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

High lipid levels associated with pre-eclampsia

New research has documented changes in lipid levels during pregnancy, and how they may influence the risk of specific obstetric complications. The main finding was that high levels of trigycerides were significantly associated with an increased risk of gestational diabetes and pre-eclampsia in the study cohort.

Specialists from centers in Be’er-Sheva, Israel, and Boston, Massachusetts, USA, analyzed data on singleton deliveries between January 2000 and February 2006 to identify a total of 9,911 women who had lipid levels measured at some point in the period from 1 year before conception to 1 year after delivery, and who were free of cardiovascular morbidity. The aim was to test the hypothesis, based on the findings of previous studies, that high levels of triglycerides and low levels of high-density lipoprotein (HDL) are associated with an increased risk of gestational diabetes and pre-eclampsia.

A comparison group comprised 31,646 women who had singleton deliveries in the same period and were without cardiovascular morbidity, but who did not have lipid levels recorded.

Of the 9,911 women, 3,058 had lipid levels assessed in the year before conception, 3,983 had levels assessed during pregnancy, and 2,870 had levels assessed in the year following delivery. The mean age of the women was 29.6 years, slightly older than the comparison group, who had a mean age of 28.8 years.

The women in the study group also had a higher rate of use of infertility treatment (2.9 percent) than the comparison group (1.8 percent). The median number of pregnancies and deliveries was three in both groups.

Changes in lipid levels:
When the researchers plotted lipid levels over time, excluding women who had gestational diabetes and/or pre-eclampsia (leaving a population of 8,700 for this analysis), they found that levels of triglycerides, low-density lipoprotein (LDL), and total cholesterol remained stable before conception then fell to a low point in the second gestational month. The levels then increased sharply to a peak in the month of delivery, before falling back to near pre-conception levels within 4 months of delivery.

The mean triglyceride level, for example, was 92.6 mg/dL before conception, falling to a nadir of 77.4 mg/dL in the second gestational month, before rising to a peak of 238.4 mg/dL in the month of delivery.

Levels of HDL followed the same overall pattern as the other lipid measures but peaked slightly earlier in pregnancy, in the seventh gestational month, then remained stable until delivery.

Lipids and complications:
The researchers found that the composite primary endpoint of gestational diabetes and pre-eclampsia occurred in 12.2 percent of the study group (6.4 percent of women had gestational diabetes and 6.3 percent had pre-eclampsia). This was a significantly higher composite rate than seen in the comparison group, where 8.8 percent had either gestational diabetes or pre-eclampsia (4.2 percent had gestational diabetes and 4.4 percent had pre-eclampsia).

To examine the relationships between lipid levels and these complications, the researchers divided the women who were tested during pregnancy into three groups for each individual lipid test:

• Low level: below the 25th percentile of the distribution for the relevant gestational month.
• Intermediate level: from the 25th to the 75th percentile.
• High level: above the 75th percentile.

They found that triglyceride levels during pregnancy were significantly associated with the risk of complications (p <>

In their full paper, scheduled for publication in the American Journal of Obstetrics & Gynecology and currently available online from the journal’s website, the researchers (Wiznitzer A et al) present detailed plots of the changes in lipid levels over time before, during, and after pregnancy. They also discuss the possible underlying mechanisms for the link with the complications studied.

The researchers point out, however, that because the women who had lipid levels recorded were slightly older than the untested women, the results “may not be fully generalizable to all pregnant women”. They conclude that high levels of triglycerides are associated with pregnancy complications, but say prospective studies are needed to evaluate the link between lipid levels and complications in more detail.

Source: Orgyn.com

Mutation in Renin Gene Linked to Inherited Kidney Disease

A mutation in a gene that helps regulate high blood pressure is a cause of inherited kidney disease, according to a new study by researchers at Wake Forest University School of Medicine, Charles University in Prague and colleagues.

The discovery provides insight into a protein, renin, that is important in blood pressure regulation, and reveals the cause of one type of inherited kidney disease occurring in adults and children, said co-investigator Anthony Bleyer, M.D., professor of internal medicine-nephrology at the School of Medicine.

The study is now available online and in the Aug. 14 issue of American Journal of Human Genetics. While more than 25,000 articles have been written about renin, this is the first article to identify a mutation in the renin gene as a cause of kidney disease.

Renin is a key component of blood pressure regulation. When blood pressure drops, kidney cells detect the change and release renin into the blood stream, where it converts inactive forms of the hormone angiotensin into angiotensin I. With the help of a molecule in the lungs called angiotensin-converting enzyme (ACE), angiotensin I is then converted to a much more powerful hormone, called angiotensin II, which acts directly on blood vessels to cause blood pressure increases.

Because of the significant role renin plays, an entire class of medications used to treat high blood pressure, called ACE inhibitors, are dedicated to preventing blood pressure from rising by blocking the renin from activating angiotensin.

A genetic mutation in the gene that encodes renin was first identified as the cause of an hereditary kidney disease by a research group led by Stanislav Kmoch, Ph.D., at Charles University in Prague. Working with Kmoch and Suzanne Hart, Ph.D., at the National Institutes of Health, Bleyer identified the condition among American families in his study group of families with rare, inherited kidney disease. Bleyer works with about 100 families throughout the world to identify the causes of inherited kidney disease that run in their families.

Families identified with the specific genetic mutation investigated in this study suffer from anemia in childhood and progressive kidney disease resulting in the need for dialysis, a mechanical way to cleanse the blood. Children typically have relatively low blood pressure. Adults suffer from gout and worsening kidney disease.

"There are many families with inherited kidney disease that do not know the cause and may suffer from this condition,” Bleyer said. “We are interested in helping these families identify the cause of kidney disease that runs in their family."

The investigators have identified a potential treatment for the disease, and a clinical trial is under way at Wake Forest University School of Medicine, Bleyer said.

Understanding how the mutation in the renin gene affects these families also provides insight into how renin works in healthy individuals. For example, the low levels of renin in children with this condition appear to cause anemia. The importance of renin in maintaining a normal blood count and preventing anemia in childhood was not previously known. The researchers plan to continue researching renin with hopes of better understanding how the protein functions in health and disease.

The research was conducted by physicians and researchers from the Czech Republic, Belgium, France, Germany and the United States.

Source: HealthNewsDigest.com

Possible Benefits Of Treating High Systolic Blood Pressure In Non-Diabetic Patients

An article published in this week's edition of The Lancet reports that treatment to lower high systolic blood pressure in non-diabetic patients is associated with a reduction in left ventricular hypertrophy (LVH), a thickening of the heart muscle that can lead to heart failure and rhythm problems. As a result, a lowering of systolic blood pressure targets from the currently recommended 140 mm/Hg or less to below 130 mm Hg should be the treatment goal in low-risk patients with high blood pressure.

Although there is a need for further confirmation,hypertension guidelines advise that blood pressure be lowered to less than 140/90 mm Hg. Evidence from earlier trials does not suggest a blood pressure target of below 130/80mm Hg in high-risk patients with cardiovascular disease or diabetes. On the other hand, the level to which systolic blood pressure should be lowered in patients without high cardiovascular risk has not been assessed in clinical trials. In fact, there is presently no proof to support a lower treatment target in patients with high blood pressure without diabetes.

Paolo Verdecchia from the Hospital S. Maria della Misericordia and ANMO Research Centre in Italy and collaborators conducted a ground-breaking randomised trial. They examined the cardiovascular effects of a systolic blood pressure target below 130 mm Hg (tight control) compared with a target below 140 mm Hg (usual control) in non-diabetic patients with hypertension.

Between 2005 and 2007, a total of 1,111 non-diabetic patients aged 55 years or older were recruited from 44 centres in Italy. They all had a systolic blood pressure of 150 mm Hg or higher. At random, 553 patients were assigned to a target systolic blood pressure of less than 140 mm Hg and 558 patients to less than 130 mm Hg. Antihypertensive drugs were used to lower blood-pressure and customized to individual patients' needs. Every four months for two years, blood pressure was checked. At the final two-year visit patients were tested for LVH.

After two years, tight (below 130 mm Hg) compared to usual (below 140 mm Hg) blood-pressure control reduced systolic blood pressure and decreased the probability of LVH and clinical events. In general, systolic blood pressure was 3.8 mm Hg lower and diastolic blood pressure 1.5 mm Hg lower in the tight-control group. Also, patients in the usual-control group were more likely to have LVH (17 percent) than in the tight-control group (11.4 percent) after two years. Even if the number of events of clinical outcome was small, coronary revascularisation and new-onset atrial fibrillation were considerably less common in the tight-control group.

The authors write in conclusion: "Because of the poor amount of blood-pressure control in the general population and clinical trials, and because of the direct relation between cardiovascular protection and blood-pressure lowering, the results…lend support to a lower blood pressure goal than is recommended at present in non-diabetic patients with hypertension."

In an associated remark, Bo Carlberg from University Hospital, Umeå, Sweden, warns that before shifting guidelines in low-risk patients with hypertension: "A systolic blood pressure treatment goal below 130 mm Hg should be evaluated in adequately powered randomised trials. Only after that will it be possible to evaluate in which groups of patients such treatment is beneficial and the cost effectiveness of such treatment."

"Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial"
Paolo Verdecchia, Jan A Staessen, Fabio Angeli, Giovanni de Simone, Augusto Achilli, Antonello Ganau, Gianfrancesco Mureddu, Sergio Pede, Aldo P Maggioni, Donata Lucci, Gianpaolo Reboldi, on behalf of the Cardio-Sis investigators
Lancet 2009; 374: 525-33
The Lancet

Written by Stephanie Brunner (B.A.)
Source: Medical News Today

Multiple pre-eclampsia experiences heightens risk of post pregnancy high blood pressure

Women who have 2 pregnancies complicated by preeclampsia are at a higher risk for hypertension after pregnancy, which is independent of the risk for subsequent type 2 diabetes mellitus, according to the results of a registry-based cohort study reported in the June issue of Hypertension.
"Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these," write Jacob A. Lykke, MD, from Rigshospitalet in Copenhagen, Denmark, and colleagues. "We have designed a study using the Danish National Registries investigating the association among the following: (1) hypertensive pregnancy disorders in a first pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; (2) combinations of (mild and severe) preeclampsia, preterm delivery, and small for gestational age (SGA) offspring in a first pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; (3) the parity and recurrence of preeclampsia (mild and severe) in the second pregnancy and later cardiovascular morbidity and type 2 diabetes mellitus; and (4) the contribution of type 2 diabetes mellitus to the above associations."
The study cohort consisted of 782,287 women delivering in Denmark from 1978 to 2007 with a first singleton pregnancy and 536,419 women with 2 first consecutive singleton deliveries. Relevant exposures were gestational hypertension and mild and severe preeclampsia, and the study outcomes were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. In 1 model, the investigators adjusted for preterm delivery, small for gestational age, placental abruption, and stillbirth, and in a second model, they also adjusted for the development of type 2 diabetes mellitus.
After gestational hypertension, the risk for subsequent hypertension was increased 5.31-fold (range, 4.90 - 5.75) vs 3.61-fold (range, 3.43 - 3.80) after mild preeclampsia and 6.07-fold (range, 5.45 - 6.77) after severe preeclampsia. Increased risks for subsequent type 2 diabetes mellitus were 3.12-fold (range, 2.63 - 3.70) after gestational hypertension and 3.68-fold (range, 3.04 - 4.46) after severe preeclampsia.
For women having 2 pregnancies with preeclampsia, the risk for subsequent hypertension was increased 6.00-fold (range, 5.40 - 6.67) vs 2.70-fold (range, 2.51 - 2.90) for preeclampsia in the first pregnancy only and 4.34-fold (range, 3.98 - 4.74) for preeclampsia in the second pregnancy only. After gestational hypertension, the risk for subsequent thromboembolism was 1.03-fold (range, 0.73 - 1.45) vs 1.53-fold (range, 1.32 - 1.77) for mild preeclampsia and 1.91-fold (range, 1.35 - 2.70) for severe preeclampsia.
"Hypertensive pregnancy disorders are strongly associated with subsequent type 2 diabetes mellitus and hypertension, the latter independent of subsequent type 2 diabetes mellitus," the study authors write. "The severity, parity, and recurrence of these hypertensive pregnancy disorders increase the risk of subsequent cardiovascular events....Physicians and other health care professionals should be encouraged to include the history of a woman's pregnancy outcomes when estimating the risk of cardiovascular disease."
Limitations of this study include low sensitivities for hypertensive diagnoses; potentially low accuracy of the endpoints; possible failure to report dyslipidemia and other factors of a metabolic syndrome; and inability to control for body mass index, smoking, or socioeconomic status.
"Because hypertensive pregnancy disorders are strongly linked with subsequent cardiovascular morbidity, especially hypertension and type 2 diabetes mellitus, both being essential components of the metabolic syndrome, a possible direct link may exist between these disorders," the study authors conclude. "Also, the severity of the hypertensive disorders seems to predispose to thromboembolic events; this also merits caution when prescribing oral contraceptives for these women. Identifying these women early will allow for prompt intervention, either primarily as modification of other classical cardiovascular risk factors or secondarily as medical prophylaxis."

Source: Medscape http://www.medscape.com/viewarticle/706565

Blood pressure drugs undermined by high salt intake

A high-salt diet not only contributes to hypertension, it can undermine the benefits of blood pressure medication, research shows.

A new study, which involved patients taking a fairly standard cocktail of three drugs for high blood pressure, found that the more salt they consumed, the less effective the medication became.

“What is striking about these results is the degree of the effect,” said David Calhoun, a professor of medicine at the University of Alabama at Birmingham and co-author of the research, published in the medical journal Hypertension.

Patients with a high-salt diet – meaning they consumed about 2.5 teaspoons of salt daily – essentially negated the benefits of the medication, researchers found. Conversely, those on a low-salt diet – about half a teaspoon daily – saw substantial drops in their blood pressure readings: 23 points in systolic blood pressure and nine points in diastolic blood pressure.
Blood pressure is a measure of the force of the blood against blood vessel walls. It is expressed in two numbers: Systolic, the upper number, is the pressure when the heart contracts; diastolic, the lower number, is the pressure when the heart is relaxed.

A person is considered hypertensive when a blood pressure reading is 140/90 millimetres of mercury (mmHg) or higher. In healthy adults, the reading should be in the range of 120/80 mmHg, although that target varies with age and health. Beth Abramson, a cardiologist and spokeswoman for the Heart and Stroke Foundation, said there is an important message in this type of research: “Medications are never enough.You also need to watch your salt intake, control your weight, exercise – all those things make the medications work better.”
They also help explain why many Canadians have trouble controlling their blood pressure.
Canadians are among the biggest consumers of salt in the world, and have some of the saltiest foods.

Canadians ingest, on average, 3,092 milligrams of sodium daily – about two teaspoons– according to Statistics Canada. Men consume markedly more sodium than women – 4,100 milligrams a day, compared with 2,900 milligrams.

The U.S. Institute of Medicine has established that the adequate daily intake for a healthy adult is between 1,200 and 1,500 milligrams of sodium – about three-quarters of a teaspoon – and it should be lower for people with cardiovascular conditions such as high blood pressure and heart failure, and for those who have had a heart attack or stroke.
Maria Ricupero, a dietitian in the cardiac program at Toronto Rehabilitation Institute, said it can be difficult for heart patients to reduce their consumption of salt because they tend to be set in their ways.

“My patients tend to be in their 50s and older, so they've been living with certain dietary habits for years. The learning curve can be steep.” Ms. Ricupero teaches patients to read labels and urges them to “work within a budget” of 1,500 milligrams a day of sodium when choosing their foods.

“You can spend your salt budget however you like. But if you splurge on a Big Mac it will run you 1,000 milligrams and you won't have much left, so you're better going with foods that have much lower concentrations,” she said. While Ms. Ricupero teaches individuals how to limit their salt consumption, she said greater efforts – regulatory and otherwise – should be made to get salt out of foods at the source.

After all, more than 80 per cent of salt consumption comes from processed foods. A study published last week by World Action on Salt and Health, an international health advocacy group, found that foods sold in Canada often contain more salt than seemingly identical products sold in other countries. This is true for products ranging from All-Bran cereal to Burger King Whoppers.
“Not having all this sodium in food in the first place would make my job a lot easier and it would make food a lot healthier,” Ms. Ricupero said. Jerry Tollinsky, a charity fundraiser in suburban Toronto, had a heart attack last November. He underwent heart surgery and then cardiac rehabilitation, working on making lifestyle changes that would prevent a recurrence.
A key component was learning how to reduce the amount of sodium in his diet by getting rid of the salt shaker, reading labels on packaged foods and cooking at home. Mr. Tollinsky found out, to his horror, that 21/2 pickles contain as much salt as you should be eating in a day.

“What I learned is that sodium sneaks up on you. It's in everything,” he said. “I love cold cuts. I love olives. I love pickles. I love hard cheese. But I don't eat those things much any more.”
Mr. Tollinsky said that knowing a low-salt diet would make his heart medication more effective was a powerful incentive.

Cardiovascular disease is one of the leading killers of Canadians, claiming 65,628 lives in 2005, the most recent year for which mortality data are available from Statistics Canada. It is estimated that one in eight cardiac events are caused by excess sodium.

Source:
André Picard Public Health Reporter
From Friday's Globe and Mail Thursday, Jul. 30, 2009 06:04PM EDT

"Silent stroke" risk higher for over 60s with hypertension

People over the age of 60, especially those with high blood pressure, may experience a "silent stroke" and won't even know it, Australian researchers say.
"These strokes are not truly silent, because they have been linked to memory and thinking problems and are a possible cause of a type of dementia," study author Dr. Perminder Sachdev, a neuropsychiatry professor at the University of New South Wales in Sidney, said in a news release from the American Academy of Neurology.
The study, published in the July 28 issue of the journal Neurology, followed 477 people aged 60 to 64 for four years. The researchers found that 7.8% of the group had evidence of strokes that do not cause any noticeable symptoms — known as silent lacunar infarctions — in which blood flow is blocked in one of the arteries leading to areas deep within the brain. An additional 1.6% of the study group had experienced silent strokes by the end of the study period.
Those with high blood pressure had a 60% greater chance of having a silent stroke than those with normal blood pressure. Also, study participants with a condition called white matter hyperintensities were almost five times more likely to have a silent stroke than those without this small type of brain damage, the researchers found.

Source: USA Today