Posts Tagged "Blood pressure"

More intensive management of high blood pressure, below a commonly recommended blood pressure target, significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure. This is according to the initial results of a landmark clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT). The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.

“This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), the primary sponsor of SPRINT. “We are delighted to have achieved this important milestone in the study in advance of the expected closure date for the SPRINT trial and look forward to quickly communicating the results to help inform patient care and the future development of evidence-based clinical guidelines.”

High blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems. An estimated 1 in 3 people in the United States has high blood pressure.

The SPRINT study evaluates the benefits of maintaining a new target for systolic blood pressure, the top number in a blood pressure reading, among a group of patients 50 years and older at increased risk for heart disease or who have kidney disease. A systolic pressure of 120 mm Hg, maintained by this more intensive blood pressure intervention, could ultimately help save lives among adults age 50 and older who have a combination of high blood pressure and at least one additional risk factor for heart disease, the investigators say.

The SPRINT study, which began in the fall of 2009, includes more than 9,300 participants age 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico. It is the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than currently recommended level will impact cardiovascular and kidney diseases. NIH stopped the blood pressure intervention earlier than originally planned in order to quickly disseminate the significant preliminary results.

The study population was diverse and included women, racial/ethnic minorities, and the elderly. The investigators point out that the SPRINT study did not include patients with diabetes, prior stroke, or polycystic kidney disease, as other research included those populations.

Source: NIH

Using less than a drop of blood, a new test can reveal nearly every virus a person has ever been exposed to, scientists reported on Thursday.

The test, which is still experimental, can be performed for as little as $25 and could become an important research tool for tracking patterns of disease in various populations, helping scientists compare the old and the young, or people in different parts of the world.

It could also be used to try to find out whether viruses, or the body’s immune response to them, contribute to chronic diseases and cancer, the researchers said.

“I’m sure there’ll be lots of applications we haven’t even dreamed of,” said Stephen J. Elledge, the senior author of the report, published in the journal Science, and a professor of genetics at Harvard Medical School and Brigham and Women’s Hospital.

“That’s what happens when you invent technology — you can’t imagine what people will do with it,” Dr. Elledge said. “They’re so clever.”

The test can detect past exposure to more than 1,000 strains of viruses from 206 species — pretty much the entire human “virome,” meaning all the viruses known to infect people. The test works by detecting antibodies, highly specific proteins that the immune system has made in response to viruses.

Tried out in 569 people in the United States, South Africa, Thailand and Peru, the blood test found that most had been exposed to about 10 species of virus — mostly the usual suspects, like those causing colds, flu, gastrointestinal illness and other common ailments.

Source: New York Times

This test is not yet commercially available but our comprehensive physicals include testing for individual viral infections and inflammation.

Isolated systolic hypertension in young and middle-age adults was associated with an increased risk of death from cardiovascular causes later in life, according to a study done over 3 decades.

Men in the study with systolic blood pressure (BP) levels of 140 mmHg or higher and diastolic BP below 90 had a 28% increased risk for death from coronary heart disease compared with men with normal BP (hazard ratio 1.28, 95% CI 1.04-1.58), reported Donald M. Lloyd-Jones, MD, of Northwestern University Feinberg School of Medicine in Chicago.

In addition, women with isolated systolic hypertension (ISH) had a more than twofold greater death risk (HR 2.12, 95% CI 1.49-3.01) than women with optimal BP, they wrote in the Journal of the American College of Cardiology.

The findings provide strong evidence that ISH is a clinically meaningful condition in young and middle-age adults and not just pseudo or ‘white-coat’ hypertension, Lloyd-Jones told MedPage Today.

“It is not well supported by science, but there has been a belief by many that elevated systolic and not diastolic blood pressure in younger adults is benign,” he said. “Most previous research hasn’t really examined hypertension by subtype. That’s why we did this study.”

ISH is defined as a systolic BP of 140 mmHg or greater with a diastolic BP of less than 90 mmHg. It is common in the elderly, but relatively uncommon in younger and middle-age adults, the researchers wrote.

NHANES data suggest that the overall prevalence of ISH among adults in their 20s and 30s has more than doubled in recent decades, from 0.7% between 1988 and 1994 to 1.6% between 1999 and 2004, but there is still a great deal of uncertainty about the clinical consequences of ISH in younger adults.

Source: MedPage Today

Exposure to bisphenol A (BPA) through consumption of canned beverages is associated with increases in systolic blood pressure, according to a randomized crossover trial in Hypertension. BPA is a chemical found in many plastic bottles, food containers, and the linings of cans.  Sixty older adults (mostly women) had three study visits, during which they consumed two servings of soy milk provided one of three ways: in two glass bottles (least amount of BPA exposure), two cans (most BPA), or one glass bottle and one can. The sequence of serving containers was randomized.  Urinary BPA concentrations were significantly higher 2 hours after participants drank from two cans versus two glass bottles. Furthermore, systolic BP was roughly 4.5 mm Hg higher after two cans versus two glass bottles. The authors write that the observed increase in systolic BP “may cause a clinically significant increase of risk of cardiovascular disorders, such as heart diseases and peripheral arterial diseases.”  Bisphenol A (BPA) is produced in high volumes worldwide. It is used in the manufacture of polycarbonate plastics and epoxy resin, which are used in the linings of food or beverage cans, water bottles, and dental fillings. BPA has been detected in 95% of the population of the United States.

BPA is considered to be an endocrine-disrupting chemical, and it shows affinity for estrogen receptors. It was initially considered to be a weak xenoestrogen, but subsequent studies showed that BPA can have effects even at low concentrations.  In addition, pathways other than binding to estrogen receptors have been proposed. These include the thyroid hormone pathway, binding to glucocorticoid receptors and androgen receptors, or interfering with the central nervous system and immune system. Epidemiological studies have suggested that BPA could have adverse effects on human health.  Specifically, BPA exposure has been shown to be associated with increased production of liver enzymes, recurrent miscarriages, premature delivery of fetuses, inflammation and oxidative stress, decreased quality of semen, and male sexual dysfunction.

Source: NEJM Journal Watch

A progressively rising blood pressure trajectory is not an inevitable part of aging in men who remain active and maintain high levels of cardiorespiratory fitness, a prospective, population-based study found.

The study included almost 14,000 men without high blood pressure, cardiovascular disease, or cancer at baseline followed for three and a half decades.

Men in the study who were categorized as having the lowest level of fitness, based on baseline treadmill tests, reached a systolic blood pressure (SBP) of >120 mmHg at approximately 46 years of age, compared with 54 years of age among those whose fitness levels were highest. Age-related diastolic blood pressure differences (DBP) were far more pronounced, with low-fitness men reaching >80 mmHg at approximately 42 years old compared with beyond age 90 in the highest fitness group.

“This suggests that highly fit men are likely to reach abnormal SBP values about a decade later than men in the low fitness category, implying that improving fitness levels may reduce the duration of elevated SBP,” researcher Junxiu Liu, MD, of the University of South Carolina Columbia, and colleagues wrote in the Journal of the American College of Cardiology, published online Sept. 15.

Exercise Keeps Heart Young

The study is one of two published in the issue suggesting that staying physically fit throughout life can keep aging hearts healthy.

In a separate investigation, researchers in Texas examined the impact of long-term exercise on left ventricular (LV) compliance and distensibility in around a hundred older men and women.

The study showed that while low levels of casual, lifelong exercise did not prevent decreased compliance and distensibility, four to five ≥30 minute exercise sessions a week throughout adulthood did prevent most age-related LV stiffness.

“This finding holds important implications for global health, as ventricular stiffening has been implicated in the pathophysiology of many common cardiovascular conditions affecting the elderly,” researcher Paul S. Bhella, MD, of the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, and colleagues, wrote.

Fit Men Had ‘Younger’ BP

The study by Liu and colleagues included an all male cohort from the Aerobics Center Longitudinal Study, which was a large study that included mostly white, college-educated people with middle to high socioeconomic status.

The men were between the ages of 20 and 90 at study entry, and they completed between three and 28 (mean 3.8) follow-up medical examinations between 1970 and 2006. Fitness was measured by a maximal treadmill exercise test, and longitudinal data were analysed using linear mixed models.

Cardiovascular fitness was assessed using the Balke maximal treadmill exercise test, with total treadmill time (highly correlated with oxygen uptake) used as an index of aerobic power. Participants were classified into low (<33rd percentile), moderate (33rd to 66th percentile), or high fitness categories (>66th percentile), according to the distribution of age-specific treadmill time.

Information on age, smoking status, and alcohol consumption were obtained by self-administered questionnaire. Body fat percentage was assessed using hydrostatic weigh in, skin fold thickness measurements, or both.

Among the key findings from the study:

-DBP tended to increase until nearly 60 years of age, when a decrease was observed, while SBP tended to increase over all age periods.

-Multivariate analysis revealed that average SBP increased by 0.30 mmHg (95% CI 0.29-0.31) with 1-year age increment after adjusting for body fat percent, fitness, resting heart rate, glucose level, triglyceride level, cholesterol level, current smoking, heavy alcohol consumption, and parental history of hypertension.

– had a yearly increase of 0.14 mm Hg (95% CI 0.13-0.15) before age 60 years.

-Overall, abnormal SBP (>120 mm Hg) began to occur at approximately 50 years of age and abnormal DBP (>80 mm Hg) began to occur at 60 years of age.

-Higher fitness levels significantly modified the risk in SBP trajectory across the lifespan, and the age-fitness interaction remained significant after adjusting for known hypertension risk factors.

Study strengths included the large number of participants, the longitudinal measure of SBP, DBP, and other time varying covariates, and the assessment of body fat percentage to measure obesity.

Limitations included the exclusion of women from the study, as well as the inclusion of only a small percentage (5%) of nonwhite and low income men, which limited its generalizability to these populations.

Findings May Not Apply to Women, Nonwhite Men

In an editorial accompanying the study, Stanley S .Franklin, MD, of the University of California Irvine, and Gary L. Pierce, PhD, of the University of Iowa, Iowa City, wrote that the exclusion of women was a major study limitation.

“There is some evidence that men have a steeper rate of increase in aortic stiffening beyond 50 years of age compared with women; therefore, fitness may have a different modifying effect on SBP and DBP trajectory with aging in women than men,” they wrote.

Even with the limitations, Franklin and Pierce wrote that the study suggests “habitual aerobic exercise may counteract the burden of cardiometabolic abnormalities that accelerate artery stiffening- characterized as ‘early vascular aging’ — and therefore slow the onset and severity of isolated systolic hypertension.”

Regular Exercise Preserves LV Function

In the study by Bhella and colleagues, 102 healthy older people (>64 years of age) were recruited and screened for lifelong patterns of exercise. The participants were stratified into four groups: sedentary (<2 ≥30 minute sessions/week), casual (2 to 3 sessions/week) committed (4 to 5 sessions/week) and competitive (6 to 7 sessions/week).

Right heart catheterization and echocardiography were performed while pre-load was manipulated using lower body negative pressure and rapid saline infusion to define LV pressure-volume relationships.

Peak oxygen uptake and LV mass increased with escalating doses of lifelong exercise, with little change in systolic function. At baseline, LV distensibility was greater in committed (21%) and competitive (36%) exercisers than in sedentary participants.

Group LV stiffness constants (sedentary: 0.062±0.039; casual: 0.079±0.052; committed: 0.055±0.033; and competitive: 0.035 ±0.033) revealed increased stiffness in sedentary subjects compared with competitive athletes, whereas lifelong casual exercise had no effect. They also showed greater compliance in committed exercisers than in sedentary or casual exercisers.

The researchers noted that sedentary aging, and the decreases in LV compliance and distensibility that accompany it, may set the stage for the cardiovascular conditions that affect the elderly, such as atrial fibrillation and heart failure with preserved ejection fraction.

In a commentary published with the study, Wilbur Y.W. Lew, MD, of the VA San Diego Healthcare System and the University of California San Diego, wrote that the effects of exercise on the heart are multifactorial and complex and that potential factors that prevent age-related changes in LV compliance include lowering blood pressure and arterial stiffness, decreasing cardiovascular comorbidities, improving endothelial function, and activating metabolic and signaling pathways to reduce chronic inflammation, fibrosis, and LV remodeling.

“A long-term commitment to exercise preserves LV compliance comparable to a young heart,” he wrote. “This may facilitate diastolic filling and preserve diastolic function. We face challenges to establishing causality, identifying mechanisms, and applying these results to an increasingly sedentary population.”

Source: medpagetoday.com

Strokes are increasingly hitting younger people–and the incidence of the crippling condition could double worldwide by 2030 according to the first global analysis of the problem. Though the chances of a stroke jump dramatically with age, the growing number of younger people with worrying risk factors such as bulging waistlines, diabetes and high blood pressure means they are becoming increasingly susceptible. Scientists combed through more than 100 studies from 1990 to 2010 studying stroke patients across the world and used modeling techniques when there wasn’t enough data. They found the incidence of stroke has jumped by a quarter in people aged 20 to 64, and that those patients make up almost one-third of the total number of strokes.

Most strokes occur when a clot blocks the blood supply to the brain. Patients often experience symptoms including a droopy face, the inability to lift their arms and garbled speech. If not treated quickly, patients can be left with long-term side effects, including speech and memory problems, paralysis and the loss of some vision.

Researchers said most strokes still occur in the elderly and that the numbers of people suffering strokes are still increasing as the world’s population ages.

Read more at CTV News.

The Food and Drug Administration warned on Tuesday of a counterfeit dietary supplement for male sexual enhancement that could be particularly harmful to patients with diabetes, high blood pressure, high cholesterol and heart disease. In a safety warning posted on its website, the FDA said the fake product is represented as “ExtenZe Maximum Strength” and looks similar to the actual product, ExtenZe, which is made by Monrovia, California-based Biotab Nutraceuticals Inc. The FDA said its analysis showed that the counterfeit ExtenZe contains sildenafil, an active ingredient in various FDA-approved prescription medicines, including Pfizer’s Viagra, for erectile dysfunction… Sildenafil may interact with nitrates — found in some prescription drugs and often taken by men with diabetes, high blood pressure, high cholesterol, or heart disease — and could lower blood pressure to dangerous levels, the FDA said.

Source: Reuters

 

A new UCSF-led study of nearly 3,000 individuals links obesity to the development of kidney disease. The work also shows that, when properly measured, declines in kidney function are detectable long before the emergence of other obesity-related diseases such as diabetes and high blood pressure. Healthy kidneys are vital to the proper functioning of the heart and brain, as well as the skeletal and immune systems, and the research adds additional urgency to the call for doctors to intervene early in life with obese patients, the researchers said. “We’re getting larger and larger at younger and younger ages, so the problems we will see that are directly related to obesity are going to become more common and they’re going to start earlier in life,” said Vanessa Grubbs, MD, UCSF assistant adjunct professor of medicine and first author of the new study. “Even before the level at which we can diagnose illnesses, decline in kidney function is happening. Is it reversible? We’re not sure. Preventable? It stands to reason that it would be.”

Source: University of California- San Francisco