Treating people with prehypertensive blood pressure readings with antihypertensive medications reduces the risk of stroke, but comes at the cost of more side effects, a meta-analysis showed.

In a pooled analysis of 16 trials, antihypertensive therapy lowered the risk of incident stroke by a relative 22% versus placebo in patients with a baseline blood pressure of 120 to 139/80 to 89 mm Hg (RR 0.78, 95% CI 0.71 to 0.86), according to Ilke Sipahi, MD, of University Hospitals Case Medical Center in Cleveland, and colleagues.

But, although reporting was not consistent between trials, active treatment was also associated with possible harm, indicated by higher rates of hyperkalemia, renal failure, hypotension, and peripheral edema, the researchers reported online in Stroke: Journal of the American Heart Association.

Guidelines do not currently recommend using drugs to lower blood pressure in patients with prehypertension, which can occur in up to 40% of individuals depending on the age, sex, and ethnicity of the population, Sipahi and colleagues wrote.  They said that any decision to use antihypertensives in these patients would have to include consideration of the costs of the initial treatment and of dealing with the potential side effects.

"Thus, although the risk reduction in incident strokes in patients with prehypertensive blood pressure levels is well elucidated in our meta-analysis, the clinical implications are uncertain," they concluded.  Although lowering blood pressure with medications has been shown to reduce rates of cardiovascular events, including stroke, in patients with hypertension, the effects of treatment are less clear in patients with prehypertension because of the lack of randomized trials.

To explore the issue, Sipahi and colleagues gathered data from 16 randomized, placebo-controlled trials that evaluated antihypertensive treatment for other conditions and included patients with prehypertensive blood pressure values at baseline. The studies included a total of 70,664 patients.  Half of the trials included angiotensin converting enzyme (ACE) inhibitors, four included angiotensin receptor blockers (ARBs), two included calcium channel blockers, one included both a calcium channel blocker and ACE inhibitor arm, and one studied an ACE inhibitor and/or a calcium channel blocker.

Active treatment reduced blood pressure in all of the trials. The average readings at the end of the trials were 130.5/76.5 mm Hg with antihypertensive treatment and 134.2/78.4 mm Hg with placebo.  There was a lower rate of incident stroke with antihypertensive therapy in all but two of the trials, and in the pooled analysis. An analysis restricted to the five trials in which participants had an average baseline blood pressure less than 130/85 mm Hg yielded a similar result.  The findings were largely consistent across drug classes, although the risk reduction did not reach statistical significance for ARBs.

In terms of absolute risk, 2.01% of patients in the treatment arm had a stroke during follow-up, compared with 2.61% of those in the placebo arm.  Meta-regression analysis did not show that risk reduction was related to the magnitude of average blood pressure reduction.  The researchers calculated that the number needed to treat was 169 (with an average treatment duration of 4.3 years), adding, however, that the figure is likely to vary widely depending on the patient population studied.  To put that number into context, they noted that the number needed to treat to prevent one stroke was 642 with statins for primary prevention.

Two other outcomes -- MI and cardiovascular death -- were not significantly reduced with antihypertensive treatment, although the risk ratios leaned toward a benefit.  "However, these trends were likely driven by the ACE-inhibitor trials in patients with established atherosclerotic disease or very high cardiovascular risk (i.e., HOPE and EUROPA trials)," the authors wrote. "Exclusion of the above trials caused the trend toward risk reduction to disappear."

The analysis was limited, the authors wrote, by the lack of access to patient-level data, the inclusion of some patients who had a diagnosis of hypertension but who had been treated to prehypertensive levels at baseline, and the uncertainty about the type and severity of strokes that were prevented through treatment.

Source: Todd Neale, Senior Staff Writer, MedPage Today 9/12/2011

Up to a third of patients home monitor - do you?

Up to a third of patients in primary care with hypertension are self-monitoring their blood pressure, suggesting home readings could be incorporated more closely into clinical practice, a new study concludes. Self-monitoring of blood pressure was particularly common among patients with diabetes who were monitoring their blood glucose, and even among patients who were not self-monitoring, the majority said they would consider doing so. Researchers sent questionnaires to 1,815 patients who had hypertension, across four GP practices in the West Midlands, between November 2008 and April 2009. Among the 53% who responded, 31% reported they currently self-monitored blood pressure, with two-thirds monitoring at least once a month. Of participants who did not self-monitor, 58% reported they would consider doing so. Patients who had diabetes and monitored their blood glucose were five times more likely to monitor their blood pressure that those with diabetes who did not monitor blood glucose. Study leader Professor Richard McManus, professor of primary care research at the University of Oxford and a GP in Birmingham, conceded the survey could have been affected by response bias. But Professor McManus, a member of the NICE guideline development group that recommended ambulatory blood pressure monitoring, said: ‘GPs should be aware around a third of their patients with hypertension could be monitoring their own blood pressure and of the opportunities this could bring to daily management.' Co-author Sabrina Grant, research associate at the University of Birmingham, said the results ‘indicate home blood pressure monitoring is more popular than we might think'. Dr Chris Arden, a cardiology GPSI in Southampton, said self-monitoring could play an important role, particularly in diagnosis: ‘I've been encouraging patients to purchase their own monitors – and we've got monitors we loan out.' He said it was an effective use of resources, moving responsibility back to patients and easing pressures on practice time.  Dr Terry McCormack, council member of the Primary Care Cardiovascular Society and a GP in Whitby, Yorkshire, said: ‘What is interesting is the high uptake amongst diabetic patients who already appreciate the advantages of self-monitoring. We do want more people to self monitor but we are not there yet.' Dr Kathryn Griffith, a cardiology GPSI in York, said: ‘I would agree that 30-50% of my patients have monitors. My concern is that they may have had them for a long time and that they may not be calibrated.' New NICE hypertension guidance recommends using clinic measurements to monitor response to anti-hypertensive drugs or lifestyle modifications, but suggests using ambulatory blood pressure monitoring or home blood pressure monitoring – in addition to clinic readings - in patients who have a white-coat effect. Source: Pulse

Hypertension risk greatly increased for children in top 15% of BMI

Children in the 85th percentile for body mass index (BMI) are at greatly elevated risk for high blood pressure and require regular monitoring as well as possible interventions, according to a study from the American Heart Association.

The study of 1,111 healthy Indiana school children—42% black, equally divided by sex (mean enrollment age, 10.2 years)—found that the adiposity effect on blood pressure was minimal until patients reached the overweight category, when it increased 4-fold. Researchers observed a similar effect on children younger than 10 years, those aged 11 to 14 years, and those older than 15 years. The group underwent 9,102 semiannual blood pressure and height/weight assessments during that time period (mean follow-up, 4.5 years).

“Higher blood pressure in childhood sets the stage for high blood pressure in adulthood,” said Wanzhu Tu, PhD, lead researcher and professor of biostatistics at Indiana University School of Medicine in Indianapolis. “Targeted interventions are needed for these children. Even small decreases in BMI could yield major health benefits.”

Researchers emphasized the importance of viewing overweight and obese children differently from their normal-weight cohort, even if they seem healthy. “The adiposity effects on blood pressure in children are not as simple as we thought,” Tu said.

He especially cautioned parents and pediatricians to monitor weight gain in already heavy children.

“If they see a dramatic weight gain in a child who already is overweight, they need to intervene with behavioral measures, such as dietary changes and increased physical activity, to improve overall health and minimize cardiovascular risk,” Tu said.

Researchers noted that leptin, the adipose tissue-derived hormone, together with heart rate, showed an almost identically patterned relationship to blood pressure as did BMI, suggesting a role of the hormone in the elevated blood pressure.

Obese girls at greater risk of high blood pressure

Although obesity does not help teens of either gender, the impact on girls is vastly greater than those of boys, according to a study.  The results from researchers at the University of California Merced were released on Friday and were presented during the American Physiological Society Conference.  The study may apply to the approximately 17 percent of U.S. children and adolescents between the ages of 2 and 19, a total of 12.5 million people. About 3 percent of children have high blood pressure, according to a 2007 study by the CDC.  Approximately 17 percent or 12.5 million children and adolescents age 2-19 are obese.  An estimated 3 percent of kids have high blood pressure according to a study in 2007 by the CDC.

In the study Dr. Rudy M. Ortiz, PhD, Associate Professor at School of Natural Sciences at UC Merced and his team, measured the systolic blood pressure and calculated the body mass index of 1,700 teenagers ages 13 through 17 during the school district health survey and physicals.

The researchers found that boys are 3.5 times more likely to develop elevated systolic blood pressure than non-obese boys.

Meanwhile, obese girls were 9 times more likely to develop elevated systolic blood pressure than non-obese girls.  Systolic blood pressure is the pressure in blood vessels when the heart beats; Body mass index helps calculate human body fat based on an individual’s height and weight.

"We were able to categorize the students in different ways, first based on BMI within each of the three blood pressure categories. Then we flipped that around and looked at each category of blood pressure for different weight categories said Dr. Ortiz."

Researchers found a connection between body mass index and systolic blood pressure. The effect of body mass index on systolic blood pressure is much greater when assessed by blood pressure.  "In each case, we are looking at SBP as the dependent variable, said Dr. Ortiz."

"The results do not bode well for obese teens later in life, especially for the girls,” said Dr. Ortiz.  "We know, for example, that obese adolescent females participate in 50 to 60 percent less physical activity than boys in the population surveyed."

Source: Medical Daily

Overweight children at risk of high blood pressure

Children who are overweight compared to their peers are nearly three times more likely to have high blood pressure, a new study shows.  The study, published in the journal Hypertension, followed 1,111 school-aged children in Indiana for an average of four years.  Twice each year, researchers visited schools to take blood pressure measurements and record the kids’ heights and weights.

About 40% of the children in the study were above the 85th percentile on growth charts for their height and weight. When children are above the 85th percentile, doctors consider them to be overweight.  Among the overweight kids, 14% had blood pressure that was higher than normal, while only 5% of normal-weight kids had elevated blood pressure.

The study also found that extra pounds are especially dangerous for kids who are already big.

"For an overweight and obese child, if you increase your BMI percentile a little bit, that would increase your blood pressure strongly,"says researcher Wanzhu Tu, PhD. Tu is a research scientist at Regenstrief Institute and professor of biostatistics at Indiana University School of Medicine, both in Indianapolis.  "In the same way," Tu says, for just a little bit of weight loss "you could benefit greatly in terms of blood pressure."

The risks of overweight were the same, regardless of the child’s sex or race. About 42% of the kids in the study were black.

Pediatricians say the study is wake-up call.  "We’ve tended to look at the overweight category as a lower-risk category," says Stephen R. Daniels, MD, PhD, chairman of the department of pediatrics at the University of Colorado School of Medicine in Denver. He was not involved in the research.  "This suggests to me that we really need to worry about kids who are in that overweight category," says Daniels, who is also pediatrician-in-chief at Colorado Children’s Hospital.

Other experts say the findings are concerning because having high blood pressure has been shown to set kids up for health complications.  Not only are children with high blood pressure much more likely to turn into adults who have high blood pressure, but newer studies have shown that kids can get the same kinds of organ damage -- to the heart, blood vessels, and kidneys -- that doctors once thought was only a problem for adults with the condition.

One study even found that kids with high blood pressure have subtle changes in the brain area that controls attention, problem solving, and working memory.  "For physicians, we have to take much more seriously this concept of the childhood origins of adult diseases and look beyond the weight and beyond the blood pressure level because we’re finding more evidence, subtle evidence, of injury," says Bonita Falkner, MD, professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia.

"So it’s not going to be a risk that’s going to be in the future. It’s a risk that’s now," says Falkner, who wrote an editorial on the study, but was not involved in the research.

"It jacks up the concern about preventing childhood obesity and also not waiting until they are obese.  Even overweight can be problematic for children."

Source: WebMD/Hypertension

Hypertension increases cancer risk

A large study has found that hypertension is associated with an increased risk for cancer death, and that hypertension increases the risk of developing cancer — although the latter effect reached statistical significant only in men, not women.

"The relative and absolute risk estimates were rather modest," said lead researcher Mieke Van Hemelrijck, PhD, from the cancer epidemiology group at King's College London, United Kingdom.

"This is important from a public health perspective, since a large proportion of the population in many western countries suffers from hypertension," she told delegates at a presidential session here at the 2011 European Multidisciplinary Cancer Congress. The paper was chosen as one of the best abstracts from the meeting.

One of the implications of this finding is the opportunity it offers for intervention, said Per Hall, MD, PhD, medical oncologist and professor of epidemiology at the Karolinksa Institute in Stockholm, Sweden, who acted as discussant for the paper.

"Primary prevention strategies developed by cardiologists have the potential to lower the risk of cancer," Dr. Hall explained.

For oncologists, this highlights the need for a more holistic approach, he continued. Oncologists must learn to think beyond cancer therapy and consider treatment of the whole person, including conditions such as hypertension and cardiovascular disease, he said. "If we look for other things also, it would definitely improve overall survival," he added.

Link With Hypertension

Previous studies exploring the link between hypertension and cancer have yielded mixed results, with some showing and some not showing an association, Dr. Van Hemelrijck told Medscape Medical News.

However, many earlier studies used just 1 measurement of blood pressure (BP), which can cause random error, she noted. To control for this, Dr. Van Hemelrijck and colleagues used data from a subgroup of individuals in their study (133,829 of the 577,799 participants) who had undergone several measurements of BP, and used these findings to correct for random error in the whole sample.

The researchers also controlled for smoking and obesity, which again was not controlled in some of the previous studies, and for age and sex. However, the study did not have any information on antihypertensive treatment; there were no records on whether and which drugs were being used to control BP, Dr. Van Hemelrijck noted.

Largest Study So Far

The study is the largest of its kind, analyzing data on 289,454 men and 288,345 women. The data come from Metabolic Syndrome and Cancer (Me-Can) project, which includes people from Norway, Sweden, and Austria who had undergone regular health examinations from 1972 to 2005.

After a median follow-up of 12 years, excluding the first year, cancer had been diagnosed in 22,184 men and 14,744 women, and 8724 men and 4525 women had died from cancer.

BP measurement was reported as mid-BP, which is the sum of systolic and diastolic pressure divided by 2. The average mid-BP in the study was 107 mm Hg for men and 102 mm Hg for women. The results for BP were divided into 5 groups, with individuals in the first quintile having the lowest BP and those in the fifth quintile having the highest BP.

Cox proportional hazard regression analysis showed that the risk of developing and of dying from cancer was linearly proportional to the increase in BP.

The increase in the incidence of cancer with increasing BP was statistically significant for men — specifically, the risk increased for oral, colorectal, lung, bladder, and kidney cancers, and for melanoma and nonmelanoma skin cancer. The overall risk of developing any cancer was increased by 29% between men in the lowest quintile and those in the highest quintile.

An increase was also seen in women, but did not reach statistical significance. An increase in incidence risk was seen for liver, pancreas, cervix, and endometrial cancers, and for melanoma.

Increasing BP also increased the risk of dying from cancer; this effect was statistically significant in both sexes. Men in the fifth quintile of mid-BP had a 49% increased risk for cancer death, compared with those in the lowest quintile; for women, this risk increased by 29%.

In terms of absolute risk, the increase from raised BP was rather modest, Dr. Van Hemelrijck noted. "Men with mid-blood pressure in the highest [quintile] had an absolute risk of developing cancer of 16%, compared with an absolute risk of 13% for those with mid-blood pressure in the lowest [quintile]," she said.

For cancer death, the absolute risk was 8% for men in the highest quintile, compared with 5% for men in the lowest quintile; for women, the risk was 5% in the highest quintile and 4% in the lowest quintile, she reported.

We cannot claim that there is a causal link between high blood pressure and cancer risk.

This study is observational, so "we cannot claim that there is a causal link between high blood pressure and cancer risk, nor can we say that the cause of cancer is a factor related to high blood pressure," Dr. Van Hemelrijck explained.

Hypertension might be a proxy for an unhealthy lifestyle, she speculated in comments made to Medscape Medical News. It is already established that cancer and diabetes are risk factors for cancer; hypertension might be part of the whole metabolic syndrome, which increases the risk, rather than just a factor on it's own, she said.

She did note that a meta-analysis reported some years ago (Am J Med. 2002;112:479-486) specifically linked hypertension to an increase in the risk for kidney cancer. In that case, a causality is perhaps more understandable because high BP increases the stress on the kidney.

The meta-analysis analyzed data from 10 studies (47,119 patients), and found that hypertension was associated with a 23% increase in the risk of dying from cancer. Those researchers found an association between hypertension and an increased risk of developing renal cancer, but not with cancer at any other site. The adjusted odds ratio for renal cell cancer among hypertensive patients, relative to their normotensive counterparts, was 1.75.

One of the coauthors on that meta-analysis, Franz H. Messerli, MD, FACC, FACP, professor of clinical medicine at the Columbia University College of Physicians and Surgeons and division of cardiology at St. Luke's-Roosevelt Hospital in New York City, was asked to comment on the study by Dr. Van Hemelrijck's team. "Since this is the largest study so far linking hypertension to cancer, it has be looked at thoroughly. However, in my opinion, the issue remains a can of worms," he told Medscape Medical News.

"We should remember that hypertension may not only be a proxy for an unhealthy lifestyle, as the authors state, but also a proxy for more frequent visits to physicians. The more often patients are seen by physicians, the greater the odds of malignancies being diagnosed," Dr. Messerli explained.

In addition, he pointed out that "patients with hypertension are commonly on antihypertensive therapy for years and decades. The long-term safety of antihypertensive drugs has not been well documented, since most safety studies only last 3 to 5 years. The present study did not provide any information on antihypertensive treatment. Thus, we don't know whether the link between hypertension and cancer was due to the blood pressure elevation per se, its treatment with various drugs, the "unhealthy lifestyle," or even to the more frequent physician visits."

"Clearly, studies like this one,...however thorough and well done, may create more heat than light and are prone to confuse patients and physicians alike," Dr. Messerli opined.

Modest Effect

Jan Willem Coebergh, MD, PhD, professor of cancer surveillance at the Eindhoven Cancer Registry in the Netherlands, and spokesperson for the European CanCer Organisation, said in a statement that "this extensive population-based study on the role of concomitant hypertension shows that it has a modest effect on the risk of certain cancers, especially the kidney and colorectum, but it is probably a smaller effect than that caused by diabetes and various vascular conditions."

Franco Berrino, MD, from the Instituto Nazionale Tumori in Milan, Italy, and spokesperson for the European Society of Medical Oncology, said that "there is increasing evidence that metabolic syndrome is associated with a higher risk of developing cancer, as well as other chronic diseases. As an unhealthy lifestyle is a major determinant of hypertension, these results from the highly productive Me-Can project add to the evidence that lifestyles affect both the risk and prognosis of cancer."

2011 European Multidisciplinary Cancer Congress (EMCC): Abstract 4LBA. Presented September 27, 2011.

Source: Medscape

Red wine may not lower blood pressure say researchers

Red wine may not lower blood pressure say researchers

We have been told a lot that a moderate intake of red wine is good for your heart health.  Some studies have suggested a glass a day lowered your heart disease risk.  The health benefits are said to come from antioxidants called polyphenols.  However, now Dutch researchers have found that the polyphenols don't seem to promote heart health by reducing blood pressure. "Our findings do not support [the idea] that potential cardiovascular benefits of red wine consumption result from blood pressure lowering by polyphenols," said researcher Ilse Botden, from Erasmus Medical Center in Rotterdam, Netherlands. The findings don't suggest red wine isn't still heart-healthy - just that it doesn't seem to work by lowering blood pressure.  The benefit of red wine and heart health, she says, ''apparently occurs in a blood pressure-independent manner." Botden presented her findings to the  American Heart Association's High Blood Pressure Research 2011 Scientific Sessions in Orlando.

Depression Raises Female Risk Of Stroke By 29%

Adult females with clinical depression are 29% more likely to suffer a stroke than other women of the same age without depression, according to an article published in the journal Stroke. The authors, from Harvard Medical School added that there is a 39% higher risk for those on SSRIs (selective serotonin reuptake inhibitors). Examples of SSRIs include Prozac, Celexa and Zoloft.

The investigators performed a six-year follow-up in the Nurses' Health Study, which included 80,574 females aged from 54 to 79 years. The study spanned from 2000 to 2006. None of the women had a history of stroke.  Dr. Kathryn Rexrode, a senior author, explained that the usage of anti-depressant medications could be an indication of the severity of depression.

Rexrode wrote:  "I don't think the medications themselves are the primary cause of the risk. This study does not suggest that people should stop their medications to reduce the risk of stroke."  The investigators assessed depressive symptoms on various occasions. They used a Mental Health Index. Starting in 1996, patient anti-depressant usage was reported every two years. Physician diagnosed depression reporting began in 2000.

For this study, depression was defined as either being currently diagnosed with the disorder or having a history of depression.

At baseline, 22% of those studied had depression. There were 1,033 cases of stroke during the six-year follow-up.  The authors wrote that women with depression were more likely to be less physically active, they had a higher BMI (body mass index), single, younger and regular smokers, compared to other women (without depression or a history of it).

A higher-than average number of women also had coexisting conditions, such as heart disease, diabetes and high blood pressure (hypertension).  Rexrode wrote:  "Depression can prevent individuals from controlling other medical problems, such as diabetes and hypertension, from taking medications regularly or pursuing other healthy lifestyle measures such as exercise. All these factors could contribute to increased risk."

Senior author An Pan PhD said that several mechanisms may be involved in raising the risk of stroke, including an underlying vascular disease in the brain, or inflammation.

An Pan stated:  "Regardless of the mechanism, recognizing that depressed individuals may be at a higher risk of stroke may help the physician focus on not only treating the depression, but treating stroke risk factors such as hypertension, diabetes and elevated cholesterol as well as addressing lifestyle behaviors such as smoking and exercise.

We cannot infer cause or fully exclude the possibility that the results could be explained by other unmeasured unknown factors. Although the underlying mechanisms remain unclear, recognizing that depressed women may be at a higher risk of stroke merits additional research into preventive strategies in this group."

The researchers concluded:  " Our results suggest that depression is associated with a

moderately increased risk of subsequent stroke."

Written by Christian Nordqvist
Copyright: Medical News Today

Food Hospital. Do you have blood pressure and live and work in London or the South East?

Channel 4 are currently working on a new food programme called Food Hospital.  They are looking for potential participants who are concerned about their health and would be willing to look at ways foods can help them control things like high blood pressure and cholesterol.  If you are interested, you can email foodhospital@betty.co.uk.

More information http://www.channel4.com/info/press/news/medicinal-diets-under-microscope-in-the-food-hospital

Watch out for the ibuprofen if you are older with high blood pressure or coronary artery disease

Older patients with hypertension and coronary artery disease who use NSAIDs for chronic pain are at significantly increased risk of cardiovascular events, a new analysis shows.

An observational study found in a cohort of more than 22,000 patients, with a mean age of 66.1, chronic NSAID use was associated with a 47% increased risk of cardiovascular events compared to non-users.  The trial was conducted with data from the hypertension trial INVEST, a trial comparing treatment with and without a calcium channel blocker in patients with hypertension and coronary artery disease.

Researchers asked each patient about their use if NSAIDs at every follow-up visit and patients who reported NSAID use at every visit were identified as chronic users, while all others were identified as non-chronic users.  After a mean follow-up of 2.7 years the researchers compared the 882 chronic NSAID users with the 14,408 non-users.

The primary outcome of all-cause death, non-fatal myocardial infarction or non-fatal stroke occurred at a rate of 4.4 events per 100 patient-years in chronic NSAID users and 3.7 events per 100 patient-years in non-chronic NSAID users, a 47% increased relative risk due largely to a 2.3-fold increase in the risk of cardiovascular mortality.  Lead author Dr Anthony Bavry, a cardiologist at the University of Florida, concluded: ‘Among hypertensive patients with coronary artery disease, chronic self-reported use of NSAIDs was associated with an increased risk of adverse events during long-term follow-up.'

Dr Barry said: ‘We found a significant increase in adverse cardiovascular outcomes, primarily driven by an increase in cardiovascular mortality. This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern.  ‘When I see patients like these… I try to get them to switch to an alternative agent, such as paracetamol, or if that's not possible I at least try to get them to reduce the dose of NSAID or the frequency of dosing. But ultimately it's up to them if this potential risk is worth taking.'

Am J Med. 2011 Jul;124(7):614-20.

Climbing the greasy class pole might be a healthy thing to do

Social climbing could be good for your blood pressure, a study has suggested.

Swedish researchers, writing in the Journal of Epidemiology and Community Health, looked at the blood pressure of 12,000 same sex twins and the social status of them and their parents.  Those born with lower socioeconomic status who then moved upwards had lower incidence of high blood pressure than those who remained in a poorer class.

One theory says moving into a different social bracket than that of your family and the people you grow up with causes added stress, while another argues that "social climbing" will in itself improve health chances.

In this study, researchers from the Karolinska Institute used data from the Swedish Twin Registry to track adult and parental socioeconomic status among 12,000 same sex twins born between 1926 and 1958.

A postal survey on health and lifestyle was carried out in 1973, and a phone interviews were conducted between 1998 and 2002 as part of the Screening Across the Lifespan Study (SALT).

Questions included any treatment for high blood pressure. Parental occupations were obtained from birth records, which routinely contain this type of information in Sweden.

Environment

Compared with those who stayed on the lower rungs of the social ladder, those who rose up were less likely to have high blood pressure - 12.5% of those who moved up compared to 15.4 who did not.  Overall, people with a low socioeconomic status were more likely to have high blood pressure (17.1%) than those of a high status (12.9%).  Writing in the journal, the team led by Dr Lovisa Hogberg, said: "These findings suggest that the risk of hypertension associated with low parental social status could be modified by social status later in life.

"This could possibly be targeted by early introduced public health or political interventions."  Cathy Ross, senior cardiac nurse at the British Heart Foundation, said: "This study adds further evidence that socioeconomic differences influence our health.  "Low socioeconomic status can increase the risk of poor health and in particular risk factors associated with heart disease such as high blood pressure.

"Furthermore, there is increasing evidence that improving people's socioeconomic status can help improve their health awareness and reduce the health risks associated with their environment."

"Action is needed at a national and local level to close the heart health gap between affluent and deprived groups, and to make sure people aren't left behind."

Where next for salt. Good or bad?

In an analysis that set off a fierce debate over the health effects of salt, researchers said on Wednesday they had found no evidence that small cuts to salt intake reduce the risk of developing heart disease or dying prematurely.  In a systematic review published by The Cochrane Library, British scientists found that while cutting salt consumption did appear to lead to slight reductions in blood pressure, that was not translated into lower death or heart disease risk.

The researchers said they suspected the trials conducted so far were not big enough to show any benefits to heart health, and called for large-scale studies to be carried out soon.  "With governments setting ever lower targets for salt intake and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake," said Rod Taylor of Exeter University, who led the review.

The Cochrane review attracted sharp criticism from nutrition experts. Francesco Cappuccio, head of the World Health Organisation's collaborating centre for nutrition at Warwick University, said it was "a surprisingly poor piece of work".  "This study does not change the priorities outlined worldwide for a population reduction in salt intake to prevent heart attacks and strokes, the greatest killers in the world," he said in an emailed comment.

Simon Capewell, a professor of Clinical Epidemiology at Liverpool University, said the review was "disappointing and inconclusive" and did not change public health consensus that dietary salt raises blood pressure.  Most experts are agreed that consuming too much salt is not good for you and that cutting salt intake can reduce hypertension in people with normal and high blood pressure.

Many developed nations have government-sanctioned guidelines calling on people to cut their salt or sodium intake for the sake of their longer-term health. The World Health Organisation (WHO) lists reducing salt intake among its top 10 "best buys" for reducing rates of chronic disease.

In Britain, the National Institute of Health and Clinical Guidance (NICE) has called for an acceleration of the reduction in salt in the general population from a maximum intake of 6 grams(g) a day for adults by 2015 to 3g by 2025.

U.S. guidelines recommend Americans consume less than 2.3g of salt daily, or 1.5g for certain people who are more at risk for high blood pressure or heart disease.  While previous trials have found there is a blood pressure benefit from cutting salt, research has yet to show if that translates into better overall heart health in the wider population. High blood pressure, or hypertension, is a major risk factor for cardiovascular diseases -- the leading causes of death worldwide.

Taylor said he thought it did not find any evidence of big benefits because the numbers of people studied and the salt intake reductions were relatively small.  "The people in the trials we analysed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large," he said.

For this review, Taylor's team found seven studies that together included 6,489 participants. This gave the researchers enough data to be able to start drawing conclusions, they said. But even so, the scientists think they would need to have data from at least 18,000 people before they could expect to identify any clear health benefits.

Elaine Rush, a professor of nutrition at Auckland University of Technology in Australia, said that putting a spotlight on single trials and generalising dietary advice for a single nutrient such as salt was "not helpful".

"What is helpful is for the food industry to reformulate products to reduce sodium and increase the nutrient quality of foods by using real ingredients," she said in an emailed comment.

More than one blood pressure measurement is necessary for accuracy

Accurate blood pressure assessment requires multiple measures regardless of whether it is measured at home, in a clinic, or in a research setting, according to findings from a study of more than 400 veterans. In a secondary analysis of a randomized trial, within-patient variability in blood pressure readings decreased and certainty about the true reading was enhanced as the number of measurements increased, according to Benjamin Powers, MD, of the Durham VA Medical Center in North Carolina, and colleagues.  "In hypertension, simple changes in the setting and number of blood pressure measurements used for decision making could greatly enhance the personalization of care," they wrote in the June 21 issue of Annals of Internal Medicine. "If providers are supposed to rely more on averaged measurements, new ways of capturing and presenting these data at the point of care are needed," Powers and his colleagues added.  "Calculated averages from home monitors, blood pressure control charts that visually display the signal–noise relationship, or personalized algorithms that account for each patient's own variability may improve the interpretation of blood pressure and facilitate more informed and individual decisions." Clinicians often cite uncertainty about a patient's true blood pressure based on clinic measurements as a common reason for not changing therapy, according to the researchers. To look at the certainty with which a patient's blood pressure can be determined using various methods, Powers and his colleagues performed a secondary analysis of the Hypertension Intervention Nurse Telemedicine Study (HINTS), which was conducted in primary care clinics affiliated with the Durham VA Medical Center.  The current analysis included 444 veterans with hypertension. Their mean age was 64, most were men (92%), and three-quarters had hypertension for at least 10 years.  Blood pressure was measured repeatedly throughout the 18-months study in three ways -- standardized study blood pressure readings at six-month intervals, clinic readings during outpatient visits, and home readings using a monitor that transmitted measurements electronically. Rates of systolic blood pressure control (a mean of less than 140 mm Hg for clinic or research measurements and less than 135 mm Hg for home measurements) varied greatly between the strategies, with 28%, 47%, and 68% considered under control by clinic, home, and research measurements, respectively. Half of the patients had a mean clinic reading that was 10 mm Hg greater than their mean home reading. Within-patient variability was substantial as well, with a mean coefficient of variation of 10% across all three randomized groups.  A single systolic blood pressure reading from 120 to 157 mm Hg could not be used to classify blood pressure control with 80% certainty. However, within-patient variation decreased and certainty about the true blood pressure value improved as the number of measurements increased. The largest improvement occurred when a second reading was added, with little additional precision beyond four to six measurements. The findings show that hypertension quality metrics based on a single clinic measurements -- as practiced within the Healthcare Effectiveness Data and Information Set of the National Committee for Quality Assurance -- may misclassify a large proportion of patients in terms of blood pressure control. The study "highlights the benefits of recording and averaging high-quality blood pressure measurements across several visits," according to Lawrence Appel, MD, MPH, of Johns Hopkins University, and colleagues. Although the cost of getting repeated measurements across clinic visits is a concern, they wrote in an accompanying editorial, home blood pressure readings improve precision to a similar extent. "Hence, a benefit of home blood pressure measurement is frequent... readings that can be averaged and can potentially obviate the need for repeated clinic visits," they wrote. Appel and his colleagues advocated "a regulatory approach in which professional organizations include blood pressure measurement as a performance metric" and pointed out that health-information technologies could be used to automatically calculate average blood pressure from previous visits. "It is time to get serious about blood pressure measurement," they wrote.  Powers and his colleagues noted some limitations of the study, including the use of patients who were mostly male, had a long-standing history of hypertension, and had a history of poor blood pressure control.  The study was supported by a grant from the U.S. Department of Veterans Affairs Health Services Research and Development Service. Powers is supported by a U.S. Department of Veterans Affairs Career Development Award. One of his co-authors is supported by an Established Investigator Award from the American Heart Association and a U.S. Department of Veterans Affairs Health Services Research and Development Service Career Scientist Award.  Powers and two of his co-authors reported receiving grant money through their institution from the U.S. Department of Veterans Affairs Health Services Research and Development Service. One of the other study authors reported being employed by the Medical University of South Carolina and the University of Iowa.

Primary source: Annals of Internal Medicine Source reference: Powers B, et al "Measuring blood pressure for decision making and quality reporting: where and how many measures?" Ann Intern Med 2011; 154: 781-788. Additional source: Annals of Internal Medicine Source reference: Appel L, et al "Improving the measurement of blood pressure: Is it time for regulated standards?" Ann Intern Med 2011; 154: 838-839.

Hypertension common amongst young people

In the NIH-funded National Longitudinal Study of Adolescent Health (Add Health), the prevalence of hypertension in 24- to 32-year-olds was 19% in 2008, according to Quynh Nguyen, MSPH, a doctoral student at the University of North Carolina's Gillings School of Global Public Health in Chapel Hill, and colleagues.  That compares with a rate of 4% among young adults participating in the National Health and Nutrition Examination Survey (NHANES) for a similar time period, the researchers reported online in Epidemiology.

"We tend to think of young adults as rather healthy, but a prevalence of 19% with high blood pressure is alarming, especially since more than half did not know that they had high blood pressure," Harris said.  Although the issue warrants further study, she added, "we think that the prevalence probably lies somewhere in between these two estimates."

Add Health was started in 1994-1995 by enrolling more than 20,000 U.S. adolescents in middle school and high school. The students have been followed up periodically since then, most recently with Wave IV in 2008, when researchers began collecting in-home blood pressure measurements.  For comparison, the researchers used participants of similar age from NHANES 2007-2008. The cross-survey comparison included 14,252 Add Health participants and 733 NHANES participants.

Both the rate of blood pressure of 140/90 mm Hg or greater (19% versus 4%) and mean blood pressure (125/79 mm Hg versus 114/67 mm Hg) were higher in Add Health than in NHANES, which remained consistent in all sociodemographic subgroups.

Survey weights and propensity for differential selection into Add Health did not account for the different rates of hypertension observed in the two studies.

After adjustment for numerous participant characteristics, examination time, use of antihypertensives, and consumption of food, caffeine, and cigarettes before blood pressure measurement, there was still a significantly increased likelihood of hypertension in Add Health (OR 6.6, 95% CI 4.0 to 11.0).

The researchers then examined other potential methodologic concerns, including digit preference, validity, reliability, measurement context, and interview content.

"We looked at numerous possible explanations, and we're not able to explain the difference," Harris said. "We've ruled out any possible explanation that's due to the design of the study or the characteristics of the people in the study."  In their paper, the researchers called their results robust, but acknowledged that such a high rate of hypertension in young adults raises questions about biologic plausibility.

They added, however, that even higher rates of hypertension have been seen among Latin American and Caribbean men.  "Prior findings in the global context suggest that [the hypertension rates] are neither biologically implausible nor without epidemiologic precedent," they wrote.  There were some limitations of the study, including the fact that the validity of blood pressure measurements was not monitored on an ongoing basis, and that the sample size was not large enough to provide adequate power to look at subgroup differences in the reliability of blood pressure measurements.  In addition, the proportion of Add Health participants defined as having hypertension based on elevated blood pressure alone may have been affected by variation in blood pressure measurement.

Source: MedPage Today

High blood pressure: stand up coffee, alcohol and lack of exercise!

Evidence continues to build that lifestyle modifications help control blood pressure (BP) levels. Data evaluating the consumption of coffee and alcohol and the impact of low fitness levels will be presented at the American Society of Hypertension, Inc.'s 26th Annual Scientific Meeting and Exposition (ASH 2011) and will be featured in the May 22 ASH press briefing.

"It's critical that we fully understand how lifestyle factors impact the ability of patients and physicians to screen, diagnosis, and treat high blood pressure," explains ASH press briefing moderator Lawrence J. Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition) Director, Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Medical Institutions. "As we continue to develop our understanding of how diet and exercise choices impact hypertension, including the nuances among specific patient populations, we are gathering evidence to help us best counsel and advise our patients."

Studies highlighted in the press briefing include:

Coffee

Effect of Coffee on Blood Pressure and Cardiovascular Disease among Hypertensive Individuals:

Studies have shown that it is possible for caffeine to cause a short, but dramatic increase in your BP, even if you don't have high BP. A new meta-analysis shows that, among hypertensive individuals, caffeine intake of 1.5 - 2 cups produces an acute increase in BP, which lasts for at least three hours. However, present evidence does not support an association between longer-term coffee consumption and increased BP or increased risk of cardiovascular disease among patients with HBP.

In five trials, the administration of 200-300 mg caffeine (the content of 1.5-2 cups of filtered coffee) produced a mean increase of 8.2 mm Hg (95% confidence interval [IC] 6.2-10 mm Hg) in systolic BP and of 5.6 mm Hg (95% CI 4.2-6.9 mm Hg) in diastolic BP. The increase in BP was observed in the first hour after caffeine intake and lasted for at least three hours. In six trials on the longer-term effect (1 week) of coffee, there was no increase in BP when comparing caffeine versus placebo, coffee versus a caffeine-free diet, or coffee versus decaffeinated coffee.

"These results have clinical implications for the control of hypertensive patients. Because caffeine intake acutely increases blood pressure, hypertensive patients with uncontrolled blood pressure should avoid consuming large doses of caffeine. Also, the consumption of caffeine in the hours before measuring blood pressure may elevate the reading and give the erroneous impression that blood pressure is poorly controlled," explains lead study author, Esther Lopez-Garcia, PhD, Department of Preventive Medicine and Public Health, Autonoma University of Madrid, Spain. "Finally, in well-controlled hypertensive patients, there is no evidence to justify avoidance of habitual caffeine consumption and healthcare providers should emphasize other lifestyle modifications, such as maintaining weight control, increasing physical activity, and stopping smoking."

Alcohol

Alcohol Consumption and the Risk of Hypertension: A Systematic Review and Meta-Analysis. The Risk for Hypertension Increases Linearly with Alcohol Consumption in Men

Drinking too much alcohol can raise BP to unhealthy levels, especially among men. The meta-analysis evaluated a total of 16 prospective studies, which included 158,142 men and 314,258 women. Among men, a linear dose-response relationship between alcohol intake and risk of development of hypertension was noted. As compared to non-drinkers, men consuming < 10g/day of alcohol had a relative risk (RR) of 1.006, those consuming 10-20 g/day had a RR of 1.091, and those consuming > 30g/day had a RR of 1.416. Among women, the meta-analysis indicated protective effects at < 10g/day (RR -0.867) and 10-20g/day (RR - 0.904) of alcohol consumption, while the risk increased in women consuming > 30g/day (RR - 1.188). The risk of hypertension significantly increases with consumption of more than 30g/day in men in women alike.

"For patients, especially men, it's very important to ask about alcohol consumption and to recommend moderation when trying to maintain blood pressure control," explains Agarwal, MD, MPH, Department of Medicine, St. Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons.

Not enough exercise

Excessive Blood Pressure Elevation during Exercise Correlates with Low Fitness among Normotensive Firefighters. Lower Fitness is Associated with a Higher Risk of an Exaggerated Blood Pressure Response

Surprisingly, the leading cause of on- duty death among US firefighters (40% of cases) is coronary heart disease (CHD), rather than burns or smoke inhalation. The strain of suppressing a fire is associated with a markedly increased risk of cardiovascular mortality as compared to non-emergency duties and firefighters with low cardiorespiratory fitness are at increased risk for cardiovascular death. A study examined the prevalence of peak exercise hypertension among firefighters who do not have hypertension to see whether it correlates with low cardiorespiratory fitness.

The study evaluated 691 firefighters without hypertension and found that 14% (93) had an exaggerated BP response to exercise and 31.1% of the "exaggerated BP" firefighters were in a low fitness group, compared to 18% in the normal responders (p=0.016). Only 13.5% of "exaggerated BP" group had high fitness (third quartile) compared to 30.6% in the normal responders (p=0.0024). Thus, lower fitness is associated with a higher risk of an exaggerated BP response.

"Firefighters present a unique opportunity to evaluate the role of fitness and its association with high blood pressure at peak exercise ," explains lead study author, Adi Leiba, MD, MHA, Fellow, Nephrology and Hypertension, Sheba Medical Center, Israel Clinical Instructor, Mount Auburn Hospital, Harvard Medical School, Boston, MA. "This data is important because it provides further evidence that improved fitness helps control blood pressure spikes, including those spikes during exercise and stress."

Source:American Society of Hypertension (ASH)

Passive smoking may raise blood pressure in boys.

Passive smoking can raise blood pressure levels in boys, scientists have found. This will put them at higher risk in later life of hypertension – which is itself associated with a greater chance of developing heart and kidney disease.  In her study, Jill Baumgartner of the University of Minnesota's Institute on the Environment looked at more than 6,400 children aged eight to 17 who had been exposed to secondhand tobacco smoke. She found an average rise of 1.6 mmHg – or a 1% increase on average healthy levels – in the systolic blood pressure of boys who had been exposed to secondhand smoke compared to boys who had not.

"For that individual child, it won't have a huge impact," said Mike Knapton, associate medical director at the British Heart Foundation. "But, if you've got two million kids with a 1% increase, you start to see changes in the prevalence of respiratory disease, heart disease and cancer."  Baumgartner, who presented her work on Sunday at the annual meeting of the Paediatric Academic Societies in Denver, Colorado, said more than a third of children in the US and globally were exposed to secondhand smoke levels similar to those associated with adverse cardiovascular effects in her study.

Previous research has linked secondhand smoke and increased blood pressure in adults, but the effect had not been measured in children.  Systolic pressure is the maximum during a heartbeat and measures the surge of blood when the heart contracts. A healthy level in adults is about 120mmHg but the level changes for children as they grow older. Knapton said a one-month-old child's average systolic blood pressure was 60mmHg, rising to 115mmHg at 15.

"We know blood pressure tends to track upwards as you get older – my blood pressure will be greater now than as a child," he said. "The higher you start, the higher it gets to when you're an adult and we know that, in adults, high blood pressure is a risk factor for heart disease.

"The assumption might be that, if you're pushing your children's blood pressure up in childhood, that will put them at greater risk of blood pressure as an adult, which will put them at higher risk of heart disease and stroke."  Baumgartner's work showed that, unlike boys, girls exposed to secondhand smoke had lower systolic blood pressures than girls who were not – by 1.8 mmHg on average.

"These findings support several previous studies suggesting that something about female gender may provide protection from harmful vascular changes due to secondhand smoke exposure," she said. "An important next step is to understand why."

The researchers collected information on passive smoking from questionnaires conducted by the US Centres for Disease Control and Prevention between 1996 and 2006. The surveys collected information on which children lived with smokers and also on the levels of cotinine in a child's blood, which is a byproduct of the metabolism of nicotine by the body and seen as a reliable marker for exposure to tobacco smoke.
Baumgartner said the relationship between secondhand smoke exposure and blood pressure observed in her study provided "further incentive for governments to support smoking bans and other legislation that protects children from secondhand smoke".

Knapton said passive smoking was only part of the story. "There has been an association between cot death and smoking in the home – 86% of cot deaths occur in families where the mother smokes," he said.
"We know that children from families that smoke are more likely to smoke themselves. Children who live with two adult smokers are four times more likely to be smokers themselves than children who live with non-smokers."

Source: The Guardian

Faith probably doesn't lower your blood pressure

Although faith in a higher power may bring you great comfort, leading a religious life won't help reduce high blood pressure, a small study suggests.  In fact, the study found that people who tried to incorporate religion into all aspects of their lives were the most likely to have high blood pressure, also known as hypertension.

But, that doesn't mean that church attendance or a deep faith can cause high blood pressure.

"I don't think the take-home message from this study is that church is causing hypertension," said one of the study's authors, Amy Luke, an associate professor in the department of preventive medicine and epidemiology at Loyola University Chicago Stritch School of Medicine.  "It may be that the people who attend church the most have a stronger social network, which may make them more aware of their health and more likely to have their blood pressure checked," Luke theorized. She added that more research needs to be done to better understand why being more religious was related to a greater incidence of high blood pressure in this study.

Results of the study, which was mainly conducted by medical students led by student Laura Heinrich, were scheduled to be presented Saturday at the Society of Teachers of Family Medicine meeting in New Orleans.
Previous research has suggested a link between religious activity and lower blood pressure levels. In addition, religious activity can likely reduce stress, hostility, depression, hopelessness and loneliness, which have been linked to raised blood pressure levels. Having a strong social network, as you might find in a community church, has also been linked to better health, according to the study's authors.

The new study was a subset of a larger study designed to assess how the economic downturn has affected people's health. It was conducted in an area of Chicago that's relatively low income, according to Luke.
Two hundred people participated in the study. All were black and 52 percent were male. The average age was 42 years old, and nearly 29 percent were taking medication to treat high blood pressure.

Fifty-eight percent said they attended church at least a few times a month, and 35 percent of those people attended at least once a week. Forty-five percent of the study volunteers said they spent private time on religious activities, such as prayer, meditation or Bible study, the investigators found.

All of the study volunteers completed a 65-point interview and religiosity was measured using the Duke University Religion Index, which asks participants to respond "true," "tends to be true," "unsure" or "not true" to statements such as "In my life, I experience the presence of the Divine" or "My religious beliefs are what really lie behind my whole approach to life."

Thirty-five percent of those who said religion carried over to all parts of their lives had high blood pressure compared to 19.6 percent of those who said that religion didn't carry over, according to the report.
Luke said that Heinrich and the other medical students were quite surprised by their findings. They had expected to see an association between religion and lower blood pressure.
"I think the whole issue of religion and health is really complex," said Luke.

Dr. Jonathan Whiteson is director of the Cardiac and Pulmonary Wellness and Rehabilitation Program at NYU Langone Medical Center in New York City. He said: "I didn't think this study was so surprising. There's been a lot of conflicting data on religion and blood pressure and cardiac disease as well. It's a confusing area, and depending on how the studies are conducted, you may see different results.
"Generally, it seems that religion should have positive health benefits. People who aren't socially isolated tend to take better care of themselves," he added.  "But, there's been research on both sides -- positive and negative," said Whiteson, adding that it's definitely an area that needs further research.

Because this study was presented at a medical meeting, the findings should be viewed as preliminary until they are published in a peer-reviewed journal.

Source: Healthday News

Coffee may not be bad for your blood pressure

High blood pressure has been linked to heart disease, stroke, and a shorter life expectancy, and some scientists have suggested that coffee might fuel the problem.  Despite earlier concerns, downing lots of coffee doesn't seem to increase the risk of high blood pressure, according to a new report -- but the evidence isn't conclusive.  Just more than one in five participants eventually developed high blood pressure, according to the findings, which appear in The American Journal of Clinical Nutrition. 

But the chance of being diagnosed with the condition was no different between people who said they chugged more than five cups of coffee per day and those who drank very little.  Still, the report "is not saying there's no risk" to drinking lots of java, Dr. Liwei Chen, who worked on the study, told Reuters Health.  Chen, from the Louisiana State University School of Public Health in New Orleans, said more data would be needed to draw a firm conclusion. 

What's more, people who drank between one and three cups per day had a slightly higher risk of high blood pressure than those who drank less -- a result the researchers couldn't explain.  Dr. Lawrence Krakoff, who studies high blood pressure at the Mount Sinai Medical Center in New York, said that the question about coffee's effects "keeps popping up" among both his patients and fellow doctors.  But it has yet to be answered completely, said Krakoff, who was not involved in the new work. 

Dr. Gary Curhan, who worked on one of the studies Chen and her colleagues looked at, agreed.  "There may be other adverse effects to (drinking) large amounts of caffeine," Curhan, of Brigham and Women's Hospital in Boston, told Reuters Health.  But based on the existing data, he said there is no reason to believe that drinking coffee would lead to high blood pressure.  Chen's team could not compare the effect of drinking caffeinated versus decaffeinated coffee, as some of the studies they analyzed had participants report both together or only asked about caffeinated coffee.

The new report pools data from six previous studies that included more than 170,000 people in total. For each study, scientists surveyed the participants to find out how many cups of coffee they drank each day -- from less than one to more than five -- and then followed them for up to 33 years.

"I don't think of coffee as a risk factor for" high blood pressure, he told Reuters Health. However, "If people are drinking 12 cups a day and aren't sleeping, I assume that that's an important issue."



SOURCE: Reuters Health / bit.ly/e9ntfJ The American Journal of Clinical Nutrition, online March 30, 2011.