Thousands impacted by "white coat" hypertension

Many patients believed to have hard-to-treat high blood pressure may actually be suffering the effects of doctor-induced nerves, a study has found.  So-called 'white coat syndrome' can result in blood pressure going up when people visit a doctor's surgery.

The new findings suggest the phenomenon may affect a third of patients who appear not to be responding to drugs for high blood pressure, or hypertension.  Researchers made the discovery after monitoring the blood pressure of almost 70,000 patients with diagnosed hypertension as they went about their daily lives.

In total, 37 per cent of around 8,000 patients previously found to be resistant to treatment turned out to have 'white coat syndrome'.  Their blood pressure rose when they visited the doctor, giving the misleading impression that their treatment was not working.

Researchers asked patients to wear a portable device that takes blood pressure readings every 20 minutes day and night. The procedure is known as 'ambulatory blood pressure monitoring'.  Study leader Dr Alejandro de la Sierra, from the University of Barcelona in Spain, said: 'Physicians should be encouraged to use ambulatory monitoring to confirm resistant hypertension in their patients as it would ensure the most effective treatment options are used.

'Patients benefit by knowing whether their blood pressure is normal during daily activities or still needs the reinforcement of dietary and drug measures.'  The research, published in the American Heart Association journal Hypertension, showed that more women than men - 42 per cent compared with 34 per cent - were affected.

Patients with "true" resistant hypertension included higher numbers of smokers, diabetics and individuals with heart conditions.  'Those with true resistant hypertension showed high blood pressure at work, during the day and at night,' said Dr De la Sierra.  'The true resistant group also was more likely to have blood pressures that abnormally rose during the night when they were sleeping.'  Ellen Mason, senior cardiac nurse at the British Heart Foundation, said: 'High blood pressure increases the risk of having a heart attack or stroke and so treating high blood pressure, whether through lifestyle changes or medication, is vital.  'This study looked at a minority of people who still had high blood pressure despite being on at least three drugs to treat it.

'Visiting the doctor seemed to make some people falsely appear resistant to the effects of these drugs so the study was helpful in trying to identify which people seemed to be truly resistant and therefore more at risk of organ damage.  'It also adds weight to new draft guidelines to include a home blood pressure test for hypertensive patients here in the UK.

'More worryingly though, nearly half of us who do have high blood pressure in the UK are not being treated for it.  While the increasing use of home blood pressure monitoring is helpful for some, it will not target those who are unaware of the silent condition because it may have been many years since they had their blood pressure taken or because they simply think they are not at risk.'  The National Institute for Health and Clinical Excellence (Nice), which issues guidelines on NHS treatments, has proposed that people with two high blood pressure readings should take a third at home to rule out 'white coat syndrome'.

Source: Daily Mail

Laughter and music can lower blood pressure

Laughter and music not only lift the mood, they might also drop blood pressure among middle-aged adults, a new study suggests.  Japanese researchers divided 79 adults, aged 40 to 74, into three groups, studying the effects of one-hour music sessions every two weeks on one group, laughter sessions on another group, and no intervention for the remaining participants (the control group).

Blood pressure readings taken immediately after the sessions were 6 mm Hg lower in the music group and 7 mm Hg lower among the laughter participants compared to measurements taken just prior to the sessions, the study authors said.  Improvements in blood pressure were still seen three months later, according to the results.  No change in blood pressure was recorded among participants who received neither intervention.

"The [participants'] cortisol level, a stress marker, decreased just after the intervention sessions," said lead author Eri Eguchi, a public health researcher at Osaka University's Graduate School of Medicine in Japan. "We think this is one of the explanations for the physiological processes."  The results of Eguchi's study were scheduled for presentation Friday at an American Heart Association conference in Atlanta. The study does not show a direct cause and effect, merely an association. Also, experts say that research presented at meetings is considered preliminary because it has not been subject to the rigorous scrutiny required for publication in a medical journal.

For three months, music therapists guided 32 participants in listening to, singing and stretching with music. They were also encouraged to listen to music at home.  Laughter sessions were led by trained laughter yogis, with 30 participants performing laughter yoga -- a combination of breathing exercises and laughter stimulated through playful eye contact -- and listening to Rakugo, Japanese sit-down comedy.

"We think yoga breathing may play some role for lowering blood pressure," Eguchi said, noting that his team will examine the link in upcoming research.  "Also, people with intervention may be more motivated to modify their health behaviors," Eguchi added. "The data showed that the amount of exercise increased in the intervention group, but not in non-intervention group."

Dr. Franz Messerli, director of the hypertension program at St. Luke's-Roosevelt Hospital Center in New York City, said he was skeptical of the results because the researchers knew all along which participants were in the intervention and control groups.  "The mechanisms involved [in lowering blood pressure] are not entirely clear," Messerli said. "Exercise does the same thing, and just sitting down will lower blood pressure, too."

Messerli said Eguchi could have "objectivated" the results by measuring participants' blood pressure over 24-hour periods before and after intervention sessions.  But Dr. John Ciccone, a preventive cardiologist at Saint Barnabas Medical Center in West Orange, N.J., contended that the study highlights "interesting physiology" about the role stress plays in blood pressure.

In Ciccone's practice, holistic nurses offer music therapy for stress management, a growing field that can incorporate techniques such as reflexology, acupressure and others, he said.  "I think there has been interesting data that shows that relaxation techniques, regardless of the technique, can possibly affect borderline elevated blood pressure," Ciccone said.  "They're not outside the mainstream anymore," he added. "I think a lot of what was considered alternative is no longer alternative."

Source: Drugs.com

Exercise counteracts impact of salt in high blood pressure

Regular exercise and a low-sodium diet are two lifestyle changes that are often recommended to lower high blood pressure.  Now a new study shows that one appears to influence the other.  Specifically, physical activity appears to help keep blood pressure from climbing after people eat eye-popping amounts of salt -- 18,000 milligrams a day to be exact. That’s about 10 times the recommended daily intake for sodium.

That’s much more than most people ever come close to, so some experts question whether the findings of the study could be applied to the real world.  “Because the high salt part of this was so high salt, I’m not sure you can gain any insight into what you can do on a daily basis, eating a normal diet,” says A. Marc Gillinov, MD. Gillinov is a staff cardiac surgeon at the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic, in Ohio.

But Gillinov also says that the study is interesting because it is among the first to look at the relationship between physical activity and salt sensitivity and that it adds to what’s already known about how to keep blood pressure within healthy limits.

“The exact mechanism by which salt influences blood pressure is not completely worked out,” he tells WebMD. “But there’s no question that over the course of years, the more salt you eat, the more likely you are to get high blood pressure as you get older, as you get to be a middle-aged or older adult.”

For the study, which was presented at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions,researchers recruited more than 1,900 Chinese adults with a family history of prehypertension or stage 1 hypertension (blood pressure between 140/90 and 159/99 mmHg). The average age of study participants was 38.

They then had participants follow two one-week diets. One diet was 3,000 milligrams of salt a day and the other was 18,000 milligrams a day.  If participants’ blood pressure rose by 5% from the lower to higher salt weeks, they were considered to be salt sensitive.

Researchers also looked at how much physical activity the participants reported on questionnaires.

They found that the more physical activity a person got, the less likely they were to be sensitive to salt.  Study participants in the group that got the most physical activity had a 38% lower risk of being salt sensitive compared to those who got the least amount of physical activity.  The researchers, who were from China and Tulane University in New Orleans, said that their results needed to be repeated, but if other studies could duplicate the finding, that would point to a need for sedentary people, in particular, to eat a low-salt diet.

Even better, Gillinov says, would be for physically inactive people to get moving and watch their sodium.

“These are two things that affect blood pressure, salt intake and exercise, and for your health and for your heart, do your best on both fronts.”

Source: WebMD

Forget the toast - go for the cereal to lower your blood pressure

Starting each day with a bowl of cereal -- especially a whole-grain variety -- could trim up to 20% off your risk of developing high blood pressure, according to preliminary research presented Tuesday at an American Heart Association meeting in Atlanta.

High blood pressure, or hypertension, can be caused or worsened by a range of factors, including obesity, lack of exercise, too much sodium, and stress. Although cereal alone won't keep blood pressure in check, eating it regularly may be an easy and practical way to prevent hypertension, the researchers say.

"Cereal is something that people can easily get into their diet and that they enjoy," says lead researcher Jinesh Kochar, M.D., a geriatric specialist at Beth Israel Deaconess Medical Center, in Boston. "And it costs a lot less than the drugs you'd have to take if you had hypertension."

Cereals made from whole grains appear to protect against hypertension slightly more than those made from refined grains (which have had their fiber- and nutrient-rich parts removed), the study found.

Julie Miller Jones, Ph.D., a professor of nutrition at the College of St. Catherine, in Minneapolis, says that cereal may be a better source of whole grain than bread and other foods because of how it tends to be served. "Usually with cereal you don't add a source of saturated fat, while you might add something like sausage to bread," says Jones, who points out that the study did not control for saturated-fat intake. Jones was not involved in the new research.

In addition, the nuts, raisins, or fruit often added to cereal contain fiber and potassium, both of which can help lower blood pressure. Milk's effects on blood pressure can't be discounted either, Jones says. "It may be more about the way you put the breakfast together than anything magical about breakfast cereal."

Kochar and his colleagues analyzed data on more than 13,000 men who were part of the long-running Physicians' Health Study, which is funded by the National Institutes of Health. All the participants had normal blood pressure and averaged 52 years old at the start of the study. Over the next 17 years, more than half developed hypertension.

Compared with men who never ate cereal, those who averaged one serving per week had a 7% lower risk of hypertension. Those who consumed cereal more frequently had even greater reductions in risk: Two to six weekly servings were associated with an 11% lower risk, and one or more servings per day were associated with a 19% lower risk. (To pinpoint the effect of the cereal, the researchers took several other risk factors for hypertension into account, including age, smoking history, fruit and vegetable consumption, and physical activity.)

Although the food questionnaires used in the study did not ask about specific brands of cereals, popular brand-name cereals made from refined grains include varieties of Corn Flakes, Special K, and Rice Krispies, while examples of whole-grain cereals include Cheerios, shredded wheat, and bran.

More research will be needed to determine whether cereal is associated with a lower risk of hypertension in women, too, Kochar says. Although previous studies have shown that women derive heart benefits from whole grain, the findings can't be immediately generalized beyond men.

Roughly 1 in 3 adults in the U.S. has hypertension, which is a major risk factor for heart attacks, strokes, and kidney problems. The AHA estimates that hypertension costs the country an estimated $90 billion in health-care and other costs each year.

Kochar presented his findings at the AHA's annual conference on nutrition, physical activity, and metabolism. Unlike the studies published in medical journals, the research presented at the meeting has not been thoroughly vetted by other experts.

Source: CNN

Blood pressure may impact on walking speed of the elderly

Researchers have found a link between high blood pressure and a greater drop in average walking speeds in older adults, according to results from a new National Institutes of Health-funded study. The drop seems to occur even in study participants whose high blood pressure is successfully treated. Drastic changes in walking speed can impact a senior’s ability to remain independent and indicate possible health problems.


The study examined the role of brain, heart, and kidney function in changes in seniors' walking speeds over 14 years. Participating seniors, with an average age of 76 at the start of the study, who had high blood pressure, saw their average walking speeds decline 0.2 miles per hour more than seniors who did not have high blood pressure. The study will appear in the March edition of the Journal of the American Geriatric Society.

"The findings from this study suggest an additional reason to stress prevention of high blood pressure," said Susan B. Shurin, M.D., acting director of the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH. "Even with medications to treat high blood pressure in older adults, it appears that the condition might be linked to a serious decline in average walking speed. As the mobility of seniors declines, there is an increased risk for falls."

About one-third of adults in the United States have high blood pressure, also known as hypertension, which can lead to coronary heart disease, heart failure, stroke, and kidney failure.  The University of Pittsburgh's Caterina Rosano, M.D., led the research as part of the Cardiovascular Health Study, which the NHLBI began funding in 1989 to help understand risk factors for cardiovascular disease in older adults.
Of the 643 participants in Rosano's study, 350 did not have high blood pressure, while 293 had undiagnosed hypertension or were taking medication for the condition. The study's hypertension participants were split into three groups:

• Those who were undiagnosed before the study began
• Those who were diagnosed and were able to control the condition
• Those who were diagnosed and were unable to control the condition

The researchers measured how long it took participants to walk a 15-foot course, starting from a standing position. At the start of the study, the average walking speed was 2.2 mph. While everyone who participated in the follow-up period walked slower, speeds decreased more steeply among all hypertension groups by about 10 percent.

"An acceptable walking speed is important for seniors to maintain their independence," Rosano explained. "For seniors, a declining walking speed can be an indicator of other health problems and can help predict who will develop dementia or disabilities."  Rosano said further study is needed to better understand the physical link between high blood pressure and the steep decline in walking speeds. Researchers thought that brain, kidney, or heart problems might account for the slowing, but magnetic resonance imaging (MRI) brain scans of study participants showed no visible problems with blood vessels in the brain, and kidney and heart function also appeared normal.

Future studies could use more advanced brain imaging equipment, which may reveal damage too small for MRI scans to detect, according to the study authors.

Source: NIH

Understanding a Blood Pressure Reading (Health Guru Tip)

Sugar full drinks bad for your blood pressure

Drinking too many sugary beverages appears to raise the risk of high blood pressure, experts are warning.  Findings suggest blood pressure goes up incrementally for every extra can of sugary drink consumed per day. Drinking more than 355ml a day of sugar-sweetened fruit juice or carbonated drink can be enough to upset the balance, data on over 2,500 people reveals.  The study by UK and US researchers appears in the journal Hypertension.

The precise mechanism behind the link is unclear, but scientists believe too much sugar in the blood disrupts blood vessel tone and salt levels in the body. Non-sugar sweetened diet drinks did not carry the same risk.
The soft drink industry maintains that the beverages are safe to drink "in moderation".  The American Heart Association says people should drink no more than three 355ml cans of soda a week.

For the study, the participants who were aged 40-59 from the UK and the US were asked to record what they had eaten in the preceding 24 hours on four separate occasions. They also provided a urine sample and had their blood pressure measured.  The researchers found that sugar intake was highest in those consuming more than one sugar-sweetened beverage daily.

They also found that individuals consuming more than one serving per day of sugar-sweetened beverages consumed more calories than those who didn't consume sugary drinks - around 397 extra calories a day.
For every extra can of sugary drink consumed per day, participants on average had a higher systolic blood pressure by 1.6mmHg and a higher diastolic blood pressure by 0.8mmHg.  Overall, the people who consumed a lot of sugar-sweetened beverages appeared to also have less healthy diets and were more likely to be overweight.

But regardless of this, the link with blood pressure was still significant even after adjusting for factors such as weight and height.  Professor Paul Elliott, senior author of the study, from the School of Public Health at Imperial College London, said: "It's widely known that if you have too much salt in your diet, you're more likely to develop high blood pressure.  "The results of this study suggest that people should be careful about how much sugar they consume as well."

In the study, the link between sugary drinks and higher blood pressure was especially strong in people who consumed a lot of salt as well as sugar. Excess salt in the diet is already a known to contribute to high blood pressure.  The British Heart Foundation said more research was now needed to better understand the relationship between sugar and blood pressure.  Victoria Taylor, Senior Dietician at the BHF, said it was best to avoid too many sugary drinks because they add extra calories to our diets that can lead to obesity, a major risk factor for heart disease.

A spokesman for the British Soft Drinks Association said the study did not establish that drinking sugar-sweetened beverages in any way causes hypertension.  "Soft drinks are safe to drink but, like all food and drink, should be consumed in moderation as part of a balanced diet," he said.

Source: BBC

Siesta good for blood pressure - you will get no arguments here!

Researchers say that having a 45 minute catnap helps lower a person's blood pressure more quickly after a stressful event.  And with the average night's sleep now two hours shorter than it was 50 years ago, researchers claim having a siesta provides a simple way of improving cardiovascular health.  Researchers from Allegheny College in Pennsylvania, USA, conducted an experiment which saw 85 healthy students split into two groups.

One group was allotted 60 minutes each day during which they could sleep, the other did not sleep during the day.  Participants in the experiment, the findings of which are published in Springer's International Journal of Behavioural Medicine, were then asked to complete a complex mental subtraction sum designed to raise blood pressure.  Students who napped for between 45-60 minutes were found to have significantly lower blood pressure rates during the post-activity recovery phase thank those who had not slept.

A questionnaire given to participants also saw those who had a siesta reporting much less sleepiness than those who hadn't.

Study authors Ryan Brindle and Sarah Conklin PhD, said the experiment proved the "recuperative and protective" benefits of a daytime snooze.  They said: "Our findings suggest that daytime sleep may offer cardiovascular benefit by accelerating cardiovascular recovery following mental stressors.


"Further research is needed to explore the mechanism by which daytime sleep is linked with cardiovascular health and to evaluate daytime sleep as a recuperative and protective practice, especially for individuals with known cardiovascular disease risk and those with suboptimal sleep quality."

Source: Daily Telegraph