficient air movement (obstructive hypoventilation).” This sleep disturbance leads to restless sleep, snoring and daytime sleepiness. Sleep breathing disorder, which seems to cause hypertension, has been associated with obesity and enlarged nostrils.

Other studies have linked high BP to lack of physical activity among children and adolescents, as reported by British researchers. The study was part of the Avon Longitudinal Study of Parents and Children.

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Your blood pressure and the weather

The temperatures are going down, but your blood pressure is going up. Is this logical?

It is, according to a French research study which observed that blood pressure varies with the season. The data of the study is based on measurements on 8,801 French adults older than 65 years and followed up for more than two years.

The study results show “that blood pressure in elderly people varies significantly with the seasons, with rates of high blood pressure readings rising from 23.8% in summer to 33.4% in winter. Blood pressure increases were seen in both the systolic (top) and diastolic (bottom) numbers.” The average systolic blood pressure was 5 mmHg higher in the winter months than in the summer months.

What is more disturbing is that the temperature-related effects on high blood pressure become more pronounced with age, and as observed in this study, in people older than 80 years.

The mechanism behind this seasonal variation is not clear but “possible explanations of the cold weather effect include activation of the sympathetic nervous system (which helps control how the body responds to stress) and release of the hormone catecholamine, which may increase blood pressure by speeding the heart rate and decreasing the responsiveness of blood vessels.”

The findings of the study help shed light on the well-documented seasonal variations in illness and death caused by stroke and aneurysms or rupture of the blood vessels. According to the American Stroke Association, stroke is the number 3 cause of mortality in the US, after heart disease and cancer.

And now that it is winter time in the northern hemisphere, people, especially the elderly should closely monitor their blood pressure. However, the increase in blood pressure in winter time should not actually discourage people from venturing outdoors. The American Stroke Association and American Heart Association encourage physical activity such as walking – even in winter time through the Start! Heart Walk. Connect with other walkers (sole-mates!) in your area using the My Start! Community. Track your walking progress using the free online tool My Start! Online Tracker. The brochure Start! Walking This Winter can give you some basic tips on how to enjoy the winter outdoors without endangering your health.

 

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Can vitamin C lower your BP?

Many studies have evaluated the effect of vitamin C (ascorbic acid) on cardiovascular health, with disappointing results. That is why the report of Dr Gladys Block and her colleagues at the University of California, Berkeley was met with surprise, and well, scepticism.

The Berkeley researchers report in the Nutritional Journal that the concentration of vitamin C in the plasma is inversely linked to blood pressure. This means that the higher the vitamin C levels in the plasma, the lower is the blood pressure. This association was observed among 242 young women aged 18 to 21 years old who were participants in the 10-year National Heart, Lung, and Blood Institute Growth and Health Study on adolescent obesity.

The author notes:

“It appears that the BP is less likely to rise if people have a good level of plasma vitamin C…This study suggests that vitamin C may be an important factor in BP regulation even among healthy young adults and that further study is warranted.”

The possible mechanism for this blood pressure lowering properties might be that vitamin C significantly decreases the levels of 2 substances: F2-isprostane, which is a marker of oxidative stress, and C-reactive protein (CRP), which is a marker of inflammation. Both inflammation and oxidative stress play a role in cardiovascular disorders, including hypertension.

Many experts do not believe that vitamin C can have some cardiovascular benefits. For one thing, the data was criticized as poor, being based only on women who are overweight or obese. In cases like this, comparative studies just simply give more credibility.

Hypertension expert Dr Franz Messerli of St Luke’s Roosevelt Hospital, New York comments at heartwire:

“To my way of thinking, plasma vitamin-C level in this population could be simply a good biomarker for intake of fruit and vegetables. Thus, the more fruits and vegetables these young women ate (ie, the healthier their diet), the lower their salt intake and not surprisingly, the lower their blood pressure… Vitamin C is a powerful antioxidant in vitro, and in some animal studies it has been shown to act as a vasodilator, possibly by enhancing the bioavailability of nitric oxide. But a recent study has failed to show an effect of the acute oral ingestion of vitamin C on oxidative stress, arterial stiffness, or blood pressure in healthy subjects.”

Despite the criticisms and scepticism, Dr. Block is planning to further investigate the vitamin C – blood pressure link in a large-scale randomized study.

Regardless whether vitamin C can lower blood pressure or not, the fact remains that eating fresh fruit and vegetables is beneficial to our health. And eating vitamin C-rich fruit such as oranges and other citrus fruits cannot hurt anybody.

Your job and your blood pressure

Increase in blood pressure has been associated with psychological and emotional stress. But how does stress in the job affect blood pressure? This has been the subject of numerous research studies over the years but the results are conflicting. In this post, I am reviewing 3 studies on 3 different types of workers in Japan.

 Managers

In Japan, the number of managerial employees suffering from cardiovascular disease is said to be higher than any other type of employee. A study of Japanese employed managers and retired managers showed that these people in the management suffer from masked hypertension. The disadvantage of masked hypertension as compared to sustained hypertension is that it often goes undiagnosed so that the people affected are not taking preventive measures or early treatment.

The author concludes that

“job stress seemed to be one of the main causes of masked hypertension…that more frequent measurements of  [blood pressure] at the work place are necessary to identify subjects with masked hypertension.”

Factory workers

This study looked at 352 male factory workers in Japan to evaluate the relationship between “job strain and subclinical indicators of arteriosclerosis.” Subclinical indicators are early indicators before the actual symptoms are actually observed in the clinical setting. The researchers measured these in cerebral artery, the aorta, and the carotid artery. The results show that job strain was associated with the indicators but the association was not significant.

Shift workers

This study which looked at Japanese male employees suggests that shift work may elevate both systolic and diastolic blood pressure – in other words increased risk for hypertension.

That’s what industrialization is all about – 24-hour, non-stop operations in factories and manufacturing plants. To keep companies running, employees have to work in shifts day and night. It is estimated that about a quarter of Japanese companies operate on shifts.

The researchers studied 3963 day workers and 2748 alternating shift workers working in a Japanese steel company. All the workers were male and had annual health check ups between 1991 and 2005.

Looking at the relative increases in blood pressure, the researchers reported that alternating shift workers have significantly higher systolic and diastolic blood pressure than their colleagues working during normal day hours.

The authors conclude that

“[the] study in male Japanese workers revealed that alternating shift work was a significant independent risk factor for an increase in blood pressure. Moreover, the effect of shift work on blood pressure was more pronounced than other well-established factors, such as age and body mass index.”

Photo credit: Workers by createsima at stock.xchng

Risk factors for hypertension: men vs women

The National Heart Lung and Blood Institute and MayoClinic list the following as the most common risk factors for hypertension:

• Older age
• Race or ethnicity
• Overweight or obesity
• Gender
• Stress
• Lack of physical activity
• Use of tobacco
• Family history of hypertension
• High alcohol consumption
• High sodium in the diet
• Low vitamin D levels
• Low potassium in the diet

This latest study by Chinese researchers reports that risk factors can contribute differentially to the developing hypertension depending on individual’s gender. The researchers studied 834 men and 835 women aged 15 to 84 years old in an ethnically isolated group and assessed their risk factors by collecting data on lifestyle, diet, and demographics as well as performing blood tests, genotyping, and blood pressure measurements.

The differences they observed were as follows:

Prevalence of hypertension	lower in women
Awareness	lower in women
Treatment	lower in women
Mean blood pressure	lower in women (116/72 vs 119/75)

Lifestyle risk factors

As expected, age is a common risk factor both gender that cannot be altered. However, several lifestyle risk factors seem to be strongly linked to males.

Lifestyle risk factors which are specific for males are:

• Physical activity
• Alcohol consumption
• Body weight and body mass index (BMI)
• Waist circumference

A lifestyle risk factor which is specific for females is calcium intake in the diet.

Other lifestyle risk factors common to both males and females are:

• education level
• plasma lipid profile (e.g. cholesterols and triglycerides)
• dietary intakes of energy, fat, sodium, and potassium

Genetic risk factors

Gene markers also varied between males and females. Genetic polymorphisms affecting the following genes encoding:

• calpastatin
• lipoprotein lipase
• thyrotropin-releasing hormone receptor
• Willebrand factor

are specific for women.

Conversely, polymorphisms in the genes encoding the following:

• angiotensin-converting enzyme
• aldehyde dehydrogenase
• hepatic lipase

 are specific for men.

Since this study was conducted on an ethnically isolated group of people and it is not clear how the results can be extrapolated to the general population. The researchers themselves are a bit cautious with the interpretation of the data and conclude that

“Sex differences in the prevalence of hypertension in the Hei Yi Zhuang population may be mainly attributed to the differences in dietary habits, lifestyle choices, sodium and potassium intakes, physical activity level, and some genetic polymorphisms.”

Whatever future studies will show, they wouldn’t change the fact that an unhealthy lifestyle is a strong factor in getting hypertension – whether you are male or female!

Photo credit: gender symbols by kikoashi at stock.xchng

CVD News Watch for the Weekend 8 August

Enjoying your summer? Here’s some new items to read over the weekend.

CVD nutrition watch

Eating fish may prevent memory loss and stroke in old age

This study which looked at 3,660 people age 65 and above, reports that eating fish rich in omega-3 fatty acids lowers the risk for stroke and cognitive decline in the elderly.

The study found that people who ate broiled or baked tuna and other fish high in omega-3 fatty acids (called DHA and EPA) three times or more per week had a nearly 26 percent lower risk of having the silent brain lesions that can cause dementia and stroke compared to people who did not eat fish regularly. Eating just one serving of this type of fish per week led to a 13 percent lower risk. The study also found people who regularly ate these types of fish had fewer changes in the white matter in their brains. (Source: American Academy of Neurology)

CVD BP watch

Blood Pressure Is So Much More than Brachial

Check out this video at Medscape to know more about other types of blood pressure (other than the usual measurements on the cuff and arm), what they tell us and why are they important.

CVD infection watch

HIV infection increases risk for aortic stiffness and CAC

This study reports a link between cardiovascular health and HIV infection. The researchers specifically looked at “aortic stiffness and coronary artery calcification, two subclinical markers of atherosclerosis.”

CVD healthcare watch

Average ER waiting time nears 1 hour, CDC says

The average time you have to reckon with when waiting in an ER in the US is almost 60 minutes – up from 38 minutes of previous years. This is because the number of ER cases is up but the number of ERs is down, thus creating a bottleneck, Physorg reports.

CDC reports:

At least 10% of emergent cases (those in which patients should be seen in less than 15 minutes) and 20% of urgent cases (should be seen in 15–60 minutes) had to wait longer than 1 hour to see a physician. Blacks and Hispanics were more likely to wait for more than 1 hour in all cases other than emergent.

CVD weight loss watch

Adults who eat eggs for breakfast lose 65 percent more weight

How about eggs for breakfast? You can add a bagel on top and won’t be hungry again for hours. This new, low-calorie, high protein diet may be the next diet craze. Check out the reviews about it here.

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