Stroke victims still hypertensive a year after event

One year after having a stroke, most patients in a moderately large Danish cohort were hypertensive. Their compliance with medication regimens appeared to be excellent, suggesting an underuse of diuretics and combination therapies, the study authors suggest.

The study was presented here at the 7th World Stroke Congress.

Between April 2004 and September 2007, 1306 patients admitted to any of 3 hospitals in Copenhagen, Denmark, with an acute stroke or first or recurrent transient ischemic attack (TIA) were included in a consecutive cohort. Researches recorded antihypertensive treatment before the stroke, at hospital discharge, and 1 year later.

In this follow-up study of 421 patients from the original cohort, 75% of participants had had an ischemic stroke, 20% a TIA, and 5% a hemorrhagic stroke. Their median age was 71 years (range, 61 – 80 years), 52% were men, 13% had a diagnosis of diabetes at discharge, 39% were current smokers, and 52% had a body mass index (BMI) greater than 25 kg/m².

Lead study author Nete Hornnes, PhD, of the Clinical Research Centre at Hvidovre Hospital in Hvidovre, Denmark, said at 2 to 3 days after being admitted to the hospital for their stroke, only 8% of this follow-up cohort had been normotensive, with blood pressure (BP) less than 120/80 mm Hg.

At that time, prehypertension existed in 22% (defined as BP ≥120/80 mm Hg and <140/90 mm Hg). Most (70%) had stage 1 (BP ≥140/90 and <160/100 mm Hg, 30%) or stage 2 (BP ≥160/100 mm Hg, 40%) hypertension, according to definitions used in the US Joint National Committee's seventh report.

On admission for stroke, 45% of patients had been undergoing antihypertensive therapy and were receiving an average of 1.7 antihypertensive drugs. At discharge, 61% were receiving treatment and were taking a mean of 1.6 drugs, and on follow-up, 67% were treated, with a mean of 1.7 drugs.

"Treatment with diuretics is often underused in patients with hypertension, and we found that of those treated, 53% of patients had a diuretic on admission, 47% at discharge, and at follow-up half the patients were treated with diuretics," Dr. Hornnes said.

When surveyed, 99% of patients reported at least 80% compliance with diuretic use in the previous 2 weeks, and 83% reported total compliance with diuretic use. For all antihypertensive medications, 98% of the patients declared 80% compliance, and 93% declared 100% compliance.

BP measurements at 1-year follow-up were made with the patient in a sitting position using both arms with a digital BP monitor after the patient was at rest for 5 minutes. Three readings at 10-minute intervals were made using the arm with the highest systolic measurements. At follow-up only 12% had no hypertension.

Prehypertension existed in 29%, 31% had stage 1 hypertension, and 28% had stage 2 hypertension. "So more than half of the participants were hypertensive 1 year after stroke," Dr. Hornnes reported. "No matter whether they were untreated or [taking] one or more drugs, more than half of the patients had hypertension."

Table 1. Percentage of Patients with Hypertension (HT) by Number of Drugs

No. of Drugs	No HT	Pre-HT	Stage 1 HT	Stage 2 HT
0	15	31	33	21
1	7	27	35	31
2	13	33	24	30
≥3	10	18	36	36

As the number of risk factors increased, so did the proportion of patients with stage 1 or stage 2 hypertension. The increase was most notable for stage 2 hypertension. The 7 risk factors that the researchers considered were age of 75 years or older, BMI of 25 kg/m² or higher, excessive alcohol consumption, hypercholesterolemia, diabetes, inactivity, and current smoking.

"You see there is a nice linear relationship between the number of risk factors and the proportion of patients with stage 2 hypertension," Dr. Hornnes said. From a regression analysis, the researchers found that systolic BP on day 2 or 3 after stroke was a significant predictor of systolic BP on follow-up, and so were age and smoking.

Table 2. Hypertension (HT) by Number of Risk Factors

No. of Risk Factors	Stage 1 HT	Stage 2 HT
0	25	7
1	35	14
2	34	25
≥3	30	36

Dr. Hornnes concluded that most patients were hypertensive 1 year after stroke despite good compliance with antihypertensive medication regimens.

"More intensive antihypertensive treatment, including a diuretic, is needed in order to reduce these patients' risk of further cardiovascular complications, and it's important to consider the whole risk factor profile of the patient," she advised.

Verifying Compliance Data

Session moderator Hans-Christoph Diener, MD, PhD, professor and chairman of the Department of Neurology at the University of Duisberg-Essen in Germany, challenged the compliance data, as he said, for the simple reason that "if you simply ask patients whether they took medications, the compliance is always very high."

He said he recently performed a series of studies in different diseases to check the patients' reports compared with prescription refill data from insurance companies. In those studies he said there was a big discrepancy. "Ninety percent of the people claimed to be compliant, but looking at the refills it was clear that only 50% of the patients were compliant," he said.

Dr. Hornnes said in her study, nurses assisted patients in taking their pills, and there were pill containers to account for use, so although the compliance may not have been as high as the reports indicated, she said she was confident that compliance was quite high.

Dr. Diener said a positive confounder in the study was that nurses came to take BP measurements, and just knowing that would probably induce patients to take their medications.

And he said about BP control in general, "I think on a global level it's a nightmare that we are still not able really to control blood pressure even in healthcare systems as sophisticated as in Denmark. In Germany, it's exactly the same problem."

Dr. Hornnes has disclosed no relevant financial relationships. Dr. Diener disclosed receiving consulting fees and lecture fees from Boehringer Ingelheim, Abbott, AstraZeneca, Bayer, Bristol-Myers Squibb, CoAxia, D-Pharm, Fresenius, Glaxo-SmithKline, Janssen Cilag, Merck Sharp and Dohme, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi and grant support from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis, Janssen-Cilag, and Sanofi-Aventis.

7th World Stroke Congress (WSC): Abstract FC60004. Presented October 15, 2010.

Source: Medscape

No change in the number of Americans with high blood pressure over the last ten years

Although many Americans are aware of the dangers associated with high blood pressure and many are controlling the condition, the prevalence of high blood pressure, also known as hypertension, hasn't changed in a decade, health officials report.

According to a new report from the U.S. Centers for Disease Control and Prevention, 30 percent of American adults suffer from hypertension.

"Overall, the prevalence of high blood pressure hasn't changed over the last 10 years," said lead author Sarah Yoon, an epidemiologist at CDC's National Center for Health Statistics.

In fact, the prevalence of hypertension did not change significantly, regardless of race, ethnicity, sex or age, she noted.

"However, there have been significant increases in high blood pressure awareness, treatment and control among people with high blood pressure over the same time period," Yoon added.

Part of the reason that treatment and awareness of hypertension has increased while the prevalence of the condition remains stagnant is the ongoing obesity epidemic and the aging population, both of which tend to produce more hypertensives, Yoon explained.

So, more people become hypertensive even as more people keep their blood pressure controlled, she explained.

Source: Business Week

Blood pressure measured in barber shops - a brilliant idea that could easily come to the UK

An outreach program in which barbers served as health educators – monitoring their black male clients’ hypertension and referring them for medical treatment when necessary – improved the rate of blood pressure control by about 9% over 10 months, according to a report published online Oct. 25 in the Archives of Internal Medicine

© Bonnie Schupp Barbers were used as health educators in an outreach program to improve the rate of blood pressure control in black men. The researchers described the barbershop as a cultural institution and an open forum of discussion for topics including health.

The intervention, which was tested in 17 black-owned barbershops in a single Texas county, motivated about half the hypertensive patrons at participating barbershops to see a physician, and reduced their systolic blood pressure by a mean of 2.5 mm Hg, said Dr. Ronald G. Victor of the University of Texas Southwest Medical Center, Dallas, and his associates.

“If the intervention could be implemented in the approximately 18,000 black-owned barbershops in the United States to reduce blood pressure by 2.5 mm Hg in the approximately 50% of hypertensive U.S. black men who patronize these barbershops (2.2 million persons), we project that about 800 fewer myocardial infarctions, 550 fewer strokes, and 900 fewer deaths would occur in the first year alone, saving about $98 million in [coronary heart disease] care and $13 million in stroke care (but offset by $6 million in additional non-CHD costs contributed by persons who would otherwise have died),” the investigators noted.

Black-owned barbershops “are rapidly gaining traction as potential community partners for health promotion programs targeting hypertension as well as diabetes, prostate cancer, and other diseases that disproportionately affect black men,” the researchers said.

Such barbershops “are a cultural institution that draws a large and loyal male clientele and provides an open forum for discussion of numerous topics, including health, with influential peers.”

However, despite the growing trend of using barbershops in this manner, the effectiveness of barber-based interventions has not been assessed in a randomized trial.

Dr. Victor and his colleagues did so by offering free blood pressure screening to patrons of 17 barbershops representing four geographic sectors with sizeable black populations in the Barber-Assisted Reduction in Blood Pressure in Ethnic Residents (BARBER-1). Nine barbershops with 695 patrons who were found to have hypertension then were randomly allocated to the intervention, and eight barbershops with 602 patrons who had hypertension were randomly allocated to a comparison group.

Most of the barbershop clients were middle-income.

The comparison group was not strictly a control group; patrons there underwent two BP screenings at baseline and received standard written explanations and recommendations for physician follow-up, because failing to advise them would have been unethical. The comparison barbershops also made available American Heart Association pamphlets entitled “High Blood Pressure in African Americans.”

For the intervention, barbers continually offered all male clients blood pressure checks along with their haircuts. They displayed large posters depicting authentic stories of other male hypertensive patrons of the same shop modeling treatment-seeking behavior, using the model’s own words to tell the story. Barbers and other male patrons also discussed the issue conversationally.

The barbers were trained, equipped, and paid to conduct BP testing and interpret the results, with the main focus on encouraging clients who had positive results to consult a physician. They referred clients who had no physician to a nursing staff that then referred them to local physicians or safety-net clinics. Barbers also gave patrons found to be hypertensive a wallet-sized card for the physician to sign, documenting an office visit concerning hypertension.

The barbers were paid $3 for every recorded blood pressure they took, $10 for every referral they made to the nursing staff, and $50 for every BP card that clients returned to them with physicians’ signatures. Patrons received free haircuts (a $12 value) for every BP card they returned with a physician’s signature.

Overall, nearly half of the patrons who were screened had high blood pressure; 78% of them were already aware that they were hypertensive, and 69% said they were taking treatment for HT, yet only 38% had their blood pressure under control.

Barbers were able to measure blood pressure in three of every four patrons who had hypertension, and each hypertensive client averaged eight blood pressure checks during the 10-month study. “The barbers motivated 50% of their patrons with elevated BP readings to visit a physician,” the researchers said.

The rate of blood pressure control – the number of men who achieved blood pressure control during BARBER-1 – improved by about 10% in the comparison group, but improved by an additional and significant 8% in the intervention group. That represents a nearly 20% improvement over the baseline rate of blood pressure control.

The intervention group also showed an absolute decrease of 2.5 mm Hg in systolic blood pressure compared with the control group, a secondary outcome of borderline significance, the investigators said (Arch. Intern. Med. 2010 Oct. 25 [doi:10.1001/archinternmed.2010.390]).

“Thus, the results of this study provide the first evidence for the effectiveness of a barber-based intervention for controlling hypertension in black men,” they added.

Dr. Clyde Yancy

Dr. Clyde W. Yancy of Baylor Heart and Vascular Institute, Dallas, said that using barbershops to convey meaningful health messages and conduct health screening appears to work, given that this intervention achieved a nearly 20% improvement in hypertension control compared with baseline, said.

But there is a greater question, he asserted: “Why must we resort to a community-driven approach that abdicates the responsibility to detect disease and institute preemptive care to well-intentioned, appropriately trained, but nonetheless clinically naive health care providers?”

The implication is that providers have collectively failed to provide adequate fundamental health information – a core foundational element in the practice of medicine. Since the study subjects were largely middle-income men with health insurance coverage, “access to care cannot be invoked as an excuse,” Dr. Yancy said.

Given the men’s ready access to conventional health care, it is “remarkable” that they did not have adequate detection and control of their hypertension, he commented.

“This finding is a cause for great concern because it indicates that simply providing better access to health care does not necessarily result in the delivery of better health care,” added Dr. Yancy, who reported (Arch. Intern. Med. 2010 Oct. 25 [doi:10.1001/archinternmed.2010.404]).

The National Heart, Lung, and Blood Institute, Donald W. Reynolds Foundation, the Aetna Foundation Regional Health Disparity Program, Pfizer, Biovail, Cedars-Sinai Heart Institute, the Lincy Foundation, and the Robert Wood Johnson Foundation supported the trial. Dr. Victor reported ties to Pfizer and Biovail. Dr. Yancy reported no financial conflicts of interests.

Source: http://www.internalmedicinenews.com

New research suggests 35% of 16 to 34 year olds may have high blood pressure

Lloydspharmacy has announced the publication of a new study that reveals 35 per cent of 16-34 year olds had high blood pressure readings.  The study, which involved 8568 people over the age of 16, showed that only one in four had an ideal or normal blood pressure reading. Alarmingly, four per cent of those under the age of 34 had readings which showed severe or very severe hypertension.

The average blood pressure for the UK gives cause for concern, with a reading of 140/86, pushing the country into the hypertensive category. Across the UK various pressure points were identified, with the average blood pressure in the East of England hitting 143/86 and 143/85 in the South West.

Research conducted by Lloydspharmacy shows that more than seven in ten adults in the UK have never had their blood pressure checked and, with one in five doing no forms of exercise, it is perhaps no surprise that the nation's blood pressure is soaring.  As the population ages, the situation only seems to worsen, as one in ten adults over the age of 55 showed signs of severe or very severe hypertension, putting themselves at serious risk of a heart attack or stroke.

Men seem to be at a higher risk of high blood pressure than women with three in four classed as having high normal blood pressure or some level of hypertension, but a high percentage of women are still at risk as more than 67 per cent of nearly 3,000 women tested over the age of 55 showed signs of hypertension.

Shafeeque Mohammed, clinical pharmacist and heart health expert at Lloydspharmacy, said: "Although we must bear in mind that a one-off blood pressure test is not conclusive, cumulatively the average readings were higher than anticipated. It was particularly worrying to see the number of younger people with readings that put them in the hypertensive category. We would certainly want to explore this further."

Professor O' Brien, Professor of Cardiovascular Pharmacology at The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, added: "Lack of blood pressure control increases the chances of cardiovascular problems such as strokes, heart attacks or kidney problems.  

"Recent evidence shows that although prescribing of blood pressure-lowering drugs has increased, BP control has not improved. It is apparent that prescribing alone is not the answer - people of all ages need to take their blood pressure seriously and re-evaluate their lifestyle to reduce the risk of hypertension. I applaud the efforts that Lloydspharmacy is making to promote awareness of blood pressure and in encouraging people to get their blood pressure checked on a regular basis."

This study is an analysis of 8586 blood pressure tests, which were conducted between January and June 2010 both in pharmacy and during the Lloydspharmacy Healthy Heart Sofa Tour, which visited a number of major cities across the UK.

Whatever happened to blood pressure sensing underpants?

Calvin Klein's for the
older generation?

Blood-pressure-sensing underpants?  This is a older piece from the New Scientist website.  Worth reading again though - I wonder if they are in development yet?  I will keep my eye out.

Blood pressure is not hard to measure, but the necessary equipment for clinically accurate measurements - a cuff, a pump, and stethoscope or electronics - is bulky and heavy.


However, researchers have recently found that a person's "pulse wave velocity" is closely linked to blood pressure. This is the rate at which the pulse pressure wave passes through the blood circulatory system.


Sensors sewn into the waistband of a person's underpants can measure the rate of this wave, consumer electronics company Philips has discovered, and could be used to calculate blood pressure for as long as the garment is worn.


Each sensor continually measures the electrical impedance of the tissue beneath it - a property that changes as the pulse wave passes by. A pair of such sensors can calculate the speed of the pulse wave by timing how long it takes to travel from one sensor to the other.


Once calibrated with a conventional blood-pressure reading, the electrodes can then give accurate blood-pressure readings, while the wearer enjoys the comfort of their own underpants.


Source: New Scientist 2008

5 Major effects of high blood pressure video

How do you measure up? - Lifestyle change to lower blood pressure.

What lifestyle changes
do you need to make?

Many of us have been to the doctor’s to be told to change our lifestyle if we want to lower our blood pressure.  The British Hypertension Society recommends a number of key changes that we should make to support our blood pressure management.  Check them out below to see how you measure up.  Over the next week or so we will be looking at each one of them, looking at the real impact that they can have on your blood pressure and what you can do about it.

Recommendations:

Maintain a normal weight for adults (body mass index 20-25)

In the UK almost a quarter of us are obese.  More than one in three of us are considered overweight.  Weight can be a real factor in high blood pressure and it has been estimated that losing 10kg could reduce your systolic blood pressure by up to 10mmHg

Reduce salt intake to < 100 mmol/day ( < 6g NaCl or <2.4 g Na+/day)

Salt intake in the UK has been falling but we still eat far too much.  Average salt intake is around 9g per day when we should be looking to reduce our salt intake to less than 6g.  Most of the salt we eat is in processed food.  Did you know the average slice of bread contains half a gram of salt?

Limit alcohol consumption to ≤ 3 units/day for men and ≤ 2 units/day for women

To keep your blood pressure down, it is important to try and keep to government recommendations for alcohol intake.  Binge drinking can be a particular risk for stroke.

Engage in regular aerobic physical exercise (brisk walking rather than weightlifting) for ≥ 30 minutes per day, ideally on most of days of the week but at least on three days of the week

Do you exercise enough?  Tell the truth now…  Exercise plays a real part in lowering your blood pressure.  We are not necessarily talking about hours down the gym.  You can start and end with basic brisk walking.  Thirty minutes a day is recommended and there is some evidence that you can even do that in three ten minute stints.

Consume at least five portions/day of fresh fruit and vegetables

A considerable number of us do not consume our 5 a day.  Did you know that your 5 a day does not need to consist of fresh fruit and vegetables?  Dried fruit, tinned or frozen vegetables it all counts – apart, I think, from the tomato paste on your pizza!  How much fruit and veg do you eat every day?

Reduce the intake of total and saturated fat

We all need to reduce our fat intake.  But do you know which fats are bad and which fats are good?

Follow Through the Roof as we look at these issues in more detail over the next few weeks. Why not sign up on our news feed.

How do you measure up? The British Hypertension Society thresholds for drug treatment.

Many of us have no idea why or how doctor’s make a decision to put us on medication.  Well, as you may have guessed, it is not finger in the air stuff.  There are recommendations for treatment and the one used in the UK has been published by the British Hypertension Society (bhsoc.org.uk).  In brief, the thresholds are as follows with my explanations:

Drug treatment should be started in all patients with sustained systolic blood pressures ≥ 160 mm Hg or sustained diastolic blood pressures ≥ 100 mmHg despite non-pharmacological measures.

When you have your blood pressure measured ask about the numbers.  Blood pressure is often recorded as a number over a number – for instance “120 over 80”.  The top number is the systolic blood pressure and the bottom number is the diastolic blood pressure.  Sustained means over a period of time so your doctor may invite you back on a number of occasions over a few months to check your blood pressure.  Non-pharmacological measures are basically lifestyle changes such as increasing exercise, cutting out salt and losing weight.

Drug treatment is also indicated in patients with sustained systolic blood pressures 140-159 mm Hg or diastolic blood pressures 90-99 mm Hg if target organ damage is present, or there is evidence of established cardiovascular disease or diabetes, or if there is a 10 year cardiovascular disease risk of ≥ 20%.

If you have additional problems that may have been exacerbated or caused by your high blood pressure, doctor’s may give you medication when your blood pressure is at a lower level than previously managed.  End organ damage may be defined as things such as thickening in the heart muscle or problems with you kidneys which mean they are leaking protein into your urine.  Your cardiovascular risk is defined by more than your blood pressure.  Doctor’s will take into account things such as your cholesterol levels, your body mass index and your family history.  If all of these factors mean that your chance of having an event – a stroke or heart attack – in the next ten years is over 20% then they will also look at medication.

For most patients a target of ≤ 140 mm Hg systolic blood pressure and ≤ 85 mm Hg diastolic blood pressure is recommended. For patients with diabetes, renal impairment or established cardiovascular disease a lower target of ≤ 130/80 mm Hg is recommended.

This is the target which you and your doctor will be aiming for when you have been put on medication.  You can see that this is lightly lower for people who have diabetes or some other problems than for those who just have high blood pressure.

When using ambulatory blood pressure readings, mean daytime pressures are preferred and this value would be expected to be approximately 10/5 mm Hg

lower than the office blood pressure equivalent for both thresholds and targets. Similar adjustments are recommended for averages of home blood pressure readings.

Some of you may have been asked to wear an ambulatory blood pressure monitor for 24 hours which takes your blood pressure on a regular basis throughout the day and night.  Some of you may have been asked to take your blood pressure at home for a period of time.  In both these cases, the doctor’s expect those readings to be lower than the ones that are taken at the surgery and they make adjustments for this.

Full guideline

Study finds almost 20% of 10 and 11 year olds in West Virginia have elevated blood pressure. Is it coming our way?

Almost 20 percent of fifth graders in West Virginia may have elevated blood pressure, according to new research from an ongoing study identifying heart disease risk factors.

"The real thrust of this research is trying to get some attention on the fact that we need to screen for hypertension [high blood pressure] in children. And, while one reading done at school isn't diagnostic, the school nurse can record that information and send it home for the parents to follow-up with their child's physician," said study author Valerie E. Minor, associate director of surveillance of the CARDIAC (Coronary Artery Risk Detection in Appalachian Communities) project and an associate professor of nursing at Alderson-Broaddus College in Philippi, W.Va.

Minor is scheduled to present the findings Wednesday at the American Heart Association's High Blood Pressure Research 2010 Scientific Sessions in Washington, D.C.

The CARDIAC project was started because West Virginia has a significantly higher age-adjusted rate of death from heart disease than the national average -- 21 percent higher, according to Minor's presentation.

Risk factors for heart disease, such as high blood pressure and high cholesterol, have their roots in childhood, but there are no universal population-based screenings for blood pressure levels in children.

For the CARDIAC study, West Virginia schools conducted blood pressure screenings on more than 62,000 fifth graders. In that group, 12,245 had blood pressure readings above the 95th percentile for their height and gender.

Youngsters carrying extra weight fared the worst. The rate of blood pressure readings above the 95th percentile in normal weight children was 12 percent, said Minor. But, for overweight children, the rate was 19 percent. In obese children, it was almost 33 percent, said Minor.

"These numbers are so significant that we're really concerned about this," said Minor, but she added that the study's findings need to be validated by another study and in different populations. West Virginia's population tends to be heavier than that of many other U.S. states, but Minor said other studies looking at the rate of high blood pressure in children usually found levels close to what was seen here.

Screening children for high blood pressure is more difficult than screening adults, Minor added. "In children, you have to listen to sounds and changes in the blood pressure as well, and age, gender and size matter. The results have to be put into a percentile. Blood pressure readings aren't the same in children as they are in adults," she said.

The current study also identified several hurdles to getting accurate blood pressure readings in schools, including a need for qualified personnel to do the screenings. Scheduling testing in the school day and quieting children down beforehand to get a truer reading are challenges as well, the researchers found.

The researchers also discovered that there aren't really blood pressure cuffs made for overweight children, Minor said. A cuff made for adults is too long from shoulder to elbow, while a standard child-size cuff doesn't fit properly around the arm. Minor said she had a hard time finding the right cuff, and she expects that other health care providers will as well.

Dr. Michael Moritz, clinical director of pediatric nephrology at Children's Hospital of Pittsburgh, agreed with Minor that one school-based screening can't diagnose high blood pressure in children.

"Hypertension is a dynamic variable. To really determine what hypertension is, it needs to be checked on three separate occasions," said Moritz.

"Nonetheless, this widespread screening showed a significant number of children with elevated blood pressure. And, when blood pressure is high, cardiac morbidity goes up. This study sends a message that as a community and as a society we need to get more serious about healthy eating and lifestyle changes, like changing sedentary lifestyles," he said.

"It's difficult and, unfortunately, there's no silver bullet, but we need to take charge of our own lifestyles and our children's to teach them healthy ways," said Minor.

Source: Bloomberg News

Watermelon for pre-hypertension?

Watermelon, apart from being rich in nutrients, has been found to lower pre-hypertension, a precursor to cardio diseases.  Assistant professor Arturo Figueroa and Professor Bahram H. Arjmandi of the Florida State University conducted the study on the health benefits of watermelon.  They found that extracts of watermelon, given daily for six weeks, lowered blood pressure in a group of pre-hypertensive men and women aged between 51 and 57 years, reports the American Journal of Hypertension.

‘Watermelon is the richest edible natural source of L-citrulline, which is closely related to L-arginine, the amino acid required for the formation of nitric oxide essential to regulate blood pressure,’ Figueroa said.  Consuming L-arginine as a dietary supplement isn’t an option as it can cause nausea, gastrointestinal tract discomfort, and diarrhoea, Figueroa said.

Consuming watermelon caused no such problems, study participants reported. Watermelon is also abundant in vitamin A, B6, and C, apart from fibre, potassium and lycopene, a powerful antioxidant.

Source: TopNews

Kitchen Table review - A&D UA-767Plus Blood Pressure Monitor

Welcome to the first of my Kitchen Table Reviews. I aim to give validated blood pressure monitors the once over and look at them in terms of value for money, bells and whistles and ease of use.

What's in the box?

Manufacturer: A&D Medical
Model: UA-767Plus Automatic Blood Pressure Monitor

Features:

• Irregular Heart Beat (IHB) monitor
• Blood pressure classification indicator
• Last reading recall
• Extra large 3-line display for an easier read
• One-touch management
• SlimFit comfortable cuff

What’s in the box
Open the box of the UA-767Plus and you will find a handy blue vinyl bag for storing your monitor. Undo the zip and you will find your monitor, batteries and your cuff. The standard A&D adult cuff measures 22-32cm which is fine for average people, however, those with larger upper arms might want to see if they can get the UA-767Plus with a large cuff. If you need to know what size cuff you need see our video on watchyourbp.co.uk.

The face of the UA-767Plus is clean and simple A large single button starts the monitor up and automatically inflates the cuff to begin your measurement.

My blood pressure (after medication) 

clearly shown with the WHO indicator

on the left hand side.

The screen has big numbers on and both the systolic and diastolic blood pressure are clearly marked with the pulse beats per minute coming at the bottom of the screen. On the left hand side of the screen which has a battery indicator and the clever bits.

Bells and whistles?
First off, the IHB or irregular heart beat monitor. What is this useful for. Well, if you know you suffer from an irregular heart beat or atrial fibrillation, this may well be able to detect it, although it is important to remember that the monitor can only pick up an irregular heart beat if it happens while you are having your blood pressure measured. Not everyone has “regular” irregular heart beats so it may not pick it up. It is, however, useful if you have a family history of stroke or irregular heart beat. Atrial Fibrilation is a risk factor for stroke and it is important that it is detected – this monitor may help you do this.

Simple but clear face

The other clever bit is the WHO Classification Indicator. WHO? They are the World Health Organisation based in Switzerland and interested in the health of us all globally. The WHO have a clear classification system which enables you to place yourself within a spectrum from optimal (120/80mmHg or below) through pre-hypertensive, mild and moderate hypertension all the way to severe hypertension. This monitor does it for you with a colour coded strip alongside the screen which clearly marks where you are in the classification.  Personally, I thought that this would be really useful for those doing occasional readings or who want to make sure that there blood pressure is staying where it should be.

Ease of use?
It is very easy to use. No need for an idiots guide as it is simply a matter of putting the cuff on properly, sitting down and pushing the single button.  All the figures are very clear and it provides what you need.

Who is it suitable for?
Anyone really, but only if you are interested in basic blood pressure monitoring. It does not connect to a PC and has no memory outside of a last reading re-call.  If you are looking for a straight out of the bag monitor which will give you accurate readings but little else (discounting the IHB indicator) this will probably work for you.  If you are looking to buy a monitor for an elderly relative who has been told to keep an eye on their blood pressure - this will work as well.

Star quality
I will give this monitor 4 stars.  It is very easy to use, is clinically validated and has a 5 year guarantee.  It falls down a bit on the bells and whistles, but if you do not want a memory or one to attach to your PC - and many people do not - this is ideal.

Cost
The RRP of the UA-767Plus is around £70.  Mine was supplied by Experts in Blood Pressure products and they are selling it for £40 - so really good value for a clinically validated monitor.

Clinical validation details
The monitor is on the British Hypertension Society list of validated monitors. It has a European protocol pass and the paper was published in 2004 in Blood Pressure Monitoring*

*Verdeccia, P, Angeli, F, Poeta, F, REboldi, GP, Borgioni, C, Pittavini, L, and Porcellati, C. Validation of the A&D UA-774 (UA-767Plus) device for self-measurement of blood pressure.
Blood Pressure Monitoring 2004, 9 (4): 225-229

Cause of pre-eclampsia found?

Scientists in the UK believe they have found the cause of pre-eclampsia, the potentially life-threatening condition which affects thousands of pregnant women.  The researchers from the University of Cambridge hope their study will help develop treatments for high blood pressure during pregnancy.  Blood pressure is controlled by angiotensins, hormones which restrict blood vessels.  The researchers used an intense x-ray beam to probe the structure of the angiotensionogen, which is the protein that releases the similarly-named hormone.

Angiotensinogen is oxidised by the beam and changes shape to permit access by the enzyme rennin, according to the findings published in the journal Nature.  Cutting off the 'end' of the protein, sparks the release of the hormone, which, in turn, raises blood pressure.  Women suffering from pre-eclampsia were found to have more oxidised angiotensinogen, than those without the condition.

Source: FIGO

DASH Diet for lowering blood pressure.

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New research suggests taking blood pressure medication at night

According to new research, timing blood pressure medication with a patient’s body clock makes the drugs more effective, providing more effective and greater protection. By taking the medication at night patients are better protected against heart attacks and strokes.  Chronobiology International has published the results of a five-year study in their journal. If the findings by researchers are followed, the way blood pressure medication is administered could change and have a profound impact on the type of treatment that hypertension patients receive. The results have the potential to change the way millions of people with hypertension treat their illness.

"This study proves that the time of day when patients take their high blood pressure medications can make a huge difference due to the effect of the body's circadian rhythms on the actions of medications and because of the importance of preserving the normal day-night pattern of blood pressure in hypertension," said Dr. Ramon C. Hermida, lead investigator of the MAPEC study and director of Bioengineering and Chronobiology Labs at the University of Vigo in Spain.  "Conventional treatment typically advises taking blood pressure medications in the morning. The MAPEC study shows that conventional treatment is not the most effective way to help patients with high blood pressure," said Hermida.

Taking at least one blood pressure medication at bedtime as opposed to taking all medications in the morning was found, based on around-the-clock ambulatory blood pressure monitoring, to best normalize the sleep-time blood pressure. This is known to be the most sensitive predictor of a patient's five-year risk of cardiovascular death mortality. Additionally, the study shows that taking medication at night is the best way to control daytime blood pressure levels.


Source: All Headline News

Treat black patients more aggressively says International Society on Hypertension in Blacks

Because high blood pressure is such a serious health problem for black patients, the International Society on Hypertension in Blacks (ISHIB) is calling for earlier and more aggressive intervention for the black community.

High blood pressure tends to cause serious complications such as stroke, heart failure and kidney damage much more often among black patients than among whites, the organization noted.

On Monday, ISHIB issued a consensus statement with two main updates to its earlier recommendations: lowering the threshold at which black patients would start treatment, and moving rapidly from a single-drug therapy to a multi-drug therapy if necessary.

"Evidence from several recently completed studies converged to convince our committee that we were waiting a little bit too long to start treating hypertension in African Americans," lead author Dr. John M. Flack, chairman of the department of internal medicine at Wayne State University in Detroit, said in a news release from the American Heart Association.

For U.S. adults, blood pressure is considered normal when it is below 120/80. That figure references both the pressure in the arteries when the heart beats (top number) and the pressure when the heart relaxes between beats (bottom number).

However, ISHIB suggests that health providers should counsel healthy black patients to make lifestyle changes as soon as their blood pressure is 115/75 or higher. Such changes would include lowering salt intake, upping potassium intake by eating more fruits and vegetables, drinking in moderation, getting more aerobic exercise and losing weight if necessary.

Similarly, the organization said that although the general threshold for starting drug treatment among healthy patients is a blood pressure of 140/90, black Americans with no history of heart disease, diabetes or organ damage should commence drug treatment to lower blood pressure when their readings reach 135/85.

For black patients who do have a history of related health complications -- such as cardiovascular disease, diabetes, kidney disease or damage to target organs such as the heart, kidneys or brain -- the organization recommends that treatment begin as soon as their blood pressure is at or above 130/80.

And if a single-drug approach doesn't cause blood pressure to drop quickly, doctors should be prepared to swiftly embrace a multi-drug approach, the organization urged.

"We believe that these recommendations will lead to better blood pressure control, and a better outlook for African Americans with high blood pressure," Flack said.

"The majority of patients of any race, and certainly African Americans, are going to need more than one drug to be consistently controlled below their goal," he added. "The debate in the medical community over which single drug is best overwhelms the most pressing question: Which drugs work best together?"

To that end, ISHIB is releasing a combination-drug chart that outlines what the organization believes to be the best multi-drug options, based on a review of the most recent research.

Flack and his colleagues present their current recommendations -- an update of ISHIB's 2003 consensus statement on blood pressure -- in the current edition of Hypertension: Journal of the American Heart Association.

Source: Bloomberg