Rising Blood Pressure Puts Women At Greater Stroke Risk Than Men

As the severity of high blood pressure rises, the risk of stroke rises almost twice as quickly in women compared with men, according to a new study.

Published Tuesday in the journal Hypertension, the research raises the question of whether sex-specific guidelines may be needed for controlling high blood pressure.

High blood pressure is the most common modifiable risk factor for stroke, which is the third leading cause of death for women and the fifth leading cause for men.

For people under 60, high blood pressure is less prevalent in women than men, study authors said. But it becomes more prevalent in older women, who are less likely to keep their blood pressure under control as they age.

“Our findings basically suggest that the risk of stroke may increase with each level of hypertension, more so in women than men,” said Dr. Tracy Madsen, the study’s lead author. She is an assistant professor of emergency medicine at Alpert Medical School of Brown University in Providence, Rhode Island.

Madsen’s team looked at sex and racial differences in the level of hypertension severity and stroke risk in 26,461 men and women in the United States. More than half of participants were women, 40% were black, and the average age of men was 66, while for women it was 64.

The study included an oversampling of people living in the southeastern states of the so-called “stroke belt,” which includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee. People in the region have a 34% higher risk of stroke than their counterparts elsewhere in the country.

Researchers found that for every 10 mmHg increase in blood pressure, the risk of stroke widened between white women and men, and the risk of stroke across increasing levels of blood pressure was about twice as high in women than men. These sex differences did not hold true, however, among black men and women, even though this group experienced more severe hypertension than whites.

The dramatic contrast in stroke risk between men and women suggests a need for closer examination of how hypertension behaves in each group, Madsen said. Women have too often been underrepresented in clinical trials, despite their higher prevalence for stroke and stroke-related mortality.

“We need to see if this (gap) holds true in a prospective, randomized clinical trial and whether it would be helpful to have tighter blood pressure control for women,” she said.

Not everyone agrees these findings point to a potential need for sex-specific guidelines for treating hypertension.

That issue was evaluated when the American Heart Association and the American College of Cardiology developed new guidelines for controlling blood pressure in 2017, said Dr. Paul Whelton, who chaired the guideline writing committee. People are considered to have high blood pressure if their systolic, or top number, is 130 or higher or their diastolic, the bottom number, is 80 or higher.

“For treatment, there hasn’t been any convincing demonstration that there’s much of a difference between men and women,” said Whelton, a professor at Tulane University in New Orleans and the Show Chwan Health System Endowed Chair in Global Public Health.

He said the new study’s findings surprised him, but more research is needed before making any conclusions.

“The differences in this study are fairly substantial,” he said. “It raises a red flag, but for me, at least, I don’t think it has convincingly demonstrated an answer one way or another.”

Madsen’s team also looked at how the number of hypertensive medications a person was taking impacted their risk for stroke.

They found the more medications it took to maintain good blood pressure control, the higher that person’s stroke risk. That risk increased 23% for each additional class of medication. This held equally true for both men and women.

“This does not suggest that the medications themselves increase the risk of stroke,” Madsen said. “But someone who takes three medications to maintain a systolic blood pressure level of 140 mmHg has a higher stroke risk than someone who needs only one medication to reach that same level. It’s because their blood pressure is more difficult to control or resistant to treatment.”

Madsen said the study points to the need to gather more sex-specific data in future investigations.

“There are hidden sex differences in many disease processes that we really don’t even know about,” she said. “We may not have enough data to say that tomorrow we need to implement sex-specific guidelines for how we treat hypertension, but we also don’t have the data to say that our one-size-fits-all approach to stroke prevention is the right one.”

Source: HealthDay


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Exercising When You Have High Blood Pressure

Len Canter wrote . . . . . . . . .

High blood pressure is a serious risk factor for heart disease, stroke and other life-threatening medical conditions. While many people need medication and dietary changes to control their blood pressure, exercise is a key component of nearly every management plan.

Scientists know that exercise causes the body to adapt in ways that lower blood pressure, but there’s no single formula guaranteed to work for everyone. However, there are general guidelines regarding four key aspects of exercise.

Frequency: Aim to do aerobic exercise on a daily basis and strength training twice a week (on non-consecutive days to allow for muscle repair).

Intensity: Aim for moderate intensity exercise to start. For aerobic workouts, that means reaching between 60% and 70% of your maximum target heart rate (or 220 minus your age). Evidence suggests that higher intensity exercise can result in greater reduction of high blood pressure, but at the moment the risks aren’t clear.

Duration: Aim for at least 30 minutes of aerobic activity a day, increasing to 60 minutes if possible. If time or ability is a problem, work out in 10-minute segments that add up to your daily total. Strength training should target all major muscle groups using weight that enables you to complete two to three sets of 10 to 12 reps each.

Type: Effective aerobic activities that are easy to start with are walking, cycling and swimming. Strength training can be done with free weights, weight machines, stretchy resistance bands and/or your own bodyweight (pushups, for instance).

Working with your doctor on your exercise plan is a must. He or she may suggest testing to determine your ideal target heart rate during vigorous activity. If you’re on high blood pressure medication, you’ll want to make sure that it doesn’t affect your ability to exercise.

Source: HealthDay


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Combating High Blood Pressure

About 1 in 3 U.S. adults has high blood pressure, a major risk factor for heart disease, stroke, congestive heart failure and kidney disease.

According to the Centers for Disease Control and Prevention, normal blood pressure is defined as a systolic (top) number of less than 120 mmHg and a diastolic (bottom) number of less than 80 mmHg. People with systolic readings of 120 to 139 mmHg and diastolic readings of 80 to 89 mmHg would be at risk for high blood pressure or could be told they have prehypertension. A diagnosis of high blood pressure is usually confirmed by a doctor after a patient has had more than one elevated reading, which, for most people, would be 140 mmHg or higher over 90 mmHg or higher.

People with high blood pressure should consult a physician and follow a heart healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) eating plan. A balanced DASH eating plan based on 1,600 to 2,600 calories per day would include:

  • 7 to 12 servings of fruits and vegetables
  • 6 to 11 servings of grains — such as whole-wheat bread, pasta or pitas; oatmeal; brown rice
  • 2 to 3 servings of fat-free or low-fat dairy products
  • 6 or fewer servings per day of lean meat, poultry and fish
  • 2 to 3 servings per day of fats and oils — avoiding trans fat and lowering saturated fat intake
  • 3 to 5 servings per week of nuts, seeds and legumes
  • Limited amounts of sweets and added sugars — 5 or fewer servings per week.

Sodium intake should be reduced to 2,300 milligrams per day for individuals 14 years of age and older. Lowering sodium intake can be especially beneficial in combination with the DASH eating plan. And, according to the 2015-2020 Dietary Guidelines for Americans, research has shown a direct relationship between sodium intake and blood pressure, and “every incremental decrease in sodium intake that moves toward recommended limits is encouraged.”

To get an assortment of nutrients, eat a variety of colors and be adventurous in the produce section by choosing a colorful fruit or vegetable you have never tried before. Tweet this You can also encourage your family to pick a new fruit or vegetable each time you shop, as well as including fruits and vegetables high in potassium such as tomatoes, beans and oranges.

Consider planning at least two meatless or vegetarian dinners per week with beans as the main source of protein. Experiment with fresh herbs and dried spices instead of salt, choose whole-grain products and add nuts to salads, soups and cereal. Make sure to include lean meat, poultry and fish into your eating plan, which can add great sources of protein, iron, zinc and the B vitamins. Finally, add variety by snacking on fresh vegetables with bean dip or eat salsa in place of other condiments with your scrambled eggs, on a baked potato or with vegetables.

The bottom line in lowering blood pressure is to follow a heart healthy eating plan, maintain a healthy weight and increase physical activity. Consult a registered dietitian nutritionist to start combating high blood pressure and for guidance regarding healthier food choices.

Source: Academy of Nutrition and Dietetics


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Medicine for Cold May Affect People with High Blood Pressure or Heart Disease

Flu has so far infected more than 6 million Americans this season, and winter colds are making their rounds. If you’ve been hit by either, you may be thinking about heading to your local pharmacy to relieve your aches, pains and congestion.

But before you do, you need to consider how some over-the-counter cold medicines may impact your heart.

“People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants,” said Sondra DePalma, a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Pennsylvania. “And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a health care provider.”

DePalma co-authored guidelines released in 2017 by the American Heart Association and American College of Cardiology focusing on the management of high blood pressure in adults. Both decongestants and non-steroidal anti-inflammatories (NSAIDs), found in many cold medicines, were listed as medications that could increase blood pressure.

Decongestants — like pseudoephedrine or phenylephrine — constrict blood vessels. They allow less fluid into your sinuses, “which dries you up,” said Dr. Erin Michos, associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore.

“But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels,” she said. “It can exacerbate or worsen the condition.”

The biggest concerns are for people who have had a heart attack or stroke, or have heart failure or uncontrolled high blood pressure, Michos said.

But research on NSAIDs suggests seemingly healthy people might also be at risk.

A 2017 study in the Journal of Infectious Diseases looked at nearly 10,000 people with respiratory infections who were hospitalized for heart attacks. Participants were 72 years old on average at the time of their heart attacks and many had cardiovascular risk factors, such as diabetes and high blood pressure. Researchers found that people who used NSAIDs while sick were more than three times as likely to have a heart attack within a week compared with the same time period about a year earlier when participants were neither sick nor taking an NSAID.

This may be due to the compound effect.

Merely having a cold or the flu strains the cardiovascular system. Fighting the illness raises the heart rate and causes inflammation. Meanwhile, NSAIDs — which carry a warning label about the increased risk for a heart attack or stroke — can cause problems by reducing the amount of sodium excreted through the urine, which increases fluid retention and raises blood pressure, DePalma said.

NSAIDs can be especially risky for people with heart disease or heart failure, Michos added. People who are sick should use both classes of medications — decongestants and NSAIDs — judiciously and understand the potential side effects.

For decongestants, blood pressure guidelines suggest using them for the shortest duration possible or using an alternative such as nasal saline or antihistamines to help with congestion. Decongestants shouldn’t be taken longer than seven days before consulting with a health care provider, DePalma said.

NSAIDs taken as pills should be avoided when possible to avoid affecting blood pressure, guidelines advise. Rather, topical NSAIDs and acetaminophen are recommended alternatives.

“There are effective therapies that are less risky and definitely should be tried first,” DePalma said. “If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like heart palpitations, they should talk with their health care provider.”

If symptoms are mild or moderate, rest and drink plenty of fluids, Michos said. Preventing dehydration should help reduce body aches, clear mucous and may reduce the need for decongestants.

To help avoid getting sick in the first place, Michos recommends frequent hand-washing and lots of sleep, especially during cold and flu season. The Centers for Disease Control and Prevention recommends an annual flu vaccine for everyone 6 months and older, and the pneumonia vaccine for children under 2 and adults 65 and older.

Source: HealthDay


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Exercise and High Blood Pressure

If you have high blood pressure, hitting the gym may be as helpful as taking drugs to lower your numbers, researchers say.

There’s “compelling evidence that combining endurance and dynamic resistance training was effective in reducing [blood pressure],” according to the authors of a new report.

The British researchers stressed that it’s still too early to recommend that people toss their antihypertensive meds, and exercise instead — there’s not yet been a head-to-head trial of drugs versus exercise for blood pressure.

But comparing the numbers from hundreds of blood pressure trials involving either exercise or medication suggests they have the same benefit, said the team led by Huseyin Naci. He’s a health policy researcher at the London School of Economics and Political Science.

For now, one U.S. expert said, exercise should be considered an “and” rather than an “or” when it comes to treating high blood pressure.

“Exercise is a pillar in the foundation of treatment for hypertension, but for those patients that require drug therapy, exercise is not a replacement for medication,” said Dr. Guy Mintz. He directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

The new research was published online in the British Journal of Sports Medicine.

In the study, Naci’s team analyzed data from 197 clinical trials that assessed the effects of structured workouts on lowering systolic blood pressure, the top number in a reading. The investigators also looked at data from 194 trials that examined the impact of prescription drugs on blood pressure. In total, the studies included nearly 40,000 people.

Overall, blood pressure was lower in people treated with drugs than in those who did an exercise regimen, the researchers reported. However, for people with high blood pressure in particular — systolic readings over 140 mm Hg — exercise appeared just as effective as most drugs in lowering blood pressure.

Also, the effectiveness of exercise against high blood pressure rose the higher the threshold that was used to define high blood pressure — anything above 140 mm Hg.

The types of exercise in the studies included: endurance, such as walking, jogging, running, cycling and swimming; dynamic resistance, such as strength training with weights; isometric resistance, such as the static push-ups (planks); and a combination of endurance and resistance.

Naci and his colleagues stressed that there were no studies in which exercise and blood pressure-lowering drugs were compared head-to-head, and the number of people in some of the studies was relatively small.

All of that means that, for now, people shouldn’t try to replace blood pressure meds with exercise.

“We don’t think, on the basis of our study, that patients should stop taking their antihypertensive medications,” Naci said in a journal news release. “But we hope that our findings will inform evidence-based discussions between clinicians and their patients.”

Another U.S. heart specialist agreed with that assessment.

“Exercise, at any risk level for cardiovascular disease, is shown to improve not only how long one lives, but also lowers the risk of heart attacks and strokes,” noted Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City.

People who are already taking a high blood pressure medication are among “the best to benefit from exercise,” Bhusri said.

“It is possible to slowly take patients off blood pressure medications as they improve their lifestyle with exercise and diet management, but for most this is a very difficult goal to reach,” Bhusri stressed. So, “we do not recommend stopping medications until close observation and discussion with their physician,” he explained.

For his part, Mintz said exercise works its magic against high blood pressure through a combination of weight loss, improved artery health and changes in chemicals controlling blood flow.

“I feel that patients should adhere to the current exercise guidelines in the United States, of performing moderate exercise of 150 minutes per week (30 minutes, five times a week), or vigorous exercise for 75 minutes per week,” he said. “This is a reasonable and obtainable goal for patients, as an adjunct to appropriate diet.”

But for most people with high blood pressure, “exercise alone will not be enough to control their blood pressure,” and that’s where medication comes in, Mintz said.

“Patients should not stop their medications, even if they are involved in a regular aerobic exercise program, unless consistent control of their hypertension is corroborated by their physician,” he said.

Source: HealthDay


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