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.

# # #

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.