Posts Tagged "High blood pressure"

More intensive management of high blood pressure, below a commonly recommended bloodblood pressure 2 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 Blood pressure 1third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.

“Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall.”

Lawrence Fine, M.D.
Chief, Clinical Applications and Prevention Branch at NHLBI

“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 blood pressure 3achieved 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

hyper 3A growing stack of medical research—including Gottesman’s recent study—suggests that high blood pressure raises risk for thinking problems, early brain aging, and even Alzheimer’s disease. These three steps may help reduce risk:

Know your number. “Have your blood pressure checked regularly,” Gottesman says. “People tend to ignore high blood pressure, particularly when they are younger, because it has no symptoms that you can feel or see. But it’s important to pay attention to it.”

Take care of higher-than-normal blood pressure right away. Talk with your doctor about what Hyperblood pressure is appropriate for you. If yours is higher than recommended, your doctor will advise you take lifestyle steps such as weight loss, regular exercise, and a lower-sodium diet that features plenty of fruits and vegetables to bring it down to a healthier level. Your doctor may also prescribe drugs that lower blood pressure.

If your doctor prescribes medications for your blood pressure, take as directed. Nearly half of all people with high blood pressure don’t have it hyper 2under control, according to the Centers for Disease Control and Prevention. One big reason: skipping medication or not taking it as directed.

It’s long been known that keeping your blood pressure within a healthy range helps protect against heart attack and stroke. Now a recent study from Johns Hopkins University has uncovered a new risk worth sidestepping: People with high blood pressure at midlife had greater decline in key thinking skills late in life than those with normal blood pressure readings.

Source: Johns Hopkins Medicine

meta 2Roughly a third of U.S. adults have the metabolic syndrome — and nearly half of those aged 60 and older have it — according to a research letter in JAMA.  Researchers evaluated National Health and Nutrition Examination Survey data from 2003 through 2012. The metabolic syndrome contributes to cardiovascular morbidity and mortality.   Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 reported a metabolic syndrome prevalence of 34%.  Understanding updated prevalence trends may be important given the potential effect of the metabolic syndrome and its associated health complications on the aging US population. We investigated meta 3trends in the prevalence of the metabolic syndrome through 2012.  Among the other findings:

  • The prevalence of the metabolic syndrome increased from 2003–2004 to 2007–2008 (from 33% to 36%) and remained stable thereafter.
  • Women were more likely than men to be affected: in 2011–2012, the prevalence was 37% and 33%, respectively.
  • Hispanics had the highest prevalence, at 39% in 2011–2012.
  • The metabolic syndrome was more common among older than younger adults, ranging from 18% for those aged 20–39 years to 47% for those aged 60 and older.

Source: JAMA

Blood pressure 3Isolated 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 Blook Pressure 21.49-3.01) 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.”

blood pressureISH 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

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.

exerciseThe 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.blood pressure

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.

bp cupThe 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

Sleep disturbances such as apnea may increase the risk of Alzheimer’s disease, while moderate exercise in middle age and mentally stimulating games, such as crossword puzzles, may prevent the onset of the dementia-causing disease, according to research to be presented Monday.

oldpeopleThe findings — which are to be introduced during the six-day Alzheimer’s Association International Conference in Copenhagen — bolster previous studies that suggest sleep plays a critical role in the aging brain’s health, perhaps by allowing the body to cleanse itself of Alzheimer’s-related compounds during downtime. The studies also add to a growing body of literature that suggests keeping the brain busy keeps it healthy.

The battle against Alzheimer’s disease has become more urgent for the United States and other developing nations as their populations turn increasingly gray. The disease is the leading cause of dementia in older people and afflicts more than 5 million Americans. At its current pace, the number is expected to soar to 16 million people by 2050.

In 2012, the United States adopted a national plan to combat the disease and the Group of Eight nations last year adopted a goal of providing better treatment and prevention by 2025.

Erin Heintz, a spokeswoman for the Alzheimer’s Association, said U.S. government funding to combat the disease now stands at about $500 million a year. To reach its 2025 goal, th e United States should be spending $2 billion a year, she said.

The sleep study, conducted by University of California at San Francisco researchers on a large sample of veterans, found that those with diagnosed sleep disorders such as apnea or insomnia were 30 percent more likely to suffer dementia than veterans without such problems. Veterans who suffered from sleep problems and post-traumatic stress disorder (PTSD) had an 80 percent greater risk.

“I would say that this is another important study showing this link between sleep and subsequent diagnosis of dementia,” Kristine Yaffe, a psychiatry professor at UCSF who heads its Dementia Epidemiology Research Group, said in a telephone interview. She said her study’s findings benefited from having such a large sample of participants: Researchers used eight years of records on 200,000 veterans, most of whom were male and 55 or older.

It is well known that people afflicted with Alzheimer’s suffer from sleep disorders, Yaffe said, but further research is necessary to determine whether sleep disturbance heightens the risk of getting dementia or is a symptom.

In a separate study, researchers at the Wisconsin Alzheimer’s Institute and the Wisconsin Alzheimer’s Disease Research Center wanted to find out whether middle-aged people who engage in mentally stimulating activities might reduce their risk of cognitive impairment and dementia. Forty percent of the subject group carried the gene linked to Alzheimer’s and 74 percent had a parent with the illness, two factors known to increase the risk of getting the disease.

The researchers studied 329 participants — 69 percent of whom were women, whose mean age was about 60 — to find out how often the participants read books, visited museums, played games such as checkers or worked on puzzles.

The subjects also underwent a battery of tests, including MRI brain scans to measure the volume of those regions commonly afflicted by Alzheimer’s.

For purposes of the study, researchers focused on the group’s game-playing habits to see if the frequency of playing games was related to better brain and cognitive health.

Stephanie Schultz, lead author of the study, said that although more research is necessary to know for sure, the findings suggest that stimulating the brain with ordinary diversions such as crossword puzzles may help some people preserve brain tissue and cognitive functions that are vulnerable to dementia. Those who reported a higher frequency of playing games also had greater brain volume in regions affected by Alzheimer’s, such as the hippocampus.

“The more they play these types of games, the better it is for … brain health,” she said.

One reason could be that game-playing involves more complicated processes across multiple regions of the brain, compared with more passive forms of mental engagement, the researchers said.

“It’s very clear it’s a different quality of mental engagement when you’re playing games of skill than when you’re reading a book,” said Ozioma Okonkwo, an assistant professor of medicine at the University of Wisconsin School of Medicine and senior author of the study. “To win a card game, you have to judge, you have to plan, you have to do something, you have to remember what the last player played.”

Okonkwo said the results were exciting particularly because they held true for people with a family history of Alzheimer’s and a genetic disposition to the disease.

“These individuals already have two strikes against them,” he said.

Similarly, a three-year study of people with mild cognitive impairment by researchers at the Mayo Clinic Study of Aging suggests that moderate physical exercise in middle age could decrease the risk that their cognitive deficits progress to dementia. The study looked at the timing of regular exercise — undertaken either in midlife between the ages of 50 and 65, or later in life, from age 70 and up — and its relationship to the onset of dementia in a group of 280 elderly people. Their median age was 81.

Oddly, however, the association did not hold for people who engaged in light or vigorous exercise in middle age or for any level of physical activity later in life.

On a similarly counterintuitive note, another study suggested that high blood pressure among people at least 90 years old — “the oldest old” — may protect against cognitive impairment. Researchers at the University of California at Irvine said that although hypertension is believed to increase the risk of Alzheimer’s and dementia for middle-aged people, the risk may shift with time.

Their study, which examined 625 people who are 90 or older, found that people who were diagnosed with high blood pressure between the ages of 80 and 89 had a significantly lower risk of dementia. People with hypertension after the age of 90 had an even lower risk, the researchers said.

(Source: Washington Post)

Stroke_Awareness_MonthA stroke occurs when blood flow to part of the brain is blocked; we sometimes refer to it as a “brain attack.” Two million brain cells die every minute during stroke, increasing the risk of permanent brain damage, disability or death.

In the United States, stroke is the fourth leading cause of death, killing over 133,000 people each year, and a leading cause of serious, long-term adult disability. Stroke can happen to anyone at any time, regardless of race, sex or age.

High blood pressure is the leading risk factor for stroke. However, other risk factors include:

  • Atrial fibrillation
  • Diabetes
  • Family history of stroke
  • High cholesterol
  • Increasing age (esp. over 55)
  • Race (black people have almost twice the risk of first-ever stroke than white people)
  • Heart disease
  • Lifestyle factors (smoking, poor diet, lack of exercise)

 Women are twice as likely to die from stroke than breast cancer annually. The estimated direct and indirect cost of stroke in the United States in 2010 is $73.7 billion.

3

Learning the signs of stroke are crucial, because time is of the essence when a stroke is occurring. Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability, or death. Recognizing the symptoms and acting FAST to get emergency medical attention can save a life and limit disabilities.

To learn more, see the National STROKE Association‘s fact sheet or the U.S. National Library of Medicine.

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Having a hot temper may increase your risk of having a heart attack or stroke, according to researchers. Rage often precedes an attack and may be the trigger, say the US researchers who trawled medical literature.

They identified a dangerous period of about two hours following an outburst when people were at heightened risk. But they say more work is needed to understand the link and find out if  stress-busting strategies could avoid such complications. People who have existing risk factors, such as a history of heart disease, are particularly susceptible, they told the European Heart Journal.

In the two hours immediately after an angry outburst, risk of a heart attack  increased nearly five-fold and risk of stroke increased more than three-fold,  the data from nine studies and involving thousands of people suggests.

The Harvard School of Public Health researchers say, at a population level, the  risk with a single outburst of anger is relatively low – one extra heart attack  per 10,000 people per year could be expected among people with low  cardiovascular risk who were angry only once a month, increasing to an extra  four per 10,000 people with a high cardiovascular risk.

But the risk is cumulative, meaning temper-prone individuals will be at higher  risk still. Five episodes of anger a day would result in around 158 extra heart attacks per  10,000 people with a low cardiovascular risk per year, increasing to about 657  extra heart attacks per 10,000 among those with a high cardiovascular risk, Dr  Elizabeth Mostofsky and colleagues calculate.

Dr Mostofsky said: “Although the risk of experiencing an acute cardiovascular event with any single outburst of anger is relatively low, the risk can accumulate for people with frequent episodes of anger.”

It’s unclear why anger might be dangerous – the researchers point out that their results do not necessarily indicate that anger causes heart and circulatory problems. Experts know that chronic stress can contribute to heart disease, partly because it can raise blood pressure but also because people may deal with stress in unhealthy ways – by smoking or drinking too much alcohol, for example. The researchers say it is worth testing what protection stress-busting strategies, such as yoga, might offer.

Doireann Maddock, senior cardiac nurse at the British Heart Foundation, said: “It’s not clear what causes this effect. It may be linked to the physiological changes that anger causes to our bodies, but more research is needed to explore the biology behind this. “The way you cope with anger and stress is also important. Learning how to relax can help you move on from high-pressure situations. Many people find that physical activity can help to let off steam after a stressful day. If you think you are experiencing harmful levels of stress or frequent anger outbursts talk to your GP.”

Source: BBC

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Nearly a third of American adults have high blood pressure, also known as hypertension. Often called the “silent killer” because it provides few warning signs, hypertension increases a patient’s risk for heart attack and stroke. New research suggests eating a vegetarian diet could help combat this deadly disease. A healthy blood pressure is 120/80 mm HG. Previous studies have shown that each increase of 20/10 mm Hg in that number doubles the patient’s risk of cardiovascular disease. But lowering that top number just 5 mm HG can reduce your chances of dying from cardiovascular disease by about 7%. And eating more fruits and vegetables may be a good way to do that, according to the new study, published Monday in the scientific journal JAMA Internal Medicine.

In seven clinical trials, participants following a vegetarian diet had a systolic blood pressure that was 4.8 mm Hg lower on average than their omnivore counterparts’. The vegetarians’ diastolic blood pressure was lower by an average of 2.2 mm Hg. In observational studies, the difference was slightly bigger. A vegetarian diet was associated with an average decrease of 6.9 mm Hg for systolic blood pressure and 4.7 mm HG for diastolic blood pressure. Many factors could be affecting the vegetarians’ blood pressure. Vegetarian diets are often lower in sodium and saturated fats, while being higher in fiber and potassium.

vegetables

Vegetarians also tend to have lower body mass indexes because fruits and vegetables are less energy dense – meaning you can eat more of them for fewer calories. The definition of a “vegetarian diet” differs from person to person, so the researchers can’t tell you how much meat is too much. Some of the observational studies also did not adjust for lifestyle factors such as exercise or alcohol intake that could have affected the results. Eating more fruits and vegetables as part of an overall healthy diet could help lower your blood pressure, says study author Dr. Neal Barnard. You should also try to limit your sodium intake, exercise regularly and avoid drinking alcohol excessively.

Source: CNN

heart disease women

While overall mortality from heart disease is declining, the number of younger women with heart disease is growing. A new study by the Canadian-led global INTERHEART group shows that nine factors account for 90% of the risk for a first myocardial infarction:

  • Smoking
  • Lipids
  • Hypertension
  • Diabetes
  • Obesity
  • Diet
  • Physical Activity
  • Psychosocial Factors

Cardiovascular disease has been the leading killer of American women since 1908. Death rates from heart disease are increasing in women aged 35 to 54 years, most likely as a result of obesity. Cardiovascular disease causes one death per minute in the U.S.– that amounts to a staggering 421,918 deaths every year. More than 12 million women in the U.S. are suffering from Type II diabetes. Across the globe, heart disease is the leading cause of death in women in every major developed country and most emerging economies.

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