Effects of high blood pressure on your body - video

Transcendental meditation and blood pressure?

Young adults who complete a program of training in transcendental meditation, and who are at risk of hypertension, are able to use the relaxation method to lower their blood pressure and levels of psychological distress, according to a study published online Oct. 1 and in the December issue of the American Journal of Hypertension.

Sanford I. Nidich, Ph.D., of the Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, and colleagues conducted a study of 298 university students who were randomized to either a waiting list or a program of transcendental meditation training. The subjects' blood pressure levels, psychological distress and coping ability were assessed at baseline and after three months.

The researchers found that, in the intervention group, there was a reduction in systolic blood pressure of −2.0 mm Hg, and a −1.2 mm Hg reduction in diastolic blood pressure, compared to an increase of 0.4 mm Hg and 0.5 mm Hg, for systolic and diastolic blood pressure, respectively, in the control group.

"This is the first randomized controlled trial to demonstrate that a selected mind-body intervention, the transcendental meditation program, decreased blood pressure in association with decreased psychological distress and increased coping in young adults at risk for hypertension," the authors write. "This mind-body program may reduce the risk for future development of hypertension in young adults."

One of the study's authors is a consultant to Maharishi Health Technologies L.L.C.

Source: HealthDay News

Study claims grapes reduce blood pressure in rats

Grapes can help lower blood pressure and improve heart function, new research has revealed.
Scientists examined the effects of red, green and purple grapes on rats that develop high blood pressure when fed a salty diet.

After 18 weeks, the rats that ate the grape-enriched diet had lower blood pressure, better heart function, reduced inflammation throughout their bodies, and fewer signs of heart muscle damage than rats that ate a salty diet but no grapes.

Researcher Mitchell Seymour of Michigan State University says the findings support the theory that grapes themselves have a direct impact on heart disease risk, "beyond the simple blood pressure lowering impact already known to come from a diet rich in fruits and vegetables."
"The inevitable downhill sequence to hypertension and heart failure was changed by the addition of grapes to a high-salt diet," says research leader Dr Steven Bolling. The grapes comprised about 3% of the rats’ diet. For humans, that would be about nine servings, or 135 grapes, a day.

Source:NBR staff Thursday November 19 2009 - 12:25pm

Migraine increases likelihood of stroke

People who suffer migraines have more than double the risk of ischemic stroke, and the risk is especially high in women, a new study has found.

Ischemic stroke, the most common type of stroke, occurs when blood supply to the brain is cut off by plaque accumulation or a blood clot.

In this study, researchers from Johns Hopkins University School of Medicine reviewed the findings of 21 studies that included a total of 622,381 men and women, aged 18 to 70, in Europe and North America. Those with migraines were 2.3 times more likely than people without migraines to suffer ischemic stroke. The risk was 2.5 times higher for migraine sufferers who experienced aura (visual disturbances such as flashing lights, zigzag lines and blurred vision), and for women experiencing aura, 2.9 times higher.

The study was to be presented Monday at the American Heart Association's annual meeting in Orlando, Florida, USA.

The findings reinforce the link between migraine and stroke and also correct some discrepancies in previous analyses that yielded mixed results, according to Hopkins cardiologist and senior study investigator Dr. Saman Nazarian.

Nazarian said nearly 1,800 articles have been written about the relationship between migraine and stroke, but the Hopkins review is believed to be the largest of its kind and was more selective, including only studies that used similar designs and groups of people.

"Identifying people at highest risk is crucial to preventing disabling strokes. Based on this data, physicians should consider addressing stroke risk factors in patients with a history or signs of light flashes and blurry vision associated with severe headaches," Nazarian said in a Hopkins news release.

There are a number of migraine prevention and treatment options, including smoking cessation, taking medications to lower blood pressure or taking blood-thinning drugs such as aspirin, Nazarian added. For women with migraines, additional options include discontinuing use of birth control pills or stopping hormone replacement therapy.

Source:HealthDay News

History of hypertensive disorders in pregnancy may increase risk of cardiac, metabolic disorders

Women with a history of hypertensive disorders during pregnancy are at higher risk of cardiovascular and metabolic disorders, particularly if the hypertension is recurrent, according to a Norwegian study in the November issue of Obstetrics & Gynecology.

Elisabeth B. Magnussen, M.D., of the Norwegian University of Science and Technology in Trondheim, and colleagues examined the association between hypertensive pregnancy disorders (preeclampsia or gestational hypertension) and modifiable risk factors for cardiovascular and metabolic diseases among 15,065 women with a first singleton birth from 1967 to 1995.

The researchers showed that women with a history of hypertensive disorders during pregnancy had a higher body mass index and blood pressure, as well as unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. The risk of diabetes was significantly higher in women with preeclampsia. Hypertensive disorders occurring in more than one pregnancy or late in pregnancy strengthened the association between cardiovascular risk factors. In addition, two episodes of preeclampsia were associated with a greater likelihood of using blood pressure medication, while three episodes of gestational hypertension were associated with higher systolic and diastolic blood pressure. However, adjusting for body mass index partially attenuated these associations.

"Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease," the authors conclude.

Source: HealthDayNews

Obesity may hinder optimal control of blood pressure

Obese patients taking medications to lower their blood pressure and cholesterol levels are less likely to reach recommended targets for these cardiovascular disease risk factors than their normal weight counterparts, according to new research presented at the 2009 Canadian Cardiovascular Congress hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.

Dr. Vineet Bhan, a resident at the University of Toronto, sought to determine whether there were differences in reaching guideline-recommended targets for blood pressure and cholesterol levels according to body mass index (BMI) in a large number of individuals deemed to be at high risk for heart disease and stroke.

"In Canada, these high risk patients frequently do not reach their blood pressure and cholesterol targets," says Dr. Bhan. "The goal of our study was to see if obesity could be a factor."

He says that other studies have looked at obese individuals in the general population and found they were more likely to have high blood pressure, high cholesterol, and diabetes. "This, to our knowledge, is the first study looking at patients with established cardiovascular disease who are on treatment to see how obesity relates to the control of these risk factors," he says.

The study recruited 7,357 high risk patients who had a history of coronary artery disease, cerebrovascular disease, peripheral vascular disease, or diabetes plus additional cardiovascular risk factors from nine Canadian provinces. This observational study, based on two outpatient registries, took place from 2001 to 2004, recruiting 95 per cent of the patients from family physician offices. The registries were led by senior co-author, Dr. Shaun Goodman, and coordinated by the Canadian Heart Research Centre.

"Although a direct cause-and-effect relationship cannot be proven, our data would suggest that pharmacologic treatment alone without achieving optimal weight may not be adequate," says senior author, Dr. Andrew Yan. "This is a potentially important message to get across to clinicians, especially primary care physicians who are on the front line managing these high risk patients in the long term."

Patients were classified into three groups according to their BMI:

normal weight (BMI <24.9)

overweight (BMI 25 -- 29.9)

obese (BMI>30)

Researchers measured their rates of attaining guideline targets of blood pressure and cholesterol. The majority of patients (3,261) were obese; 2,791 were overweight, and 1,305 were normal weight. After controlling for age, sex, diabetes, use of pharmacologic therapies and other confounders, the investigators found that obese patients were less likely to attain blood pressure and HDL levels than overweight or normal weight patients. However, there was no significant difference with regard to attainment of LDL-cholesterol targets.

Overall, 42 per cent of patients attained guideline recommended blood pressure targets, and 21 per cent achieved both blood pressure and LDL-cholesterol targets. The rate of attainment was less for overweight, and still less for obese patients in comparison with normal weight individuals.

Among normal weight patients, 52 per cent reached blood pressure targets; among overweight patients, 47 per cent reached blood pressure targets; and among obese patients, 34 per cent reached blood pressure targets.

Dr. Charles Kerr, president of the Canadian Cardiovascular Society added that the firm linkage of obesity with a failure to achieve known targets for risk prevention in coronary artery disease is important. "It is very clear that there is an interaction here that is critical," says Dr. Kerr. "You can't as effectively lower your cholesterol or your blood pressure without losing the weight."

Obesity is associated with high blood pressure, high cholesterol, and diabetes -- three well-known risk factors for cardiovascular disease (CVD). Current Canadian, European, and American guidelines call for lifestyle changes and, if necessary, medication to control these risk factors to reduce obesity-related morbidity and mortality.

Source: ScienceDaily.

You are never too old to keep your blood pressure in check

Treating hypertension in adults 60 years old and older can help them live longer, healthier lives, according to an updated review. The effects might be more obvious in those who already have cardiovascular disease, but anti-hypertensive therapy also benefits other seniors and can help reduce deaths due to stroke as well as myocardial infarction or sudden cardiac death.

The review of 15 studies comprised more than 24,000 participants in which the oldest person was 105 years old and the average age was 74. Studies took place between 1970 and 2008.
“Before the first definitive clinical-trial evidence supporting blood–pressure-lowering treatment was produced in the mid-1980s, systolic hypertension was regarded as a natural feature of aging and some feared excessive harm from blood-pressure lowering in this age group,” said lead review author Dr. Vijaya Musini.

Musini is an assistant professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia, in Vancouver.

The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Blood pressure measurements for the study patients averaged 172/81. Systolic hypertension — in which the “upper” blood pressure measurement is 140 or higher — is more likely to occur in older people and experts now consider it a better predictor of heart attack and strokes than diastolic blood pressure.

Most of the early studies on hypertension took place with lower-risk individuals, in their 50’s or younger, which does not reflect the growing numbers of Americans who are 60 or older or the increasing numbers of people receiving hypertension diagnoses.

“There are data on people under 60 that treatment of hypertension is effective and when properly utilized reduces the rate of stroke, heart attack and death,” said Dr. Scott Wright, a professor of medicine with the Mayo Clinic. “The majority of cases of hypertension and especially new cases are probably being diagnosed in those over 60.”

Lifestyle factors associated with aging might play a part in this group’s increased risk. “Older people also accumulate higher rates of other risk factors for cardiovascular disease including obesity, a sedentary life style and diabetes,” Musini said.

The review concluded that treatment for hypertension reduced the overall number of fatalities whether or not they were associated with cardiovascular disease. Treating hypertension can also reduce the risk of stroke and disability, risk factors that are independent of those for heart disease.

“It is important to update reviews to integrate new studies that have been published, to review new classes of medication which might not have been approved or widely utilized 10 years ago, and to remind clinicians of the importance of treating hypertension,” Wright said. “Hypertension is easier to treat today than five or 10 years ago because there are better agents, there’s more information about how to use them and what side effects they might cause.”

The review also found that slightly different treatment works best for the “oldest old,” people over 80.

“The new conclusions in the updated review are that most benefit is due to first-line thiazide diuretic therapy for a mean duration of 4.5 years; that the decrease in all-cause mortality was limited to persons 60 to 80 years of age; and, that the best approach in patients 80 years and over is two drugs in low doses in an effort to reduce the incidence of stroke,” Musini said.

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Source: By Joan Vos MacDonald, Contributing Writer, Health Behavior News Service


FOR MORE INFORMATION:
Reach the Health Behavior News Service, part of the Center for Advancing Health, at hbns-editor@cfah.org or (202) 387-2829.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Musini VM, et al. Pharmacotherapy for hypertension in the elderly. Cochrane Database of Systematic Reviews 2009, Issue 4.

At-home blood-pressure checks might help, but you need advice too

Most people with high blood pressure don't have the condition under control, increasing their risk of heart attack, stroke and kidney failure. So researchers at Duke University explored whether some low-key, at-home measures can make a difference.

The study, published online in the Annals of Internal Medicine, is summed up in this way:

"In this trial, 636 patients with hypertension were randomly assigned to receive usual care; a telephone-delivered, nurse-administered behavioral self-management intervention; home blood pressure self-monitoring; or both of the latter two interventions. Compared with usual care, the adjusted improvement in the proportion of patients with blood pressure control at 24 months was 4.3% for the behavioral intervention group, 7.6% for the blood pressure monitoring group, and 11.0% for the combined intervention group."

In short, the combined approach of at-home checks and regular chats with a nurse was moderately effective; the single-tactic approaches weren't especially.

The researchers quite fairly point out that it's difficult to draw broad generalizations from the study, saying many participants did, in fact, have their blood pressure under control at the beginning of the study. And, too, the work was done through an academic health center, which couldn't be the case for everyone.

Nevertheless, the results back up earlier research suggesting that home interventions have some promise -- and that the costs are minimal. These days, that's no small thing.

Source: LATimes

Salt impacting Chinese blood pressure in Beijing

Beijingers' appetite for salt has come under fire by health officials who say too many salty dishes have given Beijingers the highest blood pressure in China. The latest study by the Beijing municipal health bureau on residents' nutrition and health found high blood pressure among city residents aged above 15 was about 25 percent, ranking the highest in the country.

And health experts blame high-sodium stacked foods, such as the soy paste used in Peking duck and salt-crusted kebabs. The report was released yesterday on the country's 12th High Blood Pressure Day. According to the study, Beijingers have a low health awareness with more than half not knowing they suffered from high blood pressure.

The report said high salt intake was the main reason led to high blood pressure and other related diseases. The report said 18.8 per cent of Chinese had high-blood pressure with the daily salt intake per person averaging 12 g, about double the 6 g standard recommended by WHO. In China's rural areas the average daily intake was 12.4 g and 10.9 g in urban areas.

"In a healthy diet, the salt intake for an adult should be no more than 6g a day, but most of people eat much more than this," said cardiovascular specialist Xu Yawei who is also the vice-director of the China Elder Health Care Association. "One of the quickest ways to lower people's blood pressure is to eat less salt, but it is a road to pain food without salt can taste bland."

In response, Beijing health bureau and the city's center of disease control jointly launched a citywide healthy diet campaign to lower blood pressure by eating less salt. Professional nutritionists will be sent to local communities to give public health education talks and help improve people's daily diets. Each family can receive a 2 g salt-limiting scoop that helps them control the level of salt using while cooking.

Meanwhile, the city will establish a community health service network that encourage residents especially those young and middle-aged people to receive free blood pressure check and understand their own health. Besides, many foods people eat each day are high-sodium prepared but often ignored. About 80 percent of the salt we eat is hiding in the processed foods like biscuits, cup noodles and bread, according to health departments.

"The salt we add while cooking or at the table only accounts up a very small part," said nutritionist Susan Chen, "So it is good to eat low-salt foods and stop using salt when cooking or at the table."

Source: www.chinadaily.com

Keep flexible to beat blood pressure

Want to know how stiff your blood vessels are? Reach for your toes!

Stiff arteries (blood vessels) raise blood pressure and increase your risk of developing high blood pressure, stroke and heart disease. A simple, painless and quick test may be able to show you how stiff your arteries are – provided you are aged more than 40 years.

A Japanese study has shown that asking people aged 40 or older to try to reach beyond their toes when sitting down appears to show how stiff their arteries are. The further the person could reach, the more flexible their body and the more flexible their arteries.

The researchers measured the flexibility of 526 healthy, nonsmoking people aged between 20-83 years. They did this by asking people to sit on the floor with their back against a wall with their legs straight out infront of them. The people then reached forward by bending at the waist. Depending on how far they could reach, the people were then divided into 'poor' flexibility or 'high' flexibility.

To compare their flexibility with the stiffness of their arteries, the researchers also measured the people's blood pressure, physical strength, endurance, fitness and speed of a heart beat of blood as it moved round the body.

Overall, the researchers found that being less flexible meant that people aged more than 40 had greater stiffness of their arteries and higher blood pressure. However this link wasn't noticeable for people aged less than 40. It has been shown before that people who look after themselves and keep fit have lower blood pressures in later life, but it wasn't known if this was also true for people who kept themselves more flexible. The researchers were keen to find out and argue that their results show that there is a strong link between being more flexible and having more flexible arteries.

The study's authors suggest that you may be able to keep your arteries flexible and reduce your risk of high blood pressure by carrying out regular stretching exercises. However, these regular stretches should be in addition to (not in the place of) the recommended 30 minutes of exercise five times a week, because these activities give your heart a good work out.

Source: BPA / Yamamoto K, Kawano H, Gando Y et al. Poor trunk flexibility is associated with arterial stiffening. Am J Physiol Heart Circ Physiol 297: H1314–H1318, 2009.

Cardiovascular health ofAmericans "at a crossroads" - where they go will we follow?

The number of Americans who have a low risk-factor burden for cardiovascular disease (CVD) has decreased in recent years, because of increases in obesity, diabetes, and hypertension, a new study has found [1].

The results indicate a reversal of the progress made in fighting CVD during the 1970s and 1980s, say the researchers. "We were at increasing levels of favorable risk profiles as a nation; we were making progress," lead author Dr Earl S Ford (Centers for Disease Control and Prevention, Atlanta, GA) told heartwire. But, "the trends have unfortunately turned in the wrong direction since the early 1990s, so we are kind of regressing." Ford and colleagues report their paper online September 14, 2009 in Circulation.

In an accompanying editorial [2], Drs Rob M van Dam (Harvard School of Public Health, Boston, MA) and Walter C Willett (Harvard Medical School, Boston, MA) say: "The disturbing trends in cardiovascular disease seem difficult to reconcile with the tremendous progress in medical knowledge and technologies and the fact that Americans spend >15% of their gross domestic product on healthcare."

This study provides "an important signal that the health of Americans is at a crossroad. The current path leads toward increasing adiposity, diabetes mellitus, cardiovascular disease, and disability, and an unfit, socially isolated population stuffed with pills and subjected to frequent palliative procedures," they continue. However, "an alternative scenario is possible" if every opportunity is taken to support optimal nutrition and physical activities of children and to "create an environment that encourages healthy options throughout life. Physicians can contribute to this effort" in many ways, they observe.

Huge potential for prevention that remains to be realized
For their study, Ford et al created an index of "low risk," defined as being a never or former smoker, having a BP of <120/80 mm Hg without medications, a total cholesterol of <5.17 mmol/L (<200 mg/dL) without medications, a body-mass index of <25 kg/m2, and no diagnosis of diabetes mellitus. Using data from four national surveys in adults 25 to 74 years of age, they found the age-adjusted prevalence of low risk increased from 4.4% in 1971-1975 to 10.5% in 1988-1994 before decreasing to 7.5% in 1999-2004 (p<0.001 for nonlinear trend). The patterns were similar for men and women; whites had a significantly higher prevalence of low-risk-factor burden than blacks during each survey, except 1976-1980. And a larger percentage of whites had a low-risk-factor burden than Mexican Americans in 1988-1994 (p<0.001) and 1999-2004 (p=0.001).

The results emphasize "the huge potential for preventing cardiovascular disease that remains to be realized. Primordial prevention holds enormous promise in decreasing the burden of cardiovascular disease," say Ford et al. The findings "argue for vigorous population-based approaches to reverse the unhealthy shift in the distributions of blood pressure and body-mass index and to sustain or accelerate the improvement in the distribution of total cholesterol," they add.

Will this trend translate to increased morbidity or mortality?
Ford told heartwire that "one of the main factors driving the analysis is excessive weight, including its adverse effects on blood pressure and on driving diabetes in a major way. If you look at the trends in smoking, they are still in a favorable direction. The trends in cholesterol are a little bit ambivalent; they are not as good as they used to be." Ford said it is not entirely clear what the exact outcomes of these findings will be. "The implication is that there could be an increase in incidence of coronary heart disease down the road, and then the next question is: Does it affect mortality? It could be that we have a lot more people developing coronary heart disease, but because of modern treatments, good drugs, and interventions, they may not necessarily die, so we might see a lot more morbidity but not necessarily a lot more mortality. That's something we are just going to have to follow to see how it plays out."

In the meantime, "there's a lot of work to be done," he said. "Physicians played a big role in helping decrease the percentage of the population that smokes and, clearly, it's challenging to get people to maintain recommended weights, but they need to work together with their patients as best they can to try to get them to adopt as many healthy behaviors as they are able to." A lot of other sectors of society have roles to play, he said, "from schools to workplaces to maybe churches. There are a lot of opportunities to drive things in the right direction."

Van Dam and Willett agree wholeheartedly. "Healthcare providers should have adequate resources, time, and reimbursement to engage in the prevention of cardiovascular disease in individuals. Such efforts by clinicians need to be complemented by efforts by state and national agencies that have the responsibility to develop effective public-health interventions," they state in their editorial.

Source: www.theheart.org

Use of statins in the US favours the wealthy, creating new social disparities in cholesterol

Since the introduction of statins to treat high cholesterol, the decline in lipid levels experienced by the wealthy has been double that experienced by the poor. While statins are highly effective in reducing cholesterol and improving heart health, their use may have contributed to expanding social disparities in the treatment of cardiovascular disease, according to research by Virginia W. Chang, MD, PhD, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and Diane S. Lauderdale, PhD, of the University of Chicago, published in the September issue of Journal of Health and Social Behavior. "Income disparities in lipid levels have reversed over the past three decades," according to Dr. Chang, lead author and Assistant Professor of Medicine and Sociology at the University of Pennsylvania. "High cholesterol was once known as a rich man's disease, because the wealthy had easier access to high fat foods (e.g., red meat). Now wealthy Americans are least likely to have high cholesterol, because they are more likely to be treated with statins, an expensive but highly effective pharmaceutical treatment to lower lipid levels." While cardiovascular disease remains a leading cause of death in the U.S., mortality due to heart disease has declined dramatically since the 1980s. Researchers estimate that about one-third of that reduction is a result of pharmaceutical innovation, including the use of statins. Dr. Chang notes, "Though statins have a longer-run potential to reduce disparities by making it easier for everyone to lower cholesterol relative to lifestyle changes, they have yet to diffuse widely across all income levels." Source: Marc KaplanUniversity of Pennsylvania School of Medicine as supported in part by the National Institute of Child Health and Human Development.

What sends blood pressure soaring? Salt, and more

Perhaps nothing in medicine more aptly depicts the paradoxical statement "doing better, feeling worse" than high blood pressure. Despite an extraordinarily easy way to detect it, strong evidence for how to prevent it and proven remedies to treat it, more Americans have undetected or poorly controlled hypertension than ever before.

The aging of the population is a reason but not the only one, said Dr. Aram V. Chobanian, a hypertension expert at Boston University Medical Center. He summarized the problem in an interview and in The New England Journal of Medicine in August: Americans are too sedentary and fat. They eat too much, especially salt, but too few potassium-rich fruits and vegetables. The makers of processed and fast foods created and persistently promote a craving for high-salt foods, even in school lunch programs. And Americans without health insurance often don't know that their blood pressure is too high because they wait for a calamity to strike before seeking medical care.

Solutions to the blood pressure problem require broad-scale approaches by the public, by government, by industry and by health care professionals. Several measures are similar to those that have been so effective in curbing cigarette smoking; others require better, affordable access to medical care for everyone at risk, including children and the unemployed. Still others need the cooperation of government, industry and the public to improve the American diet and enhance opportunities for health-promoting exercise.

No one claims that the solutions are cheap. But failure to fix this problem portends even greater costs down the line, because uncontrolled hypertension sets the stage for astronomically expensive heart and kidney disease and stroke -- diseases that will become only more common as the population ages.

Doing the numbers
Once, the prevailing medical opinion was that lowering an elevated blood pressure was hazardous because it would deprive a person's vital organs of an adequate blood supply. But a few pioneering medical researchers thought otherwise and eventually showed that lowering high blood pressure could prevent heart attacks, heart failure, strokes and kidney disease -- and save lives.

Even then, it was long thought that the only important indicator was diastolic pressure -- the bottom number, representing the pressure in arteries between heartbeats. Further studies showed that the larger top number, systolic pressure, representing arterial pressure when the heart beats, was also medically important.

And as the various studies reached fruition, it became apparent that the long-accepted numbers for desirable blood pressure were too high to protect long-term health. Now the upper limit of normal blood pressure is listed as 120 over 80; anyone with a pressure of 140 over 90 or higher is considered hypertensive. Those with pressures in between are considered pre-hypertensive and should take steps to bring blood pressure down or, at least, prevent it from rising more. The change mirrors what happened with serum cholesterol, for which "normal" was once listed as 240 milligrams per deciliter of blood and is now less than 200 to prevent heart disease caused by clogged arteries.

It was also long thought that blood pressure naturally rises with age. Indeed, the Framingham Heart Study showed that when 65-year-old people whose blood pressure was below 140 over 90 were followed for 20 years, about 90 percent of them became hypertensive because their arteries narrowed and stiffened with age, causing blood to push harder against artery walls. But in many societies where obesity is rare, activity levels are high and salt intake is low, blood pressure remains low throughout life. This is the best clue we have for the lifestyle changes needed to prevent illness and premature death caused by hypertension.

Dr. Claude Lenfant, who served as director of the National Heart, Lung and Blood Institute, is 81 and has a blood pressure of 115 over 60, a level rarely found among older Americans not taking medication for hypertension. His secret: a normal body weight, 4 or more miles of walking daily and no salt used to prepare his meals, most of which are made from scratch at home.
In an interview, Lenfant, who now lives in Vancouver, Wash., said the problem of hypertension was rising all around the world and added that by 2020 the number of people with uncontrolled hypertension was projected to rise 65 percent. One reason is that doctors today are more likely to diagnose the problem, so it is reported more often in population surveys.
"But I'm much more concerned about the fact that so much high blood pressure is not controlled," he said, and called "therapeutic inertia" an important reason.

It is not enough for doctors to write a prescription and tell patients to return for a checkup in six months, he said. Rather, a working partnership between health care professionals and patients is needed to encourage people to monitor their pressure, adopt protective habits and continue to take medication that effectively lowers pressure.

Treatment and prevention
Diuretics are a first-line and inexpensive remedy, but many patients with hypertension also need other drugs to lower pressures to a desirable level. Chobanian, whose New England Journal report was titled "The Hypertension Paradox: More Uncontrolled Disease Despite Improved Therapy," noted that "in the majority of patients, two or more antihypertensive drugs are required to achieve target blood-pressure levels." In the interview, he emphasized the detrimental role played by diets high in salt and calories and low in protective fruits and vegetables -- a result of portions that are too large and of too many fast and processed foods that rely on salt to enhance flavor.

"Generally, the average person in our society consumes more than 10 grams of salt a day," Chobanian said, "but the Institute of Medicine recommends a third of this amount as optimal."
A new RAND Corp. study finds that a one-third reduction in salt consumption could save $18 billion a year in direct medical costs. Chobanian called for better food labeling, changes in foods served in cafeterias, restaurants and schools and less advertising on children's television of unhealthy foods high in fat, salt and sugar. Also needed are better opportunities for all people to get regular exercise.

"We have to focus more on children," he said. "They're the ones who will be getting cardiovascular diseases in the future."

Jane Brody writes about health for The New York Times.

Source: HeraldTribune.com

Smokers less likely to receive hypertension advice

Despite being at greater risk for health problems, smokers are less likely than non-smokers to receive advice on controlling their hypertension, according to study findings presented Friday at the American Heart Association's 63rd High Blood Pressure Research Conference in Chicago.

"We found that healthcare providers were significantly less likely to tell their hypertensive patients who smoke to reduce their salt intake, exercise, and take their high blood pressure medication as compared to hypertensive patients who do not smoke," lead author Alberto Caban-Martinez, from the University of Miami Miller School of Medicine, told Reuters Health.

"Previous studies have examined the association between lifestyle modification advice and high blood pressure control in the general population. However, few have examined if smokers with hypertension receive the same advice on lifestyle modification," he noted.

The findings stem from an analysis of data from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) and the Florida Tobacco Callback Survey. The survey featured questions on hypertension control and smoking status, among others.

Among subjects with hypertension, smokers were 11%, 21%, and 26% less likely than non-smokers to receive advice on salt reduction, exercise, and medication usage, respectively. Smoking status, by contrast, did not influence receipt of dietary advice and was directly linked to receipt of advice for alcohol use (OR = 1.44).

Among smokers told to quit smoking, hypertension was predictive of not receiving advice on reducing salt intake (0.60), engaging in exercise (0.61), and changing dietary patterns (OR = 0.61).

"Smoking is a modifiable risk factor for cardiovascular disease, particularly high blood pressure. Practicing physicians should remain vigilant and sensitive in providing the same hypertension control advice but with greater intensity to their hypertensive smoker patients as they would for their patient populations who do not smoke," Caban-Martinez emphasized.

Source: Reuters Health

Vitamin D deficiency linked to high blood pressure

Pre-menopausal women who have a vitamin D deficiency are significantly more likely to develop high blood pressure in mid-life, latest study results suggest.

Between 1992 and 2007, US researchers took annual blood pressure measurements from 559 women aged 24 to 44. Vitamin D levels were measured once in 1993 and then compared with systolic blood pressure measurements taken in 2007.

The researchers found that women who had a vitamin D deficiency in 1993 had three times the risk of developing systolic hypertension 15 years later compared to women who had normal levels of vitamin D.

The number of women diagnosed with or being treated for hypertension, or who had undiagnosed systolic hypertension, rose from six per cent at the start of the study to 25 per cent at the end, they said.

“This study differs from others because we are looking over the course of 15 years, a longer follow-up than many studies. Our results indicate that early vitamin D deficiency may increase the long term risk of high blood pressure in women at mid-life,” the researchers said last week at the American Heart Association’s annual high blood pressure research conference in Chicago, Illinois.

Source: NursingTimes.net

Your sweet tooth could be boosting your blood pressure

From soft drinks to cereal, Americans eat four times more sugar than we did a century ago. A new study, co-authored by a Colorado doctor, shows all that fructose could be making your heart sick. Fructose is found in table sugar and high-fructose corn syrup.

Dr. Richard Johnson, with the University of Colorado Denver’s School of Medicine, gave high doses of fructose to a group of men over a two-week period.

In that short time, the men experienced significant average blood pressure increases and increases in metabolic syndrome, a group of risk factors for heart disease and diabetes. "The good news is after the study we put everyone on a low-fructose diet and were able to bring everyone back to baseline," said Johnson.

He said most Americans need to cut their sugar intake by as much as one-third, to about 35 grams a day. The study also found a drug used to treat gout, allopurinol, helped lower the elevated blood pressure, but that use is still in the experimental phase.

Source: www.thedenverchannel.com

Smoking and high blood pressure take years off of your life

Middle-aged male smokers with high blood pressure and raised cholesterol levels face dying about 10 years before healthier counterparts, a study warns. The UK study looked at more than 19,000 civil servants aged 40-69 and traced what happened to them 38 years later.
It concluded that men with these three risk factors could expect a 10-year shorter life from 50 years of age. The British Heart Foundation said it was an important reminder for everyone over 40 to have a heart health check.

The study, published in the British Medical Journal, was set up in 1967-70 at the peak of the vascular disease epidemic in the UK. Participants had their height, weight, blood pressure, lung function, cholesterol and blood glucose levels measured and completed a questionnaire about their previous medical history, smoking habits, employment grade and marital status.
Current smokers made up 42% of the men, 39% had high blood pressure and 51% had high cholesterol.

They were followed up nearly 40 years later in 2005 by which time 13,501 had died.

• RISK FACTORS FACTS
  26% men & 25% women in England aged 35-49 smoke
  23% men & 22% women in England aged 50-59 smoke
  34% men & 26% women in England aged 45-54 have high blood pressure
  74% men & 78% women in England aged 45-54 have high cholesterol
  Source: BHF

The researchers from the University of Oxford focused on smoking, high blood pressure and cholesterol because they are the main cardiovascular risk factors. But when they broadened it out to look at all risk factors including obesity, diabetes and employment grade, they found a 15-year life expectancy difference between the 5% with the highest number of risk factors and the 5% who had the lowest number of risk factors. The proportion of deaths attributed to vascular disease in old age has declined from about 60% in 1950 to less than 40% in 2005 for both men and women.

Dr Robert Clarke, of the Clinical Trial Service Unit at the University, led the study. He said: "We've shown that men at age 50 who smoke, have high blood pressure and high cholesterol levels can expect to survive to 74 years of age, while those who have none of these risk factors can expect to live until 83. It is precisely this kind of very prolonged follow-up study that is necessary to get these results - that modest differences in heart risk factors can accurately predict significant differences in life expectancy."

"The results give people another way of looking at heart disease risk factors that can be understood more readily. If you stop smoking or take measures to deal with high blood pressure or body weight, it will translate into increased life expectancy. "

Professor Peter Weissberg, medical director at the BHF, said: "This important study puts a figure on the life-limiting effects of smoking, high blood pressure and high cholesterol.
"It provides a stark illustration of how these risk factors in middle-age can reduce life expectancy. The good news is that all of us can make changes to help us live a healthy life for longer, even after 50. We know that stopping smoking and reducing blood pressure and cholesterol, by lifestyle changes and/or tablets, can prevent the onset of heart disease - and these findings suggest it could make a decade of difference to our lives. Although the study only involved men, there is no reason why the same should not apply to women."

"So, I urge all men and women over 40 to have a health check - that all GPs can provide - which will include finding out their blood pressure and cholesterol levels, and starting to address any areas of concern."

Jane Landon, deputy chief executive of the National Heart Forum, said: "Public health strategies to discourage smoking and promote healthy eating and active lifestyles from childhood are vital to prevent the accumulation in middle age of these avoidable risk factors."

Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said: "These findings also help to explain why people who are less well off are more likely to die younger.
"Poorer people tend to smoke more, eat less healthy diets and suffer more psychosocial stress - all adding to their risk of heart disease. These are the people who need help most."

Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/8260561.stmPublished: 2009/09/17 23:00:32 GMT

Researchers seek clues to high blood pressure's origins, impacts

How high blood pressure develops and the effects it has on the body are the focus of a two-part study under way at Penn State and Johns Hopkins University that will look at hypertension in the human body and in the laboratory.

"One quarter of the population in the United States has undiagnosed or is being treated for essential hypertension," said Lacy Holowatz, assistant professor of kinesiology, who is the principal investigator on the project. "Not only is it pervasive, but it takes an emotional, physical and financial toll on the people it affects. The results from our studies should provide new and important information on the how hypertension impacts the body's cardiovascular system."

The National Heart, Lung and Blood Institute of the National Institutes of Health will fund this five-year study for $1.7 million. The NIH's American Recovery and Reinvestment Act funding will supply $750,000 of the grant.

Essential hypertension, also known as primary hypertension, is high blood pressure with no identifiable cause. Secondary hypertension, in contrast, is high blood pressure that results from another condition or disease.

The research team will use a dual-examination approach analyzing hypertension and blood flow in the body and, in a more controlled situation, outside the body. The human studies will take place on Penn State's University Park campus and will use microdialysis, a method where researchers insert a microfiber into a portion of skin about the size of a quarter and infuse certain drugs or solutions to only that area. For the external examination, Holowatz will work with researchers from the Johns Hopkins University who will analyze skin biopsy samples.

Holowatz will heat and cool the skin to examine blood vessel function. She will see how this differs in someone with hypertension compared with someone with normal blood pressure. Holowatz's aim is to shed light on potential therapeutic strategies for people with hypertension. The work is an extension of previous work by Holowatz and her colleagues that provided a better understanding of how hypertension affects the body's vascular system.

Other key individuals working on the project include Larry Kenney, professor of physiology and kinesiology; Mosuk Chow, associate professor of statistics, and Jane Pierzga, research assistant, all at Penn State, and Daniel Berkowitz, associate professor of anesthesia and critical care medicine at Johns Hopkins University.

Road noise link to blood pressure

People living near noisy roads are at greater risk of developing high blood pressure, a Swedish study suggests. A Lund University team found risk rose above an average daily exposure of 60 decibels, which accounts for about one in four people in western Europe.

They said it was likely noise caused stress - and maybe sleep disruption - leading to blood pressure problems. But UK experts questioned the findings, saying other factors such as diet and smoking were more important. Researchers analysed questionnaires completed by nearly 28,000 people as well as analysing neighbourhood traffic noise. They found that at above 60 decibels the risk of high blood pressure rose by more than 25%.

Above 64 decibels the risk rose by more than 90% although the team cautioned that the low numbers in this group could have skewed the findings. The report, published in the Environmental Health journal, said the findings were worrying as high blood pressure increased the chances of heart disease and stroke.

However, the link was not apparent for people above 60 years old. The researchers said this was either because they had become desensitised to the noise or already had high blood pressure.

Report author Theo Bodin said: "Road traffic noise is the most important source of community noise so we felt it was important to look at this. "I think what we have found is probably linked to the noise triggering stress. Previous research has found this, although we need to look at this issue further before we make firm conclusions."

But Professor Alan Maryon-Davis, president of the UK's Faculty of Public Health, said: "It seems to me that they have found an association rather than a cause. Other factors, such as smoking, diet and deprivation, are likely to be playing more of a role.

"However, it is an area of research which merits further work."

Source: BBC

Only 3 cigarettes a day significantly increases cardiovascular disease

Exposure to relatively low levels of fine particulate matter (PM) significantly increases the risk of cardiovascular disease [1]. The risk trajectory levels off with higher levels of exposure, researchers report, in a study published online August 31, 2009 in Circulation. The study will appear in the September 15 issue.

Risk of cardiovascular disease increased 64% by smoking three cigarettes a day. Risk doubled by smoking a pack a day, according to data on more than one million adults prospectively collected by the American Cancer Society, as part of the Cancer Prevention Study II of 1982.
Using this database, Dr C Arden Pope (Brigham Young University Provo, UT) and colleagues calculated adjusted relative risks of mortality according to an estimated average daily dose of fine PM from active cigarette-smoke inhalation, as well as the PM doses from secondhand cigarette-smoke exposure and from exposure to air pollution.

"There were substantially increased cardiovascular mortality risks at very low levels of active cigarette smoking and smaller but significant excess risks even at the much lower exposure levels associated with secondhand cigarette smoke and ambient air pollution," the researchers report. "The results indicate that it is fundamentally implausible that the relationship between cardiovascular mortality and fine particulate pollution from cigarette smoke and ambient air pollution can be characterized as linked by a simple linear dose-response relationship," the authors write. "Rather, our results suggest that the exposure-response function is relatively steep at very low levels of exposure, flattening out at high exposure levels."

Pope and colleagues note several limitations of the study, among them the large exposure gap between ambient air pollution, secondhand-smoke exposure, and active smoking. And, the authors say, there are no prospective cohort or related studies of long-term exposure across the range of exposure that would fill this gap.

Even with its limitations, the study findings have important public-health implications, Pope's team comments. Most studies of the effects of fine PM on cardiovascular disease risk have been conducted in areas where the annual average PM concentrations rarely exceed 30 µg/m3. Recent estimates indicate average concentrations of particulate air pollution in urban areas of China, India, and other developing countries often exceed 100 µg/m3.

Source: http://www.theheart.org/article/999851.do

Information about how fat causes high blood pressure

Some of the first information about how fat causes hypertension have been identified by researchers who say the findings should one day help identify which obese people - and maybe some thin ones too - are at risk for hypertension and which drugs would work best for them.

Medical College of Georgia researchers have found that deleting or mutating the gene PTP1B puts mice at risk for hypertension by interfering with an endogenous mechanism that should help prevent it. The findings are published in the Sept. 1 issue of the American Heart Association journal Circulation.

"In a normal individual gaining weight, PTP1B should increase and they would be protected in theory from hypertension," says Dr. David Stepp, vascular biologist at the MCG Vascular Biology Center, co-director of the Diabetes & Obesity Discovery Institute and the study's corresponding author.

"But if you don't have a good copy of PTP1B and you become obese, then you are going to have a problem. So in theory this gene can segregate the obese people who will become hypertensive and those who won't."

Knowing the gene's status could also one day help physicians better select an antihypertensive medication for those who do.

A key player is the hormone leptin, produced by fat cells. Overweight individuals generally produce more of the hormone that essentially revs up the body, suppressing appetite and increasing metabolism so you won't get fatter. But leptin also increases blood pressure by activating the sympathetic nervous system, the so-called fight-or-flight response. Mutated or missing PTP1B dramatically increases leptin's negative effects.

MCG scientists studying how blood pressure got the message to increase found leptin also provides protection against high pressures by turning off the signaling pathway that squeezes blood vessels and drive pressures up in a process called adrenergic desensitization.

"Normally, if you give someone leptin, his blood pressure would probably not go up because he would have this protective mechanism intact that would basically turn off his blood pressure signaling pathway," Dr. Stepp says. "His blood pressure would be regulated differently, but it would not be high."

But the combination of missing or mutated PTP1B and too much leptin means increases in constriction are too strong to turn off.

Mice missing PTP1B tend to have lower body fat but high blood pressure, not usually what you see in people, Dr. Stepp notes. While this single gene can't explain every combination of body size and blood pressure found in nature, it could help explain why some skinny people are hypertensive and why others who get fat are as well.

"It's a vulnerability gene," he says. "If you stimulate leptin in individuals who can't activate their protective mechanisms, they are going to get hypertension. This tells us there are a lot of people and diseases

And what about those people who have great blood pressure? They likely have well-functioning PTP1B, he notes. Interestingly, PTP1B often is over expressed in obese people, which is good for the blood pressure but bad for leptin's positive effect on metabolism.

"I think we have identified at least a couple of new pieces of information that clarify the relationship between obesity and hypertension," Dr. Stepp says. "We have identified a gene that, if it's not functional, will greatly increase the extent to which a metabolic signal from leptin translates into a cardiovascular signal. We also have identified a protective mechanism that, if it's not working, contributes to hypertension."

The MCG research helps illustrate the need to pay particular attention to the cardiovascular side effects of potential new anti-obesity drugs as well, experts say. In an accompany editorial, Dr. Allyn L. Mark, Carver Professor of Medicine, Center on Functional Genomics of Hypertension at the University of Iowa Carver College of Medicine, noted the irony that despite lower body fat, mice with disturbed PTP1B had higher blood pressure than control animals. "Unfortunately several of the interventions that inhibit appetite, increase metabolism and decrease adiposity (fat) may increase (not decrease) sympathetic activity and arterial pressure," he writes. "This may complicate the safety of potential anti-obesity drugs," and emphasizes the importance of evaluating the cardiovascular impact of potential new therapies.

Now MCG scientists want to develop markers so one day people determine their PTP1B expression through a blood test. They also want to learn more about exactly how leptin increases blood pressure to see if there are ways to target some of the downstream impact of missing or mutated PTP1B.

"We want to look the impact on the kidneys and angiotensin 2," says Dr. Eric J. Belin de Chamtemèle, postdoctoral fellow in Dr. Stepp's lab and the study's first author. The kidneys, which determine how much sodium and water are excreted from the body, are major players in blood pressure regulation. Renin, which is secreted by the kidneys, constricts blood vessels to help blood pressure increase when blood volume gets low.

They want to know if leptin is acting directly on the kidneys or whether it's an indirect result from leptin's action in the brain. They suspect it's primarily a brain effect that they want to pursue by using mice with leptin deficits localized to the brain.

Source: Mednews / Toni Baker Medical College of Georgia

Patient race more important than blood pressure control status for determining the quality of patient-doctor communication

Patient race more important than blood pressure control status for determining the quality of patient-doctor communication

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European Society Releases Guidelines for Pediatric Hypertension

The European Society of Hypertension has issued guidelines for managing high blood pressure in children and adolescents. The guidance was issued to fill a gap left by the exclusion of the topic in the latest adult guidelines from the ESH and the European Society of Cardiology, according to a committee led by Empar Lurbe, MD, of the University of Valencia in Spain.

Although many of the recommendations are made on the basis of expert consensus, owing to the lack of randomized data, they said "it would be unethical to neglect giving due attention to this medically and socially important problem." They said the guidelines, published in the September issue of the Journal of Hypertension, "should encourage public policymakers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents."

Normal blood pressure for children younger than 18 was defined as less than the 90th percentile according to age, sex, and height. This should be the target for treatment for most children with elevated blood pressure, according to the guidelines. A child is considered hypertensive with measurements in the 95th percentile or higher on at least three occasions. Measurements between the 90th and 95th percentiles are considered high-normal.

According to the guidelines, the auscultatory method should be used to measure blood pressure, which should be done in all children older than 3 and in younger children when special circumstances place them at risk for high blood pressure.

The authors said 24-hour ambulatory blood pressure monitoring should be used to confirm a diagnosis of hypertension before initiating treatment. The first steps following a diagnosis should involve the recording of a family and clinical history, a physical examination, a cardiovascular examination, and a neurological examination, they said. This should be followed by routine blood tests and tests for plasma renin activity, plasma aldosterone concentration, urine and plasma catecholamines or metanephrines, and urinary free cortisol, as well as a Tc99 dimercaptosuccinic acid scan.

In addition, children should be evaluated for organ damage, specifically in the heart, great vessels, kidneys, central nervous system, and retina, the authors said. This process will help identify any secondary causes of hypertension that require treatment.

The guidelines contained the following additional recommendations for managing a pediatric patient with hypertension:

First target the risk factors for elevated blood pressure, including overweight, increased salt intake, and low physical activity. Body mass index should be kept below the 85th percentile.

• Regular exercise and a well-balanced diet are recommended. These measures should be continued even when drug treatment is started.
• Pharmacological treatment should be started when patients have symptomatic hypertension, hypertensive target organ damage, secondary hypertension, or diabetes at the time of presentation.
• For children with chronic kidney disease, blood pressure should be lowered below the 75th percentile if they do not have proteinuria, and below the 50th percentile if they do have proteinuria. Combination drug treatment might be necessary.
• When initiating drug treatment, start with a low dose of a single drug. If there is no response within a few weeks, increase to a full dose.
• If the initial drug does not work, try a drug in a different class. In pediatric studies, all drug classes resulted in similar blood pressure reductions, but ACE inhibitors and angiotensin receptor blockers are the most widely used.

The authors acknowledged that there was little data from randomized clinical trials guiding the recommendations and said there was an urgent need for studies establishing doses and addressing the advantages and disadvantages of individual agents in pediatric patients.

In addition, they called for further research to obtain reference values for office, home, and ambulatory blood pressure, to collect information about early organ damage in hypertensive children, and to provide information about when to initiate pharmacologic treatment and which targets to meet.

Source: Medical News Europe / Journal of Hypertension

Glucose intolerance in pregnancy may be an indicator of cardiovascular risk

Mild glucose intolerance in pregnancy may be an early identifier of women who are at increased risk of heart disease in the future, found a new study published in CMAJ (Canadian Medical Association Journal).

In a large population-based cohort study, researchers from the University of Toronto and the Institute for Clinical Evaluative Sciences (ICES) studied data on 435,696 women in Ontario, Canada, who gave birth between April, 1994 and March, 1998. All women were followed until March 31, 2008. The study excluded women with pre-existing diabetes.

As cardiovascular disease is the leading cause of death in Canadian women, it is important to identify early predictors of future vascular risk. While women with gestational diabetes have a higher risk of cardiovascular disease than those without, it previously has not been known whether mild glucose intolerance in pregnancy is associated with heart disease. The study sought to answer this question.

Gestational diabetes is a condition leading to temporarily high blood sugars during pregnancy. It is an important risk factor for future type 2 diabetes. Women are generally screened for gestational diabetes with a glucose challenge test in the late second trimester. If the result is abnormal, they go on to have an oral glucose tolerance test to confirm the diagnosis.

"Women who had an abnormal glucose challenge test but then did not have gestational diabetes had an increased risk of future cardiovascular disease compared to the general population, but a lower risk than women who actually did have gestational diabetes," writes Dr. Baiju Shah, Institute for Clinical and Evaluative Sciences and coauthor.

They suggest that "in women with glucose intolerance during pregnancy, type 2 diabetes and vascular disease may develop in parallel, which is consistent with the "common soil" hypothesis for these conditions." Current screening procedures for gestational diabetes might also provide a means for the early identification of women who are at risk for developing heart disease later in life.

In a related commentary Dr. J. Kennedy Cruickshank and Dr. Moulinath Banerjee of the Manchester Royal Infirmary, University of Manchester, UK write that "what the study by Retnakaran and Shah shows is that we all have a great deal to learn from sub-clinical blood vessel changes in younger women who are likely overweight during pregnancy."

They suggest that diabetes research should focus on the blood vessel rather than glycemia.

Source: Science Daily

Beta-blockers And Stroke: New Insights Into Their Use For Older People

A University of Leicester-led study may have uncovered the reason why Beta-blockers are less effective at preventing stroke in older people with high blood pressure, when compared to other drugs for high blood pressure.

The research, carried out by Bryan Williams, Professor of Medicine at the University of Leicester, and his colleague Dr. Peter Lacy, has been published in the Journal of the American College of Cardiology and has been cited on the MDLinx.com site as currently the world’s number one leading finding in its field.

Professor Williams’ research shows that lowering heart rate in older people, as Beta blockers do, can have a potentially detrimental effect on central aortic pressures (pressures in the large arteries close to the heart).

He commented: “Such findings can help define the template for optimal treatment strategies and highlight why new methods to estimate central aortic pressures are providing new insights into the pathogenesis of cardiovascular disease and how new drugs can be tailored to limit the damage.

“Leicester is acknowledged as one of the leading centres in the world in this field of research.”

This study used analysis of the pulse wave measured at the wrist to estimate pressures in the large artery near to the heart, in people with high blood pressure. It shows that reducing heart rate in older people with high blood pressure can result in a higher than expected pressure in the large arteries.

This may be the reason why drugs such as Beta-blockers, a widely used drug to treat high blood pressure, have been shown to be less effective than other treatments at preventing stroke. In 2006, NICE recommended that Beta-blockers should no longer be used as a routine treatment for high blood pressure because they appeared somewhat less effective than other types of blood pressure lowering drugs at reducing the risk of stroke, especially in older people.

Professor Williams, who is also consultant physician with the University Hospitals of Leicester NHS Trust, suggests that the present study provides important insights into the mechanism. “There is no doubt that by better understanding of how modern drugs work in reducing the risk of stroke and heart disease, we will be able to continually refine treatments for the future,” he said.

Should patients taking Beta-blockers stop them? Professor Williams emphasised: “No they should definitely not stop them. Beta-blockers are prescribed for a number of medical conditions, including angina and heart disease and in this context they are very beneficial.

“The new study is specifically exploring the reasons why Beta-blockers or other drugs that lower heart rate may be less effective at preventing stroke than some of the other drugs we use to lower blood pressure.”

Source: Science Daily

Chemical compound found in food implicated in pre-eclampsia

A chemical compound found in unpasteurised food has been detected in unusually high levels in the red blood cells of pregnant women with the condition pre-eclampsia. These results are important because they suggest that the compound, ‘ergothioneine’, is an indicator of pre-eclampsia and may help scientists to understand the cause of the condition, which is currently unknown. Scientists at the University of Leeds took blood samples from a group of thirty-seven pregnant women and compared the red blood cells from women with pre-eclampsia with the red blood cells from women with no symptoms.

In results published in the journal Reproductive Sciences, chemists found a significantly higher concentration of the ergothioneine - a compound made by fungi - in the red blood cells of the women with pre-eclampsia. Ergothioneine is already well known to be made by micro-organisms that are commonly found in foods such as unpasteurised dairy products. As it cannot be synthesised by humans it finds its way into human cells exclusively through our diet.

The NHS does not advise against pregnant women eating fungi or foods such as unpasteurised dairy products which contain ergothioneine producing fungi. In fact scientific studies on animals highlight the benefit of ergothioneine. “These results suggest that a higher level of ergothioneine is an indicator of pre-eclampsia,” says Dr Julie Fisher, a chemist at the University of Leeds who lead the research.

“I would not recommend that pregnant women stop eating fungi. However, the high concentration of ergothioneine in the red blood cells of women with pre-eclampsia is a very interesting finding – the more we know about the chemicals involved in the disease the closer we get to understanding what causes it,” says Professor James Walker, Professor of Obstetrics at the Leeds Institute of Molecular Medicine (LIMM), and a co-author of the research.

The symptoms of pre-eclampsia include high blood pressure, protein in urine and fluid retention and affects almost 10% of pregnancies after 20 weeks. Left untreated, the condition can cause a range of problems such as growth restriction in babies and even foetal and maternal mortality. There is no known cause of the condition. “Ergothioneine is known as an antioxidant and antioxidants have been proposed to be helpful in reducing the risk of preeclampsia. It is therefore very interesting that we have found it to be in excess for women with the condition,” says Dr Fisher.

The team used a technique which is based on the same science as MRI scans but which operates on fluids taken from the body, to identify chemicals in the red blood cells of pregnant women. The amount of these chemicals was found to depend on whether the women were healthy or whether they were suffering from pre-eclampsia. In previous studies the team found that chemical markers for pre-eclampsia also exist in blood plasma.

The research was funded by the Engineering and Physical Sciences Research Council and the Medical Research Council, UK. The paper Imidazole-Based Erythrocyte Markers of Oxidative Stress in Preeclampsia-An NMR Investigation is published in the journal Reproductive Sciences

Does high blood pressure lead to memory loss?

A study released Monday ties high blood pressure to memory problems in people over age 45.

The study found that people with high diastolic blood pressure, which is the bottom number of a blood pressure reading, were more apt to have thinking or "cognitive" impairment, or problems with their memory, than people with normal diastolic blood pressure readings.


For every 10 point increase in the reading, the likelihood of a person having thinking problems was seven percent higher. The results held up after the researchers adjusted for other factors that could affect cognitive abilities, such as age, smoking status, exercise level, education, diabetes or high cholesterol.



The findings, reported in the August 25th issue of the journal Neurology, stem from an analysis of data for 19,836 people in a long-term study. A total of 1,505 of the participants, or 7.6 percent, had cognitive problems, and 9,844, or 49.6 percent, were taking medication for high blood pressure. High blood pressure is defined as a reading equal to or higher than 140/90 or taking medication for high blood pressure.



After adjusting for a variety of factors, higher diastolic blood pressure was directly associated with an increased risk of cognitive trouble as seen on standard tests, Dr. Georgios Tsivgoulis, from the University of Alabama, Birmingham, and colleagues report. "It's possible," Tsivgoulis noted in a statement, "that by preventing or treating high blood pressure, we could potentially prevent cognitive impairment, which can be a precursor to dementia."



Research has shown that high diastolic blood pressure can weaken small arteries in the brain, which can damage the brain. In a statement, Dr. Walter J. Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, said: "These latest data suggest that higher blood pressure may be a risk factor for cognitive decline, but further studies will be necessary to understand the cause-effect relationship."



SOURCE: Neurology, August 25, 2009. / Reuters

Stroke survivors face long term risks

The risk of a repeat stroke, which is more likely to be disabling or fatal than a first stroke, remains high long after the first stroke, a study indicates. The study also "demonstrates the importance of different risk factors at different time points post-stroke," lead researcher Dr. Kitty M. Mohan, of King's College London, UK noted in an interview with Reuters Health.

For example, she said, high blood pressure gains importance as a risk factor for stroke recurrence in the middle and long term periods but is not significant in the early period (up to 1 year) after the initial stroke. Mohan and her colleagues used data from the South London Stroke Register to estimate risks and predictors of long-term recurrence in 2874 patients who suffered a first stroke between 1995 and 2004 who were followed for up to 10 years.

During follow-up, 303 recurrent strokes were documented. The cumulative risk of stroke recurrence was 7.1 percent at 1 year, 16.2 percent at 5 years, and 24.5 percent at 10 years. Patients who had a history of heart attack or the heart rhythm disorder atrial fibrillation were at increased risk for suffering another stroke in the first year after the initial stroke, the researchers found.

Pre-stroke high blood pressure and atrial fibrillation increased the risk of stroke recurrence at 5 years, while older age at first stroke, pre-stroke high blood pressure, heart attack and atrial fibrillation increased the risk of a second stroke at 10 years.

"By demonstrating different predictors for stroke recurrence in the early, medium and long term period, we have highlighted the long-term commitment needed to modify cardiovascular risk factors prior to stroke and after stroke," Mohan said.

"Knowing when a patient is likely to have their stroke recurrence means that management of their modifiable risk factors may be individually tailored in order to have an effect at the most beneficial time, therefore reducing the risk of further strokes occurring," added Mohan.

Source: Reuters Health

Royal Pharmaceutical Society issues guidance to Muslims on safe medicine management during Ramadan

The Royal Pharmaceutical Society of Great Britain (RPSGB) is urging Muslims who are taking medication, and fasting from sunrise to sunset during the religious festival of Ramadan, to seek advice from pharmacists on how to manage medicine intake effectively and safely in the interests of their health.

This year Ramadan begins on Friday 21 August and ends on Saturday 19 September. During this period Muslims do not eat or drink between sunrise and sunset each day. This religious observance could pose a problem to individuals with chronic conditions requiring regular medication says the Society. Although people who are ill may be exempt from fasting, many who take regular oral medication may fast. By doing so they may not realise that fasting can mean disruption to treatment schedules and/or failure to absorb an active ingredient dependent on the ingestion of food - both factors which in turn can compromise a patient's health and well being.

The RPSGB believes that spending just a few minutes discussing medication with a pharmacist will help to ensure it is taken correctly during fasting.

RPSGB spokesperson and pharmacist, Waqas Ahmad, himself a Muslim, offers the following advice. "Community pharmacists are easily accessible and can play a key role in helping and supporting people with their medicine use when they are fasting," he says. "Discussing their plans with a pharmacist will allow patients to identify potential problems or difficulties. In turn possible solutions may be suggested to help people keep their fasts while continuing to take their medication in a safe and effective manner. In many cases pharmacists may be in a position to offer advice on different medicine formulations such as sustained release formulations, whereby the drug only requires one daily dose."

The total number of Muslims in Great Britain is 2,422,000. Against a total UK population of 61,000,000 this means that potentially almost 4% of the population may be suffering from chronic long term conditions such as asthma, diabetes, and high blood pressure which require regular medicine intakes. Failure to comply with treatment for whatever reason may mean that they are putting their health at risk.

Assistant Secretary General of the Muslim Council of Britain, Shaykh Ibrahim Mogra, is supportive of the RPSGB's advice. He says; "Although the Qur'an says Muslims can be exempt from fasting, some people refuse to take advantage of the exemptions and allowances which are available. That higher type of piety isn't required, especially where health complications are possible and can arise. We recognise that it's important that people are able to observe their religious practice but are equally clear that they should not risk their health."

Source: PRNewswire