Exposure to Some Airborne Chemicals Found Indoors May Increase Blood Pressure

Kat Long wrote . . . . . . . . .

Acrolein, crotonaldehyde and styrene, compounds found in everything from cigarette smoke to plastics, were associated with higher blood pressure measurements for both the top, systolic, and bottom, diastolic, numbers.

“Acrolein is a well-known cardiotoxic chemical, and styrene had a causative signal with diastolic blood pressure,” said lead researcher Katlyn E. McGraw, a postdoctoral fellow at Columbia University’s Mailman School of Public Health in New York. “We’ve seen effects in the vascular system in other studies with acrolein and crotonaldehyde.”

For the new research, which will be presented at the American Heart Association’s virtual Scientific Sessions conference, McGraw and her colleagues examined the relationship between exposure to so-called volatile organic compounds, or VOCs, and blood pressure among 778 nonsmokers in the Jackson Heart Study, a long-term study of Black residents in Mississippi. The findings are considered preliminary until they are published in a peer-reviewed journal.

VOCs are gases given off by many common items, such as cleaning products, paint, cigarettes, vehicle exhaust, pesticides and other substances. Exposure to VOCs has been linked to ear, nose and throat irritation; headache; nausea; nervous system damage; and cancer. According to the Environmental Protection Agency, studies show indoor levels of VOCs are consistently higher than those outdoors.

Exposure to fine particulate matter, such as pollution from car engines, is a known risk factor for cardiovascular disease. But the heart health impacts of non-particulate VOCs are less clear.

In the new study, researchers used urine tests to detect metabolites from 17 VOCs. Metabolites are the byproducts when the body breaks down a substance. They adjusted for participants’ age, sex, body mass index, kidney function, cholesterol, triglycerides and exposure to fine particulate matter. Researchers also controlled for whether participants took blood pressure medications or had diabetes.

Metabolites of acrolein and crotonaldehyde were associated with an increase in systolic blood pressure of 1.5 mmHg (milligrams of mercury) and 1.1 mmHg, respectively. Styrene metabolite was linked to an increase in diastolic blood pressure of 0.5 mmHg. After further analysis, the effects of the crotonaldehyde and styrene were seen only in men.

While at the individual level, the increases weren’t clinically significant, they make a difference when viewed from a community perspective, said Dr. Joel Kaufman, a professor of environmental and occupational health sciences, medicine and epidemiology at the University of Washington.

“If you have a community of people with higher exposures and blood pressure versus another community, then that collectively elevates the population’s risk of heart attacks, stroke and kidney disease, all of which are affected by blood pressure,” said Kaufman, who was not involved in the study.

Dr. Sanjay Rajagopalan, chief of cardiovascular medicine at University Hospitals Harrington Heart & Vascular Institute in Cleveland, said that while the study doesn’t prove cause and effect, it suggests exposure to the three VOCs raises the risk of cardiovascular issues via high blood pressure.

But, he said, the results could be influenced by where the study participants lived – for example, near a highway with a high level of car exhaust.

“Acrolein could be associated with other VOCs they didn’t analyze or other determinants that are co-associated with acrolein exposure,” said Rajagopalan, who was not involved in the new research. “There are thousands of VOCs and other chemicals that all travel together.”

The commonness of VOCs all around us, McGraw said, highlights the importance of lessening our exposure wherever we can. “For example, to not have smokers smoke indoors. You can reduce the types of products you use in your home or improve ventilation by opening a window or turning on your bathroom fan while you’re cleaning.”

Source: American Heart Association

Most U.S. Adults Unaware that Over-the-counter Pain Relievers May Increase Blood Pressure

While nearly half of U.S. adults have high blood pressure (HBP), only 29% think over-the-counter (OTC) pain relievers may raise blood pressure, according to a recent survey commissioned by the American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives for all.

According to the American Heart Association’s 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure, high blood pressure is defined as a consistent blood pressure measurement of 130 over 80 or higher. The guidelines also state that some OTC pain relievers may elevate blood pressure.

While majority of adults in the general population, as well as people with high blood pressure, aren’t sure about the effect of OTC pain medicine on their blood pressure, only a little more than half of those diagnosed with high blood pressure, who take OTC pain relievers (53%) check with their doctor before taking this medicine.

“People who have high blood pressure or are being treated with blood pressure medication – along with their loved ones and caretakers – need to be informed about safe over-the-counter pain relievers,” said Willie Lawrence, Jr., M.D., interventional cardiologist, medical director for health equity, Spectrum Health in Benton Harbor, Michigan, and volunteer lead of the American Heart Association’s National Hypertension Control Initiative oversight committee.

“Because some pain relievers may cause elevated blood pressure, the American Heart Association recommends consulting your doctor or pharmacist and making sure you read the label before taking any over-the-counter medication for pain, especially if you’ve been diagnosed with high blood pressure.”

Conducted by The Harris Poll, the survey polled 2,013 U.S. adults aged 18 and older. Additional findings from the survey include:

  • 38% of those with high blood pressure think over-the-counter pain relievers may raise blood pressure.
  • Only 21% of U.S. adults know that acetaminophen does not raise blood pressure, and those with high blood pressure are only slightly more aware of this fact (28%).
  • 39% of U.S. adults with high blood pressure report acetaminophen is the over-the-counter medication they take most often for pain.
  • Only 10% of U.S. adults with HBP self-measure their BP multiple times a day and only 14% do so at least once a day.

In the U.S., high blood pressure is the No. 1 preventable cause of heart disease and stroke and second only to cigarette smoking as a preventable cause of death for any reason. Checking your blood pressure regularly at home with a validated blood pressure device for the most accurate reading and working with your doctor on a plan to control it, is a proven way to manage your blood pressure.

Source: American Heart Association

Elevated Stress Hormones Linked to Higher Risk of High Blood Pressure and Heart Events

Adults with normal blood pressure and high levels of stress hormones were more likely to develop high blood pressure and experience cardiovascular events compared to those who had lower stress hormone levels, according to new research published today in Hypertension, an American Heart Association journal.

Studies have shown that cumulative exposure to daily stressors and exposure to traumatic stress can increase cardiovascular disease risk. A growing body of research refers to the mind-heart-body connection, which suggests a person’s mind can positively or negatively affect cardiovascular health, cardiovascular risk factors and risk for cardiovascular disease events, as well as cardiovascular prognosis over time.

“The stress hormones norepinephrine, epinephrine, dopamine and cortisol can increase with stress from life events, work, relationships, finances and more. And we confirmed that stress is a key factor contributing to the risk of hypertension and cardiovascular events,” said study author Kosuke Inoue, M.D., Ph.D., assistant professor of social epidemiology at Kyoto University in Kyoto, Japan. Inoue also is affiliated with the department of epidemiology at the Fielding School of Public Health at the University of California, Los Angeles.

“Previous research focused on the relationship between stress hormone levels and hypertension or cardiovascular events in patients with existing hypertension. However, studies looking at adults without hypertension were lacking,” Inoue said. “It is important to examine the impact of stress on adults in the general population because it provides new information about whether routine measurement of stress hormones needs to be considered to prevent hypertension and CVD events.”

Study subjects were part of the MESA Stress 1 study, a substudy of the Multi-Ethnic Study of Atherosclerosis (MESA), a large study of atherosclerosis risk factors among more than 6,000 men and women from six U.S. communities. As part of MESA exams 3 and 4 (conducted between July 2004 and October 2006), white, Black and Hispanic participants with normal blood pressure from the New York and Los Angeles sites were invited to participate in the substudy MESA Stress 1. In this substudy, researchers analyzed levels of norepinephrine, epinephrine, dopamine and cortisol – hormones that respond to stress levels. Hormone levels were measured in a 12-hour overnight urine test. The substudy included 412 adults ages 48 to 87 years. About half were female, 54% were Hispanic, 22% were Black and 24% were white.

Participants were followed for three more visits (between September 2005 and June 2018) for development of hypertension and cardiovascular events such as chest pain, the need for an artery-opening procedure, or having a heart attack or stroke.

Norepinephrine, epinephrine and dopamine are molecules known as catecholamines that maintain stability throughout the autonomic nervous system—the system that regulates involuntary body functions such as heart rate, blood pressure and breathing. Cortisol is a steroid hormone released when one experiences stress and is regulated by the hypothalamic-pituitary-adrenal axis, which modulates stress response.

“Although all of these hormones are produced in the adrenal gland, they have different roles and mechanisms to influence the cardiovascular system, so it is important to study their relationship with hypertension and cardiovascular events, individually,” Inoue said.

Their analysis of the relationship between stress hormones and development of atherosclerosis found:

  • Over a median of 6.5-year follow-up period, every time the levels of the four stress hormones doubled was associated with a 21-31% increase in the risk of developing hypertension.
  • During a median of 11.2-years of follow-up, there was a 90% increased risk of cardiovascular events with each doubling of cortisol levels. There was no association between cardiovascular events and catecholamines.

“It is challenging to study psychosocial stress since it is personal, and its impact varies for each individual. In this research, we used a noninvasive measure — a single urine test — to determine whether such stress might help identify people in need of additional screening to prevent hypertension and possibly cardiovascular events,” Inoue said.

“The next key research question is whether and in which populations increased testing of stress hormones could be helpful. Currently, these hormones are measured only when hypertension with an underlying cause or other related diseases are suspected. However, if additional screening could help prevent hypertension and cardiovascular events, we may want to measure these hormone levels more frequently.”

A limitation of the study is that it did not include people who had hypertension at the study’s start, which would have resulted in a larger study population. Another limitation is that researchers measured stress hormones via a urine test only, and no other tests for stress hormone measurement were used.

Source: American Heart Association

Gut Bacteria and Flavonoid-rich Foods Are Linked and Improve Blood Pressure Levels

Flavonoid-rich foods, including berries, apples, pears and wine, appear to have a positive effect on blood pressure levels, an association that is partially explained by characteristics of the gut microbiome, according to new research published today in Hypertension, an American Heart Association journal.

“Our gut microbiome plays a key role in metabolizing flavonoids to enhance their cardioprotective effects, and this study provides evidence to suggest these blood pressure-lowering effects are achievable with simple changes to the daily diet,” said lead investigator of the study Aedín Cassidy, Ph.D., chair and professor in nutrition and preventive medicine at the Institute for Global Food Security at Queen’s University in Belfast, Northern Ireland.

Flavonoids are compounds found naturally in fruits, vegetables and plant-based foods such as tea, chocolate and wine, and have been shown in previous research to offer a variety of health benefits to the body. Flavonoids are broken down by the body’s gut microbiome—the bacteria found in the digestive tract. Recent studies found a link between gut microbiota, the microorganisms in the human digestive tract, and cardiovascular disease (CVD), which is the leading cause of death worldwide. Gut microbiota is highly variable between individuals, and there are reported differences in gut microbial compositions among people with and without CVD.

With increased research suggesting flavonoids may reduce heart disease risk, this study assessed the role of the gut microbiome on the process. Researchers examined the association between eating flavonoid-rich foods with blood pressure and gut microbiome diversity. The study also investigated how much variance within the gut microbiome could explain the association between intake of flavonoid-rich foods and blood pressure.

A group of 904 adults between the ages of 25 and 82, 57% men from Germany’s PopGen biobank were recruited for this study. (The PopGen biobank includes participants from a network of seven biobanks in Northern Germany.) Researchers evaluated the participants’ food intake, gut microbiome and blood pressure levels together with other clinical and molecular phenotyping at regular follow-up examinations.

Participants’ intake of flavonoid-rich foods during the previous year was calculated from a self-reported food questionnaire detailing the frequency and quantity eaten of 112 foods. Flavonoid values were assigned to foods according to United States Department of Agriculture data on flavonoid content in food.

Gut microbiome for participants was assessed by fecal bacterial DNA extracted from stool samples. After an overnight fast, participants’ blood pressure levels were measured three times in three-minute intervals after an initial five-minute rest period. Researchers also collected participants’ lifestyle information, including sex, age, smoking status, medication use and physical activity, as well as family history of coronary artery disease, the number of daily calories and fiber consumed, and each participant’s height and weight was measured to calculate BMI (body mass index).

The analysis of regular flavonoid intake with gut microbiome and blood pressure levels found:

  • Study participants who had the highest intake of flavonoid-rich foods, including berries, red wine, apples and pears, had lower systolic blood pressure levels, as well as greater diversity in their gut microbiome than the participants who consumed the lowest levels of flavonoid-rich foods.
  • Up to 15.2% of the association between flavonoid-rich foods and systolic blood pressure could be explained by the diversity found in participants’ gut microbiome.
  • Eating 1.6 servings of berries per day (one serving equals 80 grams, or 1 cup) was associated with an average reduction in systolic blood pressure levels of 4.1 mm Hg, and about 12% of the association was explained by gut microbiome factors.
  • Drinking 2.8 glasses (125 ml of wine per glass) of red wine a week was associated with an average of 3.7 mm Hg lower systolic blood pressure level, of which 15% could be explained by the gut microbiome.

“Our findings indicate future trials should look at participants according to metabolic profile in order to more accurately study the roles of metabolism and the gut microbiome in regulating the effects of flavonoids on blood pressure,” said Cassidy. “A better understanding of the highly individual variability of flavonoid metabolism could very well explain why some people have greater cardiovascular protection benefits from flavonoid-rich foods than others.”

While this study suggests potential benefits to consuming red wine, the American Heart Association suggests that if you don’t drink alcohol already, you shouldn’t start. If you do drink, talk with your doctor about the benefits and risks of consuming alcohol in moderation. According to a statement on dietary health by the American Heart Association, alcohol intake can be a component of a healthy diet if consumed in moderation (no more than one alcoholic drink per day for women and 2 alcohol drinks per day for men) and only by nonpregnant women and adults when there is no risk to existing health conditions, medication-alcohol interaction, or personal safety and work situations.

The authors note that participants for the study were from the general population, and the participants were unaware of the hypothesis. However, residual or unmeasured confounding factors (such as other health conditions or genetics) can lead to bias, thus these findings cannot prove a direct cause and effect, although the researchers did conduct a detailed adjustment in their analyses for a wide range of diet and lifestyle factors. The authors noted the focus of this study was on specific foods rich in flavonoids, not all food and beverages with flavonoids.

Source: American Heart Association

Kids Who Snore Could be at Risk for Blood Pressure, Heart Problems

Obstructive sleep apnea, a type of sleep disorder characterized by disrupted breathing, may be linked to changes in blood pressure and heart structure in children and adolescents, according to a new scientific statement.

The American Heart Association report urges parents and health care providers to consider testing for children who exhibit symptoms, have obesity or have enlarged tonsils, which puts them at higher risk.

Estimates show up to 6% of all children and adolescents have obstructive sleep apnea, according to the statement published Wednesday in the Journal of the American Heart Association.

Symptoms of obstructive sleep apnea include habitual snoring, gasps, snorting or labored breathing while sleeping, daytime sleepiness, sleeping while seated with a distended neck, a headache upon waking and signs of an upper airway obstruction. The condition often occurs in children with obesity. About 30%-60% of children who meet the criteria for obesity – having a body mass index in the 95th percentile or higher – also have sleep apnea.

“We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease,” statement writing group chair Dr. Carissa M. Baker-Smith said in a news release. Baker-Smith is director of pediatric preventive cardiology at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. She also is associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Obstructive sleep apnea is associated with cardiovascular disease in adults but less is known about how the condition affects the immediate and long-term heart health of children and adolescents. A review of the most current research included in the statement found evidence it can impact emotional health, as well as the immune, metabolic and cardiovascular systems in children and adolescents.

Obstructive sleep apnea risk factors vary with age. In addition to obesity, they include upper and lower airway disease; allergic rhinitis, inflammation and swelling in the nose’s mucous membrane; low muscle tone; enlarged tonsils and adenoids; craniofacial malformations; and neuromuscular disorders. Sickle cell disease, an inherited blood disorder, also is a risk factor.

Children born prematurely, who have delayed development of respiratory control and smaller upper airways, also may be at higher risk for sleep-disordered breathing. However, this risk gets smaller as children grow.

The statement supports recommendations from the American Academy of Otolaryngology and Head and Neck Surgery that say sleep studies, or polysomnographies, are the best test for diagnosing sleep-disordered breathing. Prior to getting a tonsillectomy, children should take this test if they have conditions that raise their risk for breathing complications during surgery. These include obesity, Down syndrome, craniofacial abnormalities such as a cleft palate, and disorders such as muscular dystrophy or sickle cell disease.

Children and adolescents with obstructive sleep apnea also may have trouble regulating blood pressure. While blood pressure typically dips during sleep, children with this condition see smaller dips than those without it. Adults whose blood pressure fails to dip during sleep have a higher risk for cardiovascular events. Because of this, the statement calls for 24-hour blood pressure monitoring to check levels in children with sleep apnea.

Even mild cases of sleep apnea – defined as just two pauses in breathing per hour – are associated with a higher risk for metabolic syndrome in children. Metabolic syndrome is a cluster of factors including high insulin and triglyceride levels, elevated blood pressure and low levels of high-density lipoprotein, or HDL, the “good” cholesterol. Continuous positive airway pressure, or CPAP, is a treatment for sleep apnea that delivers pressurized air through a mask that can lower triglyceride and improve HDL levels.

Long-term, severe sleep apnea also may put children at higher risk for pulmonary hypertension, when pressure in the blood vessels from the heart to the lungs is too high. The statement committee recommends that future research on how sleep apnea affects children’s risk for heart problems incorporates 24-hour blood pressure monitoring and measures of metabolic syndrome factors.

Source: American Heart Association