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

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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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Hot Women Are Bad For Your Health (Study)

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New TYT Facebook Page(!): www.facebook.com Don’t forget to check out Ana’s blog at: www.examiner.com Follow us on Twitter: twitter.com TYT Network (new WTF?! channel): www.youtube.com Check Out TYT Interviews www.youtube.com Watch more at www.theyoungturks.com

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Preeclampsia: hypertension during pregnancy

You could be young, healthy, and fit with no history of hypertension. But suddenly, your blood pressure skyrockets to hypertensive levels. And the main reason is – pregnancy.

Preeclampsia, usually used synonymously with pregnancy-induced hypertension, occurs when the blood pressure of a pregnant woman increases dramatically within a short period of time usually during the second half of her pregnancy. This leads to hypertension, kidney damage, inflammation, preterm delivery and premature babies with low birth weights and presents a serious risk to the mother and to the baby. According to FamilyDoctor.org, preeclampsia commonly occurs:

• in women having their first pregnancy
• in women carrying multiples
• in women with family history of preeclampsia
• in pregnant teenagers and those above 40
• in women with hypertension or kidney problems before they got pregnant

The real cause of preeclampsia hasn´t been identified. It affects about 2 to 8% of pregnancies, making it one of the leading causes of maternal and fetal complications and death worldwide.

There are ways of lowering one’s risk for preeclampsia, as summarized by the 2 studies below.

Blood pressure monitoring

Ambulatory blood pressure monitoring (ABPM) could help identify women with early-onset severe preeclampsia who are most likely to require early delivery according to South African researchers.

They found that by monitoring both diastolic blood pressure (DBP) and day-night blood pressure difference (DND) and combining the mean values, the onset of preeclampsia can be predicted.

The research “studied 44 women presenting with severe pre-eclampsia between 28 and 34 weeks’ gestation, who they managed expectantly for 8 days. They measured the women’s blood pressure every 30 minutes with an automated monitor for 24-hour periods on alternate days.”

The researcher observed that Caesarean sections are significantly lower among pregnant women with normal DND and mean DBP. These women also had, on the average, longer pregnanciey and less very premature babies. Only one delivered before 32 weeks’ gestation.

The authors conclude:

“The combination of mean [DBP and DND] may be a supplementary measurement of disease severity in early onset severe pre-eclampsia and seems to be of prognostic value”

Preeclampsia and exercise

This study involved 79 women who had a previous history of pre-eclampsia and had a sedentary lifestyle. The study compared two types of exercise regime: a 40-minute moderate‑intensity walk 5 times a week and a slow, non-aerobic stretching exercise program accompanying a 40-minute video 5 times a week.

The results of the study are as follows:

15% of women in the walking group developed preeclampsia. Only 5% of women in the stretching group developed the condition.

It seems that stretching had a more protective effect against pregnancy-induced hypertension than walking. The researchers believe that stretching may induce more production of transferrin, which is

“a plasma protein that transports iron through the blood and protects against oxidative stress on the body, and that helps guard against preeclampsia.”

However, walking and other moderate forms of exercise are beneficial to the mother’s as well as the baby’s health in general, as posted before. At the same time, any form of exercise regime during pregnancy should only be performed after consultation with your doctor.

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.”

INTERSTROKE study identifies 10 stroke risk factors that we can do something about

The majority of studies on stroke have been conducted in westernized or developed countries. Yet, recent surveys show that the disease burden of stroke is concentrate in low- and middle income countries, where 85% of deaths due to stroke occur.

The INTERSTROKE study might be able to rectify this knowledge gap. The study looked at 3000 first time acute stroke cases from 22 countries and compared these with 3000 controls. In the study, low income and developing countries are well-represented, with only 14% of the participants coming from high-incomes countries whereas 81% come from Southeast Asia, India or Africa.

The results indicate that 90% of stroke risk can be explained by 10 risk factors, all of them modifiable.

As expected, hypertension occupied the top position, accounting for 34.6% of population attributable global risk of stroke. But other risk factors were also identified that can highly contribute to the risk.

The factors identified by the INTERSTROKE study are:

• Hypertension – 34.6%
• Regular physical activity – 28.5%
• Waist-to-hip ratio (abdominal obesity) – 26.5%
• Ratio of apolipoproteins (cholesterol, triglycerides)- 24.9%
• Cigarette smoking – 18.9%
• Dietary risk score – 18.8%
• Cardiac causes (atrial fibrillation, flutter, valve disease, history of heart attack) – 6.7%
• Psychological factors
  • Stress – 4.6%
  • Depression – 5.2%
• Diabetes – 5%
• Alcohol intake – 3.8%

The same risk factors were identified for different stroke subtypes, especially the tow most common. Ischemic and hemorrhagic stroke.

“Along with hypertension, current smoking, abdominal obesity, diet, and physical activity accounted for 80% of the global risk of stroke, explaining 80% of the risk of ischemic stroke and 90% of the risk of hemorrhagic strokes.”

The INTERSTROKE results showed that the risk factors for stroke and heart disease are more or less the same but the importance of each factor may vary. In the case of heart disease (as shown by the INTERHAERT study), 50% of the risks are attributed to lipids. In stroke, high blood pressure is the most important factors.

According to an editorial by Dr Jack Tu

“This finding is particularly relevant, because it highlights the need for health authorities in these regions to screen the general population for high blood pressure and, if necessary, offer affordable treatment to reduce the burden of stroke.”

It is good to know that all the risk factors are modifiable, e.g. lifestyle factors. There is something we can do about them. And we should start now.

Does your blood pressure pill increase your cancer risk?

If you have to choose between stroke and cancer, which would it be? Touch choice, eh?

Unfortunately, health professionals as well as patients might be forced to make the choice. A recent meta- analysis of studies on popular drugs used against hypertension brings some worrying news. These blood pressure pills actually increase the risk of developing cancer.

The five randomized controlled trials analyzed contained data of more than 60,000 patients who were taking the drugs called angiotensin-receptor blockers (ARBs) for hypertension, heart disease, and chronic kidney disease. The results of the analysis showed that patients on ARBs have about 1% higher risk for developing different types of cancers than those who are not taking the drugs. The cancers associated with this increased risk are prostate, breast and lung cancers.

Now, we may think that 1% is not much. But if we consider the number of people worldwide taking ARBs – estimated to be up to millions – then we can see how this 1% can actually translate to a large number of people who will be getting cancer.

According to study author Ilke Sipahi, associate director of heart failure and transplantation at University Hospitals Case Medical Center in Cleveland:

“The risk for the individual patient is modest. However, when you look at it from the population level, millions and millions of people are on these drugs and it can cause a lot of excess cancer worldwide.”

The authors estimate that for every 105 patients who take ARB for 4 years, one extra case of cancer will be diagnosed. However, the author cannot tell whether this increased risk is reversible after cessation. Also, there is no significant difference between cancer mortality between people on ARB and people who are not.

The bestselling drug in this class is telmisartan (Micardis), which was taken by about 85.7% of the patients in the studies. It is no wonder that its manufacturer Boehringer Ingelheim Corp is not too happy about the report which was published in Lancet Oncology.

Why do ARBs increase cancer risk? The experts do not know exactly why but it might have something to do with the drugs’ ability to enhance growth of new blood, the same enhancement that can promote tumor growth.

So what now?

Well, the study authors are cautious enough to tell patients on ARB not to stop their medications. In most cases, “their chances of dying from heart failure outweighed their chances of getting cancer”

The study conclusions are:

This meta-analysis of randomized controlled trials suggests that ARBs are associated with a modestly increased risk of new cancer diagnosis. Given the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each particular drug. These findings warrant further investigation.

Their ultimate advice: if in doubt, talk to your doctor about it.

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.

High Blood Pressure Education Month: Know the Enemy

May is National High Blood Pressure Education Month in the US. For this observance, we will be bringing you a series of articles on blood pressure and hypertension.

Here are some statistics on hypertension.

From the Centers for Disease Control and Prevention (CDC):

• 74.5 million – number of people in the US have high blood pressure or hypertension.
• 45 million – number of Americnas who consulted a doctor for hypertension in 2006
• 326,000 – number of Americans who died with high blood pressure as primary or contributing cause of death in 2006
• $76.6 billion – estimated direct and indirect health care costs for hypertension management in 2010.

Other Quick Facts from the CDC:

• Almost 90% of adults aged 45–64 years will develop high blood pressure during the remainder of their lifetime.
• About 25% of American adults aged 20 years or older have prehypertension.
• One of every three U.S. adults aged 20 years or older have hypertension.
• Nearly one of five people have hypertension and are not aware that they have it.
• In the United States, high blood pressure is more common among blacks than whites. About 44% of black women have high blood pressure.
• Mexican-Americans have the lowest level of hypertension control compared to non-Hispanic whites and blacks.

So why is high blood pressure a major health concern?

Because hypertension is a major major risk factor for stroke, heart disease, congestive heart failure, and kidney disease.

How can we increase our awareness about high blood pressure?

In observance of this month, the American Heart Assocaition gives us several resources on high blood pressure.

Look at this 5-step blood pressure awareness program:

1. Leanr about High Blood Pressure (HBP).
2. Disocver why HBP matters
3. Undertsnad your rislk fro developin HBP
4. Diagnose and monitor HBP
5. Prevent and treat HBP

Animated feature on HBP

Test your knowledge of HBP facts and myths by taking the HBP Quiz “Can You Escape the Silent Killer.”

Blood Pressure Risk Calculator

How can we prevent HBP?

• Here are some tips from the CDC:
• Have your blood pressure checked regularly.
• Maintain a normal body weight (body mass index of 18.5-24.9 which is kilograms divided by height in meters squared).
• Keep up physical activity (2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest,  shoulders, and arms).
• Follow a healthy eating plan of a diet rich in fruits, vegetables, and low in sodium.
• Quit smoking.
• If you drink alcoholic beverages, do so in moderation (≤ 2 drinks per day for men and ≤ 1 drinks per day for women).
• If you have high blood pressure and are prescribed medication(s), take as directed.

Unhealthy behavior + genes = hypertension

It all adds up – unhealthy behaviour and genes – to pave the way towards hypertension and cardiovascular disease.

We all know that certain lifestyle factors, e.g. cigarette smoking, alcohol consumption and lack pf physical exercise lead to high blood pressure. However, for the first time, researchers found that there are specific genes which interact with these behaviours and result in increased hypertension risk.

According to lead author Dr. Nora Franceschini, assistant professor of epidemiology at the University of North Carolina in Chapel Hill

“The three lifestyle characteristics are well-known risk factors for high blood pressure. What’s new is that we are showing that these behaviors interact with your genes to influence blood pressure levels.”

This means that your genes aren’t the only ones that determine your risk. You may be predisposed to hypertension based on your family history but by modifying your lifestyle, you can actually minimize your chances of being hypertensive.

“The most interesting study finding is that a susceptibility to hypertension in your genetic background doesn’t mean that your lifestyle exposures do not matter, they do. Drinking, smoking and exercise habits can be modified, which would, in turn, influence the risk of developing hypertension, even in people who are predisposed to the condition.”

The researchers looked at the medical and genetic history of 3,665 participants as part of the ongoing Strong Heart Family Study which is a large epidemiologic study of American Indians. The participants were aged 14 to 93 years of age and were part of large families of several generations. The goal of the study was to see how inherited genetic patterns vary among those with different lifestyles and educational levels. The results showed that lifestyle factors interact with genes/ethnicity and lead to hypertension. Educational level also seems to play a role but at a very minor level.

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Hypertension: does “pay-for-performance” deliver quality care?

Nowadays, health care practitioners are reimbursed on a “pay-for-performance” basis also called P4P which rewards physicians financially for achieving targets and treatment goals. The financial rewards can vary from increase in percentage of reimbursements, bonuses, and grants. Even though the P4P program aims to promote better health care delivery, it can backfire when doctors may avoid patients with complex disorders (and therefore more difficult goals to achieve) and opt more for patients with simple, straightforward ailments (e.g. easy targets). As an example, patients with diabetes are also likely to present with concomitant illnesses such as high blood pressure, heart disease, and other cardiovascular disorders.

Researchers looked followed up 141,609 patients with high blood pressure from at eight Veterans Affairs (VA) hospitals in three states. They compared quality of care and patient satisfaction between patients with simple hypertension and those who are “sicker” hypertensive patients, e.g. with other co-existing conditions, from diabetes to chronic lung diseases.

According to lead author Dr. Laura A. Petersen of the VA Health Services Research and Development Center of Excellence and affiliated with the Baylor College of Medicine, in Houston, Texas

“Many clinicians are concerned that when they care for patients with multiple medical conditions, their performance on measures of health care quality is going to suffer due to that complexity. The concern is that the time spent treating other unrelated conditions would take away time from treating high blood pressure, causing performance on measures of quality to suffer.”

The results of the study show that:

• “Sicker patients” are more likely to receive high quality health care.
• Patients with multiple diseases have to take many types of medications but expressed an overall high satisfaction with the medical care they receive.
• Patient satisfaction is generally positive regardless whether patients are treated for high blood pressure only or for other conditions as well.

“Overall good quality care” was defined as:

• When doctors managed to keep blood pressure under 140/90 millimeters of mercury (mm Hg) at first visit and within the six-month follow-up period.
• When doctors are actively trying to control blood pressure (even if the patient fell short of the treatment goal) as shown by intensified follow-up care that would include change in medication, nutrition and lifestyle change counselling, etc.

The study results indicate that P4P measures do not necessarily “penalize physicians who treat patients with more complicated medical conditions”, at least in the case of hypertensive patients.

One weak point of the study is the fact that it looked only at patients under the VA system which essentially differs in a lot of ways from the civilian health care system.

However, the results of the study should be a reassurance to both health care practitioners and patients alike that indeed the P4P program seems to be also achieving its goal – quality health care.

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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The STITCH study: hypertension management made simple

“Less is better” might be the new strategy in treating high blood pressure, according a study by Canadian researchers. The study called “Simplified Treatment Intervention to Control Hypertension” (STITCH) was conducted by researchers at the Robarts Research Institute of the University of Western Ontario. The study followed up 2,104 participants with high hypertension, basically patients from 45 family practices in southwestern Ontario, Canada.

There are many different guidelines of the management of hypertension depending on the country and the medical group you are talking to. They can be complicated and confusing and can be challenging to both patients and doctors alike. Furthermore, they are frequently updated and amended.

The objective of the STITCH study is “to see if there are simpler ways to help patients (and their doctors) reduce their blood pressure to goal levels than by following national guidelines which can be complicated.”

The STITCH study came up with the following simplified treatment regime:

(1) initial therapy with a low-dose angiotensin-converting enzyme (ACE) inhibitor/diuretic or angiotensin receptor blocker/diuretic combination;

(2) up-titration of combination therapy to the highest dose;

(3) addition of a calcium channel blocker and up-titration; and

(4) addition of a non-first-line antihypertensive agent.

The results of the study suggest that starting with low doses of combination drug, then gradually increasing may actually be better for recently diagnosed hypertensive patients. “A half tablet of a single pill combination drug (e.g. an ACE-inhibitor/diuretic or angiotensin receptor blocker/diuretic combination) than the regular starting dose of a single drug” may actually be more effective. The results of the study will be published in the April edition of the journal Hypertension.

High blood pressure is a risk factor for heart disease and stroke. According to the most recent estimates (source: American Heart Association), one in three Americans have high blood pressure.

Aside from pharmacological therapy, lifestyle changes are necessary to prevent, manage and control high blood pressure. Some of these lifestyle changes are (Source: American Heart Association Scientiific Advisory):

• Weight Loss
• Dietary Salt Restriction
• Moderation of Alcohol Intake
• Increased Physical Activity
• Ingestion of a High-Fiber, Low-Fat Diet

Honestly, even the “simplified” treatment regime of the STITCH study doesn’t look that simple to me. I’d rather go for the lifestyle changes and got for prevention.

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Preeclampsia may not just be a temporary pregnancy complication

Preeclampsia belongs to a group of hypertensive disorders of pregnancy. Other related disorders are pregnancy-induced hypertension and toxaemia. These conditions can cause life-threatening pregnancy complications that endanger both the mother and the baby.

The conditions are all characterized by elevated blood pressure during the second half of pregnancy but in addition, preeclampsia is characterized by increased concentrations of proteins in the urine.

About 10% of pregnancies are affected by pregnancy-induced hypertension while preeclampsia affects 5 to8% of pregnancies. Preeclampsia is common in low-income countries, where it occurs in about 1 out of every 100 up to 1 out of 700 pregnancies. In contrast, it estimated to occur in about 1 in 1000 pregnancies (Source: Clinical Evidence BMJ).

Aside from high blood pressure, symptoms of preeclampsia also include “swelling, sudden weight gain, headaches and changes in vision“.

It has always been thought that once the baby is delivered, the condition of preeclampsia is resolved. Apparently not, according to this joint research by American and Danish researchers. The effects of preeclampsia may actually track through life and brings with it increased risk for future cardiovascular problems including hypertension, diabetes and blood clots. And the risks increase with every pregnancy.

According to lead author Dr. Michael J. Paidas, director of the Program for Thrombosis and Hemostasis in Women’s Health in the Department of Obstetrics, Gynecology & Reproductive Science at Yale University:

“The only reliable treatment for preeclampsia is delivery of the baby. But while delivery may ‘cure’ preeclampsia in the moment, these mothers are at high risk of chronic hypertension, type 2 diabetes mellitus and blood clots for the rest of their lives.”

There is therefore a great need to prevent preeclampsia not only to prevent complications that threaten both mother and baby, but also to prevent long-term health problems.

According to MayoClinic, preeclampsia may be caused by the following:

• Insufficient blood flow to the uterus
• Damage to the blood vessels
• A problem with the immune system
• Poor diet

The risk factors for the condition are

• First pregnancy
• Preeclampsia in a previous pregnancy
• Maternal age above 35
• Pregnancy with multiples
• Obesity
• Gestational diabetes
• Family of history preeclampsia
• Underlying medical conditions before pregnancy such as cardiovascular disease, diabetes, or kidney disorder.

Aside from medical management, lifestyle changes can also help prevent or manage preeclampsia. Previous studies, for example, indicate that preeclampsia can be prevented by exercise and intake of dietary fiber.

In the making: a vaccine against hypertension

You’ve heard of vaccines against polio, measles, small pox. What about a vaccine against hypertension? Last year, a paper presented at the American Heart Association Scientific Sessions reported about an investigational vaccine against angiotensin II. Angiotensin II is a vasoconstrictor agent – it causes constriction of blood vessels leading to increase in blood pressure. When a vaccine is investigational, it is still being tested and not yet ready for use.

However, this vaccine being tested by Cytos Biotechnology seems to be promising.

The name of the vaccine is CYT006-AngQb and is a virus-like particle-based conjugate vaccine. The vaccine is now tested in Phase II clinical trials. This means that the vaccine has passed through tests with animals and healthy humans without major safety problems. In Phase II trials, medications are tested in people showing the symptoms for which the drugs are indicated. In this case, CYT006-AngQb is intended for patients with mild to moderate hypertension.

Is the vaccine effective?

Preliminary results of the 2007 tests show that

“treatment with the high dose produced a significant reduction of daytime ambulatory blood pressure [BP] and a marked reduction in the early morning hours, when most adverse cardiovascular events occur.”

If approved, what would be the advantage of the vaccine over currently available antihypertensive drugs?

Well, antihypertensive drugs have to be taken on a daily basis because of their short half-life. CYT006-AngQb, on the other hand, produces extended antibody response because it has a half-life of about 4 months. That means, a hypertensive patient only needs to take medication 3 to 4 times a year.  In addition, currently available hypertensive drugs are not so effective in controlling early morning increases in blood pressure, the time of the day when major cardiac events such as heart attacks and stroke usually occur.

Even if the vaccine proves to be effective, will it be safe?

The study tested the vaccine in 72 patients with mild to moderate hypertension and followed-for 12 moths. During this period, the vaccine was observed to be well-tolerated by the study participants. There were side effects but they were mostly mild and the most common of these were headaches and irritation on the injection site.

The author, Prof. Juerg Nussberger

“Despite the fact that effective drugs are available to treat hypertension, only about one out of four hypertensive patients has the blood pressure successfully controlled. Once people are aware of the often symptomless hypertension, they have to take their medications daily, and many are apparently unable or unwilling to take pills every day for the rest of their lives. The major remaining medical need in this important therapeutic area is thus improved patient compliance. If we could support or substitute the oral therapy with a vaccine that would need to be given just every few months, I think we could achieve a better control of high blood pressure.”

The results of the study were later published in the journal Lancet.

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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!

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Birth weight and cardiovascular health – where is the connection?

How much did you weigh at birth? Your baby/babies? Does it matter?

A new study by British researchers published in the European Heart Journal shows that there is a link between low birth weight and predisposition to hypertension later in life.

Increasing evidence suggests that adverse prenatal environments, as indicated by low birth weight, cause long-term changes in cardiovascular physiology that predispose to circulatory disease.

The study followed up 140 healthy children aged 7 to 9 years old who were born at full-term, had a wide-range of birth weights though still considered normal. Blood pressure and heart rate (by ECG) were regularly monitored. In addition, the children were also subjected to psychological stress tests (e.g. speaking in public, mental arithmetic task) and the response in the form of cardiac impedance was measured.

The results show that there birth weight is linked to certain cardiovascular response to stress. However, the relationship is different depending on gender. Boys with low birth weights are more like to have higher vascular resistance and higher blood pressure during the stress test. In girls, this link is not evident. However girls with low birth weight tended to have higher activity of the sympathetic nervous system in response to stress. This is the part of the nervous system usually located in the spinal cord and is responsible for regulation of many processes in the body, including stress response. Both responses translate to a predisposition to cardiovascular problems later in life.

The study concludes

Smaller size at birth is associated with sex-specific alterations in cardiac physiology; boys had higher systemic vascular resistance and girls had increased cardiac sympathetic activation.

The results of this study are based on children with birth weights considered to be low, nevertheless still within a range considered normal.

Can you imagine what possible health problems premature babies with below normal birth weights can have? A baby is considered premature when born before the 37th week of gestation. Premature babies – preemies for short – tend to be smaller and weigh less than full-term babies. Several studies have shown that preemies are more likely to have health problems ranging from respiratory problems to autism

This doesn’t mean that preemies are doomed to be ill for the rest of their lives. My twins were born 5 weeks early but I didn’t resign myself to the fact that they will be just as healthy as their peers just because they were small babies. I strongly believe in the power of prevention through a healthy lifestyle. Exercise, proper nutrition, and the right attitude can make a lot of difference and I can to attest this when I look at how my boys can outrun and outcycle other kids of their age.

Still, now that the health consequences of low birth weight are known, pregnant and wanna-be pregnant women should pay closer attention to factors that can affect a fetus’ growth in the womb – and these include maternal nutrition, smoking, and alcohol consumption.

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There’s no place like home: home monitoring program for cardiovascular patients

Is home monitoring by patients with heart disease and/or hypertension a feasible alternative? According to experts and results of recent studies, there’s actually no place like home for monitoring cardiovascular patients.

 

Hypertension patients

In a recent joint scientific statement by the American Heart Association (AHA), American Society of Hypertension (ASH), and Preventive Cardiovascular Nurses Association (PCNA), experts push for more home monitoring programs of hypertension patients.

“Given the amount of accumulated evidence about the value of home blood-pressure monitoring (HBPM), it is time to make HBPM a part of routine management of hypertensive patients, especially those with diabetes, coronary heart disease, chronic kidney disease, substantial nonadherence, or a substantial white-coat effect.”

according Dr Thomas Pickering, who is a member of the scientific committee who write the statement, as quoted by heartwire.

HBPM is recommended to be a routine part of the management of hypertension, be it known or suspected. It is also recommended for those with the so-called “white-coat hypertension” because routine monitoring may detect “masked hypertension” before it becomes critical.

The committee notes that regular use of home monitoring will improve the quality as lower the cost of health care to the 72 million people with some form of hypertension. It urges the reimbursement of HBPM costs by health insurance.

The use of HBPM has gained popularity in recent years as people’s health literacy improved. According to a recent Gallup poll:

The number of patients monitoring their BP at home has increased steadily over the past 5 years, being 38% in 2000 and 55% in 2005, an increase of 17%. 

The proportion of patients owning a monitor has increased from 49% in 2000 to 64% in 2005.

Of patients who do not own monitors, 14% said that expense was the reason.

Heart failure patients

According to another study, home monitoring programs of heart failure patients may actually be more beneficial than initially thought, Health Day News reports

110 patients at the Massachusetts General Hospital in Boston were randomly divided into 2 groups. One group of 68 patients received the usual follow-up care for heart failure patients. Another group of 42 patients were monitored remotely while they stayed at home. The patients in the remote care group had remote monitoring equipment attached that measured vital signs such as heart rate, pulse and blood pressure. They also measured their weight daily and answered a questionnaire about their general well-being. When any of the remote care patients show abnormal values, a health care professional makes a house visit to make a proper assessment. The remote care program is called the Connected Cardiac Care program and was conducted by the Center for Connected Health.

After 3 months of follow-up, patients in the remote care group had much lower hospital readmission rates (31%) compared to the control group (38%). The remote care group also had lower incidence of heart-failure related admissions and emergency room visits.

In a future resource post, I will go into detail about different home monitoring programs available.

Source:

Pickering TG, Houston-Miller N, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring. Hypertension 2008.

Health Day News, 1 May 2008

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