5 Things to Know About Blood Pressure Before It’s a Problem

Michael Merschel wrote . . . . . . . . .

Blood pressure is more than just numbers your doctor writes on a chart.

To explain it, Dr. Shawna Nesbitt, medical director of the Hypertension Clinic at Parkland Hospital in Dallas, talks about plumbing.

Think of blood vessels as pipes in a house, she said. Those pipes feed blood to the whole body. If the pressure in them gets too high, it can damage the pipes or whatever they connect to – such as the heart, brain or kidneys.

“Controlling it doesn’t just matter to one of those organs. It matters to all of those organs,” said Nesbitt, also a professor of medicine and associate dean of student diversity and inclusion at UT Southwestern Medical Center.

In other words – high blood pressure, or hypertension, is a big deal. Here are five things you might not know about it.

You should start thinking about it before you have it.

Blood pressure tends to increase as people age. But that doesn’t mean you can ignore it until it’s a problem, said Dr. Raymond Townsend, director of the hypertension program at the Hospital of the University of Pennsylvania in Philadelphia.

It rarely has symptoms. “So unless you check it, you don’t know,” he said.

It could be wreaking invisible havoc, for example, by aging the circulatory system, Townsend said. “You may be 60 years old, but if you’ve had untreated high blood pressure for a while, your blood vessels may be 80.”

High blood pressure affects 121.5 million U.S. adults, American Heart Association statistics show. It is defined as a systolic pressure (the top number) of 130 or higher or a diastolic pressure (the bottom number) of 80 or higher that stays high over time.

People who are Black; have a family history of high blood pressure, heart disease, stroke or kidney disease; and women who had blood pressure issues during pregnancy should pay extra attention, Nesbitt said.

The good news, Townsend said, is if you spot high blood pressure before it does damage, “you’re in the primary prevention game. And that’s where you want to be. Because we have great evidence to show that managing your blood pressure will keep your heart, brain and kidneys working a whole lot longer.”

Managing it protects your brain.

If high blood pressure damages your brain’s blood vessels, bad things can happen. A stroke is one. But the risk goes beyond strokes.

Neurologists are finding that dementia is a vascular disease, which means high blood pressure can cause a little damage in lots of small areas of the brain, Nesbitt said. “And because you’ve got a little damage in a lot of places, then you have the sum total of all of those areas that just don’t function so well anymore.”

Townsend said studies suggest people whose blood pressure is better controlled tend to score better on tests of cognitive function.

Lowering blood pressure isn’t a cure-all for brain health, he said, but prevention is key. “The goal is to preserve it at its high level when you’re 30 or 40 years of age.”

Black Americans need to pay special attention.

Hypertension is far more common in Black adults in the U.S. than in adults of other races and ethnicities. Yet it’s less of a problem for people of African heritage living in other countries. “Which makes you question why it is so much more prevalent in America than in other places,” Nesbitt said.

Systemic problems, such as the fact that Black Americans are more likely to lack access to healthy food or safe places to exercise, are significant factors. So is the stress of dealing with racism.

“What we are looking at is a manifestation of the living conditions of Black Americans,” she said. “And because we have rampant examples of differences in how we live, and how we experience the world every day, those things have a toll on our physical health. And blood pressure’s one of the first things that we see that makes that difference very evident.”

Watching sodium? Remember potassium, too.

Sodium has long been singled out for its relationship to high blood pressure. But many experts these days emphasize the importance of the sodium-potassium balance, Townsend said.

Potassium helps regulate blood flow. And if you’re eating a lot of processed foods, you’re probably getting too much of the former and not enough of the latter, Nesbitt said.

The DASH or Mediterranean diets offer a healthy balance of nutrients. Potassium-rich foods include bananas, sweet potatoes and low-fat dairy products.

Little changes can make a big difference.

For decades, Townsend said, researchers have known the most important predictor of blood pressure when you’re older is excess weight.

But you don’t have to go to extremes to help blood pressure, he said. “You may be 40 or 50 pounds overweight, but if you lose 10 or 15, not only are you headed it in the right direction, often you begin to see some benefit.”

There isn’t a quick fix for high blood pressure, Nesbitt said. But you don’t have to fix everything at once.

“I always talk to patients about the changes that you can make that you will commit to,” she said. Someone having four alcoholic beverages a day might cut back to one or two for a sustained period. Once they develop that habit, they can attack the next.

“It is important that we keep focus on that we’re not doing this for vanity’s sake,” she said. “We’re doing this for your healthy lifestyle and longevity. This is for the long run.”

Source: American Heart Association

Managing Children’s Weight, Blood Pressure & Cholesterol Protects Brain Function Mid-life

Managing weight, blood pressure and cholesterol in children may help protect brain function in later life, according to new research published in the American Heart Association’s flagship journal Circulation. This is the first study to highlight that cardiovascular risk factors accumulated from childhood through mid-life may influence poor cognitive performance at midlife.

Previous research has indicated that nearly 1 in 5 people older than 60 have at least mild loss of brain function. Cognitive deficits are known to be linked with cardiovascular risk factors, such as high blood pressure, obesity, type 2 diabetes, smoking, physical inactivity and poor diet, as well as depression and low education level.

Many diseases that cause neurological deficits, such as Alzheimer’s, have a long preclinical phase before noticeable symptoms begin, so finding links between childhood obesity and other cardiovascular risk factors is important for cognitive health. The researchers noted that there are currently no cures for major causes of dementia, so it is important to learn how early in life cardiovascular risk factors may affect the brain.

“We can use these results to turn the focus of brain health from old age and midlife to people in younger age groups,” said the study’s first author Juuso O. Hakala, M.D., a Ph.D. student at the Research Centre of Applied and Prevention Cardiovascular Medicine at the University of Turku, in Turku, Finland. ”Our results show active monitoring and prevention of heart disease and stroke risk factors, beginning from early childhood, can also matter greatly when it comes to brain health. Children who have adverse cardiovascular risk factors might benefit from early intervention and lifestyle modifications.”

The Cardiovascular Risk in Young Finns Study is a national, longitudinal study on cardiovascular risk from childhood to adulthood in Finland. Researchers followed the participants’ cardiovascular risk factor profiles for 31 years from childhood to adulthood. Baseline clinical examinations were conducted in 1980 on approximately 3,600 randomly selected boys and girls, ranging in ages from 3 to 18, all of whom were white. More than 2,000 of the participants, ranging in ages from 34 to 49, underwent a computerized cognitive function test in 2011. The test measured four different cognitive domains: episodic memory and associative learning; short-term working memory; reaction and movement time; and visual processing and sustained attention.

Researchers found:

  • Systolic blood pressure, total blood cholesterol and low-density lipoprotein (LDL) cholesterol, as well as body mass index, from childhood to midlife are associated with brain function in middle age.
  • Consistently high systolic blood pressure or high blood total cholesterol and LDL cholesterol were linked to worse memory and learning by midlife when compared with lower measures.
  • Obesity from childhood to adulthood was associated with lower visual information processing speed and maintaining attention.
  • Having all three cardiovascular risk factors was linked to poorer memory and associative learning, worse visual processing, decreased attention span, and slower reaction and movement time.

These results are from observational findings, so more studies are needed to learn whether there are specific ages in childhood and/or adolescence when cardiovascular risk factors are particularly important to brain health in adulthood. Study limitations include that a definite cause-and-effect link between cardiovascular risk factors and cognitive performance cannot be determined in this type of population-based study; cognition was measured at a single point in time; and because all study participants are white, the results may not be generalizable to people from other racial or ethnic groups.

Source: American Heart Association

Which Blood Pressure Number Matters Most Might Depend on Your Age

Thor Christensen wrote . . . . . . . . .

Systolic blood pressure is the best way to predict future cardiovascular events and death, irrespective of age, according to new research. But in younger people, diastolic blood pressure could still be important.

Systolic pressure – the upper number in a blood pressure reading – measures how hard the heart pumps blood into arteries. Diastolic – the bottom number – indicates the pressure on the arteries when the heart rests between beats.

In recent years, many medical experts shifted their focus to systolic readings when trying to determine the risk of heart problems, but questions lingered about how important diastolic readings really were, said Dr. Michael Hecht Olsen, lead author of a new study published Monday in the American Heart Association journal Hypertension.

To find out more, researchers looked at 26 years of data from 107,599 adults ages 19-97. Participants didn’t start out with cardiovascular disease, but some eventually reached a “cardiovascular endpoint,” which the study defined as stroke, heart attack or death from heart disease.

The study found that for people under 50, diastolic blood pressure readings “provided additional prognostic predictive information,” Olsen said. But the study showed systolic readings were still “a strong predictor of cardiovascular risk independent of age, sex and other cardiovascular risk factors.”

“Our results underline the importance of measuring not only the systolic but also the diastolic blood pressure, especially in individuals younger than 50,” said Olsen, a hypertension and cardiovascular prevention professor in the department of regional health research at the University of Southern Denmark.

The study also found that mean arterial pressure was a good measure of cardiovascular risk and death at any age. Also called MAP, it is the average pressure in a person’s arteries during one cardiac cycle, and it is calculated using both diastolic and systolic blood pressure.

Dr. Deepak L. Bhatt, who was not involved in the research, called it a “well-done study that adds to prior work supporting that diastolic blood pressure is important.”

“The implications of this study are that both patients and physicians need to pay attention not only to the systolic blood pressure but also to the diastolic blood pressure,” said Bhatt, executive director of Interventional Cardiovascular Services at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School in Boston.

“Hypertension remains an extremely common cause of cardiovascular complications such as stroke, heart attack and kidney failure. Further research remains critically important in how best to identify, classify and treat high blood pressure,” he said.

According to AHA statistics, nearly half of adults in the United States have high blood pressure, which is defined as systolic blood pressure of 130 mmHg or above or a diastolic blood pressure of 80 mmHg or above. But it’s not just an older person’s disease. High blood pressure is common among younger adults, affecting more than 1 in 5 people ages 18 to 39, based on data from the Centers for Disease Control and Prevention.

“The study’s finding that diastolic blood pressure may be particularly important in younger people is noteworthy,” Bhatt said.

High blood pressure often is called a “silent killer” because it quietly damages blood vessels and can lead to serious health problems. While there are medications available to treat the condition, experts say people of all ages can help avoid high blood pressure by eating a well-balanced diet that’s low in sodium, limiting alcohol, avoiding tobacco use, engaging in regular physical activity, managing stress and maintaining a healthy weight.

Source: HealthDay

Lower Your Sodium, and Blood Pressure Will Follow

Reducing sodium intake by any amount can lower blood pressure over the long term – and may benefit everyone, including people with normal blood pressure, new research shows.

While the link between consuming less-salty foods and lower blood pressure is well established, researchers wanted to understand the exact nature of the link over a range of daily sodium amounts, not simply the results of eating a high-salt versus low-salt diet.

After analyzing 85 studies that followed participants for up to three years, they found any reduction in sodium decreases both systolic blood pressure (the top number in a reading) and diastolic pressure (the bottom number). This trend was seen across a spectrum of daily sodium levels, with no evidence there was a bottom threshold in benefit.

“We found this decrease in sodium was beneficial for people consuming very low sodium intakes, having normal blood pressure, and in the long term,” said Dr. Marco Vinceti, senior author of the analysis published Monday in the American Heart Association journal Circulation. Vinceti is professor of epidemiology and public health at the University of Modena and Reggio Emilia Medical School in Italy and an adjunct professor at Boston University School of Public Health.

Too much sodium in your system promotes water retention in the bloodstream. Over time, the extra volume of blood can stress and stiffen blood vessels, making the heart work harder to maintain blood flow. The whole process can lead to an increased risk of heart attack and stroke.

The ideal daily sodium limit to maintain healthy blood pressure, and thus lower the risk for cardiovascular diseases, has been debated for years. While people do need some sodium – less than 500 milligrams a day – to maintain the body’s functions, most Americans eat far too much of it.

The average person consumes about 3,400 mg of sodium per day, and most of it comes from packaged and prepared foods, according to federal dietary guidelines. Those guidelines recommend adults consume no more than 2,300 mg per day – that’s about 1 teaspoon of salt – to avoid hypertension and cardiovascular disease. The AHA, however, recommends most adults limit daily intake to 1,500 mg.

Vinceti said the study’s findings support the AHA guidance. “The lower, the better,” he said. “Even below 1.5 grams (1,500 mg), there is a decrease in blood pressure.”

Indeed, for every 2,300 mg reduction in sodium intake, systolic blood pressure fell by an average of 5.6 millimeters of mercury and diastolic pressure fell by 2.3 mmHg.

The study is not a comprehensive assessment of sodium because it looked only at blood pressure as an outcome, Vinceti said. However, because uncontrolled high blood pressure is a top risk factor for heart disease, stroke and neurological conditions like dementia, “we think this is probably – as most people think – the most important point to be assessed,” he said.

The findings suggest people who reduce their sodium intake through eating a healthier diet could see significant impacts on cardiovascular health. Among the studies analyzed, those based on a modification of diet showed a bigger effect than those that used other interventions.

Simply eating healthier may itself be having an effect, said Dr. J. Brian Byrd, an assistant professor of internal medicine at the University of Michigan Medical School. He was not involved in the study.

“Just changing the amount of sodium in the diet had an effect in the study, no question,” he said. “But it seems like you magnify that effect when you improve your diet in general.”

For those looking to lower their blood pressure and cardiovascular disease risk, Byrd said, “one of the messages seems to be that changing the diet for a healthier one will be even more powerful than just reducing salt.”

Source: American Heart Association

High Blood Pressure at Any Age, No Matter How Long You Have It, May Speed Cognitive Decline

High blood pressure appears to accelerate a decline in cognitive performance in middle-aged and older adults, according to new research published today in Hypertension, an American Heart Association journal.

Nearly half of American adults have high blood pressure or hypertension. Having high blood pressure is a risk factor for cognitive decline, which includes such things as memory, verbal fluency, attention and concentration. Blood pressure of 120 mmHg – 129 mmHg systolic (the top number in a reading) or higher is considered elevated. Systolic pressure above 130 mmHg, or diastolic pressure (the bottom number) of 80 mmHg or higher is considered hypertension.

“We initially anticipated that the negative effects of hypertension on cognitive function would be more critical when hypertension started at a younger age, however, our results show similar accelerated cognitive performance decline whether hypertension started in middle age or at older ages,” said study author Sandhi M. Barreto, M.D., M.Sc., Ph.D., professor of medicine at the Universidade Federal de Minas Gerais in Belo Horizonte, Brazil. “We also found that effectively treating high blood pressure at any age in adulthood could reduce or prevent this acceleration. Collectively, the findings suggest hypertension needs to be prevented, diagnosed and effectively treated in adults of any age to preserve cognitive function.”

Barreto and colleagues analyzed findings from an existing study that included blood pressure and cognitive health information for more than 7,000 adults in Brazil, whose average age was about 59 years old at the study’s start. The study participants were followed for an average of nearly 4 years; testing included analysis of memory, verbal fluency and executive function, which includes attention, concentration and other factors associated with thinking and reasoning.

Their analysis found:

  • Systolic blood pressure between 121 and 139 mmHg or diastolic blood pressure between 81 and 89 mmHg with no antihypertensive medication use was associated with accelerated cognitive performance decline among middle-aged and older individuals.
  • The speed of decline in cognition happened regardless of hypertension duration, meaning high blood pressure for any length of time, even a short duration, might impact a person’s speed of cognitive decline.
  • Adults with uncontrolled hypertension tended to experience notably faster declines in memory and global cognitive function than adults who had controlled hypertension.

“In addition to other proven benefits of blood pressure control, our results highlight the importance of diagnosing and controlling hypertension in patients of any age to prevent or slow down cognitive decline,” Barreto said. “Our results also reinforce the need to maintain lower blood pressure levels throughout life, since even prehypertension levels were associated with cognitive decline.”

According to Barreto, some of the study’s limitations are the relatively short follow-up period and that the participants self-reported the hypertension diagnosis at baseline.

“Although the participants of our study are adults from Brazil, we believe that our findings are applicable to other regions. Previous studies have shown that similar unhealthy behaviors and risk factors, including hypertension, are common in the development of cardiovascular diseases in different populations across the globe,” Barreto said.

Source: American Heart Association