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.