High Blood Pressure While Pregnant Linked to Poorer Memory Years Later

High blood pressure and pre-eclampsia during pregnancy may follow women through the years, causing lower scores on tests of memory and thinking skills, a Dutch study suggests.

The study of nearly 600 pregnant women included 481 with normal blood pressure and 115 who developed high blood pressure during their pregnancies.

Of those 115 women, 70% had gestational hypertension, which is high blood pressure that starts after 20 weeks of pregnancy in women who previously had normal readings. The other 30% had pre-eclampsia, a pregnancy complication marked by high blood pressure and elevated protein levels in the urine that develop after 20 weeks of pregnancy.

“Women with high blood pressure that starts in pregnancy, as well as women with pre-eclampsia, should be monitored closely after their pregnancy, and they and their physicians should consider lifestyle changes and other treatments that may help reduce their risk of decline in their thinking and memory skills later in life,” said study author Dr. Maria Adank. She is with the department of obstetrics and gynecology at Erasmus University Medical Center in Rotterdam, the Netherlands.

Adank’s team tested the study participants after 15 years, asking them to recall a list of 15 words, first right away and then again after 20 minutes.

On the immediate recall test, which was given three times, women who had no high blood pressure problems 15 years earlier scored an average 28 points out of a possible 45. The women who had high blood pressure during pregnancy posted an average score of 25.

After adjusting for other factors that could affect thinking skills, such as a woman’s weight before pregnancy, her education and ethnicity, the researchers found that women who had high blood pressure during pregnancy performed worse on the immediate and delayed recall task.

The investigators found no differences between the two groups on tests of fine motor skills, verbal fluency, processing speed and visual-spatial ability.

The women were not given memory or thinking tests before or during their pregnancies, the authors noted in the report published online Dec. 30 in the journal Neurology.

Adank said the study does not show a cause-and-effect relationship between high blood pressure and test scores, only an association.

“It’s important to consider gestational hypertension and pre-eclampsia as risk factors for cognitive impairment that are specific to women,” Adank said in a news release from the American Academy of Neurology. “Many women may think of this as a temporary issue during pregnancy and not realize that it could potentially have long-lasting effects.”

More study is needed to learn whether early treatment can prevent thinking and memory problems in women with a history of high blood pressure in pregnancy, she added.

Source: HealthDay

Study: Blood Pressure Often Differs Widely Between Two Arms

Amy Norton wrote . . . . . . . . .

Blood pressure readings between the two arms can be different, and that disparity can sometimes be a warning sign of heart trouble down the road.

That’s the finding of an analysis of 24 past studies: When people have at least a 5-point difference in blood pressure between the two arms, their risk of heart attack, stroke or premature death inches up. And the greater the difference, the more those risks climb.

Experts said the findings give more support to something that’s been advocated, but not commonly done by doctors and nurses: Checking patients’ blood pressure in both arms.

“Unfortunately, blood pressure is not routinely measured in both arms,” said Dr. Jeffrey Berger, a cardiologist who was not involved in the study. “But I think it should be.”

Berger directs the Center for the Prevention of Cardiovascular Disease at NYU Langone Health in New York City. He said he always checks blood pressure in both arms, and thinks it should be a matter of routine in all patients.

“It’s such a simple thing to do,” Berger said.

It’s not that the blood pressure difference, itself, is the problem. But a discrepancy between arms might be a sign of early atherosclerosis that is developing asymmetrically, Berger explained.

Atherosclerosis refers to a hardening and narrowing in the arteries that, eventually, could lead to heart disease or stroke.

Measuring blood pressure in both arms gives doctors “a simple way of noticing possible arterial stiffening,” said Dr. Christopher Clark, lead researcher on the new analysis.

There’s no way to “fix” between-arm discrepancies, but that’s not the point, said Clark, a clinical senior lecturer at the University of Exeter Medical School in the United Kingdom.

Instead, he explained, doctors can consider between-arm differences one “marker” of a patient’s heart disease risk.

And then what? Berger said it depends on a patient’s overall health. Eating more healthfully and getting regular exercise is always wise, he said, but some people might need medication, like a statin, to ward off cardiovascular trouble.

The findings, published online in the journal Hypertension, are based on 24 studies from around the world, involving almost 54,000 adults in all. Over 10 years, 11% had a fatal or non-fatal heart attack or stroke.

It’s normal, Clark said, to have a few points of variation in blood pressure between the two arms — due to anatomy and the fact that one hand is typically dominant.

“Our interest was to identify when that difference is large enough to be regarded as signifying more than this,” Clark said. “When is the difference large enough to suggest a change in the arteries that might signify additional risk of strokes or heart attacks?”

Overall, his team found, people’s risks started to climb when the two arms showed at least a 5-point difference in systolic blood pressure (the “top” number in a blood pressure reading).

For each 1-point increase, the risk of dying from heart disease causes in the next 10 years rose by 1% to 2%. Meanwhile, the odds of suffering a first-time heart problem or stroke also crept up.

Those increases were small, but the researchers said that a 10-point difference in systolic pressure between arms should be considered the “upper limit of normal.”

Between-arm differences are more common in people with high blood pressure, Clark said, but people with normal readings can have them, too.

The phenomenon matters more for someone with high blood pressure or other risk factors, like diabetes and high cholesterol, he added.

Berger said that it’s not clear why so few health care providers measure blood pressure in both arms.

“This is not a new finding,” he said of the current study. “It’s been shown many times.”

For now, Berger suggested patients ask questions the next time they have a blood pressure check: If it’s not being done in both arms, why not?

As for home blood pressure monitoring, he said, if people repeatedly detect a significant difference between the arms, they should tell their doctor.

Clark was also in favor of doctors checking both arms, at least once — in part to get a more accurate gauge of patients’ blood pressure. If one arm has a higher reading, he said, then future measurements should be taken on that arm.

Source: HealthDay

Social Isolation during COVID-19 Pandemic Linked with High Blood Pressure

“Admission to the emergency department during the mandatory social isolation period was linked with a 37% increase in the odds of having high blood pressure – even after taking into account age, gender, month, day and time of consultation, and whether or not the patient arrived by ambulance,” said study author Dr. Matías Fosco of Favaloro Foundation University Hospital, Buenos Aires.

Mandatory social isolation due to COVID-19 was implemented on 20 March in Argentina as a part of a general lockdown. People were told to stay at home, except for essential workers (e.g. doctors and nurses). The general public were permitted to leave home only to buy food, medicine and cleaning supplies. Schools and universities were closed, and public events were suspended.

“After social isolation began, we observed that more patients coming to emergency had high blood pressure,” said Dr. Fosco. “We conducted this study to confirm or reject this impression.”

The study was conducted in the emergency department of Favaloro Foundation University Hospital. The frequency of high blood pressure1 among patients aged 21 and above during the three-month social isolation (20 March to 25 June 2020) was compared to two previous time periods: the same three months in 2019 (21 March to 27 June 2019) and the three months immediately before social isolation (13 December 2019 to 19 March 2020).

Blood pressure is a standard measurement on admission to the emergency department and almost every patient (98.2%) admitted between 21 March 2019 and 25 June 2020 was included in the study. The most common reasons for admission were chest pain, shortness of breath, dizziness, abdominal pain, fever, cough, and hypertension.

The study included 12,241 patients. The average age was 57 years and 45.6% were women. During the three-month isolation period 1,643 patients were admitted to the emergency department. This was 56.9% less than during the same three months in 2019 (3,810 patients) and 53.9% lower than during the three months immediately before social isolation (3,563 patients).

During the social isolation period, 391 (23.8%) patients admitted to emergency had high blood pressure. This proportion was significantly higher compared to the same period in 2019, when it was 17.5%, and compared to the three months before social isolation, when it was 15.4% (p<0.01).

Dr. Fosco said: “There are several possible reasons for the connection between social isolation and high blood pressure. For example, increased stress because of the pandemic, with limited personal contact and the onset or exacerbation of financial or family difficulties. Changed behaviours may have played a role, with higher intake of food and alcohol, sedentary lifestyles and weight gain.”

Dr. Fosco noted that the reasons for admission were similar between the periods studied, so were not responsible for the increase in high blood pressure. But he said: “Patients may have felt more psychological tension during transportation to the hospital because of travel restrictions and police controls and a fear of becoming infected with coronavirus after leaving home. In addition, patients being treated for high blood pressure may have stopped taking their medicine due to preliminary warnings about possible adverse effects on COVID-19 outcomes (which were later dismissed).”

He concluded: “Blood pressure control helps prevent heart attacks and strokes and serious illness from COVID-19, so it’s essential to maintain healthy lifestyle habits, even under social isolation and lockdown conditions. Many regulations related to the pandemic have now relaxed and we are investigating if this is reflected in the blood pressure of patients admitted to emergency.”

Dr. Héctor Deschle, Scientific Programme Chair of SAC 2020, said: “This study illustrates the collateral damage generated by isolation. There has been a significant decrease in heart disease consultations, which inevitably leads to avoidable complications. But I would like to emphasise the psychological damage pointed out by the authors, which we perceive daily in consultations and which is expressed as fear, hopelessness, irritability, and difficulty concentrating. This affects interpersonal relationships and physical health. This study puts the spotlight on the concomitant consequences of the outbreak and the restrictions used to struggle against it.”

Professor Jose Luis Zamorano, ESC regional Ambassador for Argentina at SAC 2020, said: “This very interesting study simply highlights that we as cardiologists must keep a watchful eye on our cardiology patients beyond the pandemic. If we do not treat and carefully follow our cardiac patients during the pandemic, we will see an increase of adverse outcomes in the future."

Source: European Society of Cardiology

The Connection between Diabetes, Kidney Disease and High Blood Pressure

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

It’s a triple health threat faced by tens of millions of Americans. But few think about it until they’re forced to.

Even then, the interplay between diabetes, high blood pressure and kidney disease can be a challenge for people to grasp. But doctors say having an understanding is key for anybody who wants to reduce their risk or already has the conditions, or who helps a family member with them.

It’s especially important for people who could benefit from new medications – but face barriers slowing their use.

More than 34 million people, or 10.5% of the U.S. population, have diabetes, according to the Centers for Disease Control and Prevention. Most cases are Type 2, or adult-onset. When someone has diabetes, they can’t make or use insulin as well as they should. That causes blood sugar to rise, which leads to various complications throughout the body.

Dr. Vivek Bhalla, an associate professor of medicine and nephrology at Stanford University School of Medicine in California, summed it up: “Diabetes can affect small blood vessels. And that can result in hypertension. And that can also result in kidney disease.”

It can be a vicious cycle, said Bhalla, past chair of the American Heart Association’s Council on the Kidney in Cardiovascular Disease.

Diabetes causes kidneys to become less efficient at filtering blood. It also causes blood vessels to stiffen, which leads to high blood pressure. And high blood pressure, he said, accelerates kidney disease like kerosene thrown on a fire. That worsens the high blood pressure, the root of many heart-related problems.

Much of that cycle goes on invisibly, Bhalla said.

“Most people with Type 2 diabetes don’t receive a diagnosis and don’t start taking medication for about five years into their diabetes,” he said. “High blood pressure is infamous as a ‘silent killer.’ And kidney disease has no symptoms until it is almost end-stage.”

According to the CDC, an estimated 37% of U.S. adults with diagnosed diabetes also have chronic kidney disease. The National Kidney Foundation estimates up to 40% of people with Type 2 diabetes eventually will develop kidney failure.

A new generation of diabetes drugs could radically improve that.

One type, known as SGLT2 inhibitors, works by preventing blood sugar, or glucose, from being absorbed by the kidneys. Another, GLP-1 receptor agonists, mimics a hormone that helps the pancreas produce insulin. They both promote and support healthy blood glucose levels.

These drugs are “game-changing therapies,” said Dr. Janani Rangaswami, who led the writing group for an AHA scientific statement on the drugs, published in September in Circulation. Not only do the medicines dramatically cut deaths from kidney disease, studies show they can reduce rates of heart failure, stroke and death from cardiovascular causes.

“Multiple trials looking at patients with varying risk profiles have shown these benefits pretty consistently,” Rangaswami said. She is associate chair of research in the department of medicine at Einstein Medical Center and associate clinical professor at the Sidney Kimmel College of Thomas Jefferson University, both in Philadelphia.

Bhalla, who also helped write the scientific statement, acknowledged the drugs come with side effects. But he shared Rangaswami’s enthusiasm. “Every nephrologist will consider these medications,” he said.

The drugs’ effects on multiple systems in the body might be slowing their adoption, he said, because specialists might be waiting for multiple members of a patient’s care team to weigh in.

Rangaswami said that highlights the need for doctors to better communicate with one another.

“The approach to patient care is somewhat fragmented,” she said, “meaning patients go to one person, and they’re dealing with one part of the problem, and then they go to the next specialist, who’s treating the next part of the problem.”

Jane DeMeis, who developed kidney disease and diabetes after a bad reaction to arthritis treatment, said her current group of doctors does a good job of talking. But it hasn’t always been that way.

Jane DeMeis, a patient with kidney disease and diabetes, stresses the importance of communication among your health care providers. (Photo courtesy of Jane DeMeis)

DeMeis, 66, of Fairport, New York, has had to sort out conflicts on medical advice – what’s best for someone with one condition can be problematic for someone with another. She said she had to part ways with one doctor.

“I stress that you have to be the head of your own health care committee, and you need to make sure that everybody communicates, with you as the center,” said DeMeis, who volunteers with the National Kidney Foundation, the American Diabetes Association and the AHA.

Bhalla suggests patients “pick one physician as their main advocate. And let the physician be the one that’s doing the juggling.”

He also reminded people they can head off many problems by living a healthy lifestyle.

“Weight loss helps on so many fronts,” he said. “If you feel that you are slightly overweight, losing weight through diet can reduce your blood sugar. It can reduce your blood pressure. It can reduce your risk of kidney disease. It’s not easy to achieve but is possible and is the silver bullet in this scenario of these three conditions.”

Source: American Heart Association

Social Isolation Puts Women at Higher Risk of Hypertension

It’s no secret that loneliness and social isolation have a negative impact on the mental and physical health of older adults. Now, researchers at the University of British Columbia are discovering that social isolation affects the health of men and women in different ways—including placing women at higher risk of high blood pressure.

In a study recently published in the Journal of Hypertension, researchers discovered that middle aged and older women who lacked social ties were much more likely than men to suffer from hypertension—a known risk factor for heart disease, which is the leading cause of death among women—and stroke.

“Among older adults, social isolation is the largest known risk factor for mortality, equal only to smoking,” said principal investigator Annalijn Conklin, assistant professor in the faculty of pharmaceutical sciences at UBC and researcher with the Centre for Health Evaluation and Outcome Sciences. “Less well known is how social isolation affects men and women differently, or how it affects biomarkers of longevity. Our research indicates that women, in particular, are more likely to be hypertensive when they experience isolation in middle and older age.”

Using data from the Canadian Longitudinal Study on Aging, these researchers analyzed the social ties of 28,238 adults aged 45 to 85, and found that women who were non-partnered, engaged in fewer than three social activities a month, or had a small social network (fewer than 85 contacts) had higher odds of hypertension. Average systolic blood pressure was highest among widowed, lone-living and socially inactive women, and the largest difference in blood pressure was between widowed and married women. Widowed women were found to have the strongest likelihood of hypertension across all categories.

Among men, the picture was quite different. Those who were single, shared a home with others, and had the largest social networks had the highest blood pressure, while those who had smaller networks and lived alone had lower blood pressure.

The researchers found that combinations of different social ties also mattered. Regular social participation appeared to have a protective effect among non-partnered women, suggesting that health care providers may want to screen for the number of monthly social activities, and include these alongside healthy diet and exercise when treating non-partnered older women.

“Among women, the increase in blood pressure that was associated with the lack of social ties was similar to that seen with non-steroidal anti-inflammatory use, increased sodium diets pollution or weight gain,” said Conklin. “This represents a significant women-specific risk factor for heart disease or stroke.”

Previous research by Conklin using the same data set found that women who were single, widowed, divorced or separated had higher odds of abdominal and general obesity, while men were less likely to be obese if they lived alone and had a smaller social network.

“Taken with our previous research, our new findings underline how social isolation affects health in men and women differently,” said Conklin. “At a time when COVID-19 is forcing us to limit our social interactions, it’s important for those working in health care and public health to encourage older women, in particular, to find new ways to be socially active.”

Source: University of British Columbia