Dash Diet plus Low Salt are Effective as Drugs for Some Adults With High Blood Pressure

A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure — the top number in a blood pressure test — especially in people with higher baseline systolic readings.

Results of the randomized clinical trial of the dietary combination, conducted by researchers at the Johns Hopkins University School of Medicine, were published in the Nov. 12 issue of Journal of the American College of Cardiology.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—antihypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” says Stephen Juraschek, M.D., an adjunct assistant professor at Johns Hopkins and an instructor of medicine at Harvard Medical School.

The Dietary Approaches to Stop Hypertension (DASH) diet, long promoted by the National Heart, Lung, and Blood Institute and the American Heart Association, is rich in fruits, vegetables and whole grains, along with low-fat or fat-free dairy, fish, poultry, beans, seeds and nuts.

While both low-sodium and DASH diets have long been known to prevent or lower high blood pressure, Juraschek says the new study was designed to examine the effects of combining the two diets in adults with early or modest forms of high blood pressure—those considered to be at greatest risk for developing more severe forms of hypertension known to increase the likelihood of stroke, kidney disease, heart attacks and heart failure.

For the study, investigators tested and followed 412 adults, including 234 women, ranging in age from 23 to 76 years and with a systolic blood pressure of 120-159 mm Hg and a diastolic blood pressure between 80-95 mm Hg (i.e., prehypertension or stage 1 hypertension). Fifty-seven percent of the participants were African-American.

At the start of the study, none of the participants was taking antihypertensive drugs or insulin, none had a prior diagnosis of or current heart disease, renal insufficiency, poorly controlled cholesterol levels or diabetes.

Investigators put all participants on the DASH diet or a control diet for 12 weeks. The control diet was similar to that of a normal American diet based on the average macronutrient and micronutrient profile of the U.S. population.

All participants were also fed 50 (low), 100 (medium) or 150 (high) mmol/day of sodium in random order over four-week periods. Fifty mmol/day is equivalent to 1,150 mg of sodium. A teaspoon of salt is equal to 2,400 mg of sodium. A diet that includes 100 mmol/day of salt is equivalent to 2,300 mg of sodium — or nearly a teaspoon of salt. This is the maximum level of sodium intake recommended by the U.S. Food and Drug Administration (FDA) and is thought to reduce the risk for heart disease and stroke.

At the time of the study, according to the National Health and Nutrition Examination Survey, Americans consumed about 150 mmol/day of sodium, which is considered by the FDA to be harmful and may increase a person’s risk for high blood pressure, heart disease and stroke.

Participants were sorted into four groups based on their baseline systolic blood pressure: 120-129, 130-139, 140-149 and 150 or greater baseline systolic blood pressure.

After four weeks, the investigators found that the group with 150 or greater baseline systolic blood pressure on just the DASH diet had an average of 11 mm Hg reduction in systolic blood pressure compared to a 4 mm Hg reduction in those solely on the DASH diet, but whose baseline systolic pressures were less than 130.

When the researchers combined the DASH diet with the low-sodium diet and compared participants’ blood pressures to those on the high-sodium control diet, they found that the group with less than 130 systolic blood pressure at baseline had a 5 mm Hg reduction in systolic blood pressure; the group with 130-139 mm Hg baseline systolic blood pressure had a 7 mm Hg reduction; and the group with baseline systolic blood pressure between 140-149 had a 10 mm Hg reduction.

Most surprisingly, say the researchers, a participant who had a baseline systolic blood pressure of 150 or greater and was consuming the combination low-sodium/DASH diet had an average reduction of 21 mm Hg in systolic blood pressure compared to the high-sodium control diet.

“This is outstanding, it’s huge,” says Juraschek, because it suggests that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

To put the potential impact of the findings into context, Juraschek says, the FDA requires any new antihypertensive agent submitted for approval to lower systolic blood pressure by 3-4 mm Hg. Most established medications on the market, such as ACE inhibitors, beta-blockers, or calcium channel blockers, on average reduce systolic blood pressure by 10-15 mm Hg.

“What we’re observing from the combined dietary intervention is a reduction in systolic blood pressure as high as, if not greater than, that achieved with prescription drugs,” says senior study author Lawrence Appel, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine. “It’s an important message to patients that they can get a lot of mileage out of adhering to a healthy and low-sodium diet.”

The researchers caution that the study did not address effects in people with systolic blood pressure of 160 or greater or in persons with prior cardiovascular disease or medication treated diabetes. Further studies with larger sample sizes are needed to investigate the impact of the low-sodium/DASH diet on these populations.

Source: Johns Hopkins University


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High Blood Pressure Redefined for First Time in 14 years: 130 is the New High


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High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – according to the first comprehensive new high blood pressure guidelines in more than a decade. The guidelines are being published by the American Heart Association (AHA) and the American College of Cardiology (ACC) for detection, prevention, management and treatment of high blood pressure.

The guidelines were presented today at the Association’s 2017 Scientific Sessions conference in Anaheim, the premier global cardiovascular science meeting for the exchange of the latest advances in cardiovascular science for researchers and clinicians.

Rather than 1 in 3 U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension. However, there will only be a small increase in the number of U.S. adults who will require antihypertensive medication, authors said. These guidelines, the first update to offer comprehensive guidance to doctors on managing adults with high blood pressure since 2003, are designed to help people address the potentially deadly condition much earlier.

The new guidelines stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions, the authors said.

High blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking. It’s known as the “silent killer” because often there are no symptoms, despite its role in significantly increasing the risk for heart disease and stroke.

Paul K. Whelton, M.B., M.D., M.Sc., lead author of the guidelines published in the American Heart Association journal, Hypertension and the Journal of the American College of Cardiology, noted the dangers of blood pressure levels between 130-139/80-89 mm Hg.

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

The new guidelines eliminate the category of prehypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).

Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines.

The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45 according to the report.

Damage to blood vessels begins soon after blood pressure is elevated, said Whelton, who is the Show Chwan professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans. “If you’re only going to focus on events, that ignores the process when it’s beginning. Risk is already going up as you get into your 40s.”

The guidelines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications.

“People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure,” Whelton said. “Masked hypertension is more sinister and very important to recognize because these people seem to have a similar risk as those with sustained high blood pressure.”

Other changes in the new guideline include:

  • Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
  • Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
  • Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.

The new guidelines were developed by the American Heart Association, American College of Cardiology and nine other health professional organizations. They were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies. The guidelines underwent a careful systematic review and approval process. Each recommendation is classified by the strength (class) of the recommendation followed by the level of evidence supporting the recommendation. Recommendations are classified I or II, with class III indicating no benefit or harm. The level of evidence signifies the quality of evidence. Levels A, B, and C-LD denote evidence gathered from scientific studies, while level C-EO contains evidence from expert opinion.

The new guidelines are the successor to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7), issued in 2003 and overseen by the National Heart, Lung, and Blood Institute (NHLBI). In 2013, the NHLBI asked the AHA and ACC to continue the management of guideline preparation for hypertension and other cardiovascular risk factors.

Source : American Heart Association

High Blood Pressure in 40s a Dementia Risk for Women

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Women who develop high blood pressure in their 40s could be much more vulnerable to dementia later in life, a new study suggests.

That increased risk could run as high as 73 percent, the researchers reported, but the same did not hold true for men.

These new findings suggest that high blood pressure can start playing a role in brain health even earlier than previously thought, said lead researcher Paola Gilsanz, a postdoctoral fellow with the Kaiser Permanente Northern California Division of Research in Oakland.

Prior studies have linked high blood pressure with dementia, but “it wasn’t clear if hypertension before one’s 50s was a risk factor,” Gilsanz said.

A healthy circulatory system is key to a health brain, said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association.

“The brain is a very metabolically active organ in the body. It requires an outsized amount of oxygen and other nutrients,” said Fargo, who wasn’t involved with the study. “Because of that, there’s a very, very rich blood delivery system in the brain. Anything that happens to compromise that is going to compromise the overall health and function of the brain.”

Because of that, it stands to reason that long-term exposure to high blood pressure could leave one more vulnerable to dementia as they enter old age, Gilsanz said.

Gilsanz and her colleagues reviewed the records of more than 5,600 patients of the Kaiser Permanente Northern California health care system, tracking them from 1996 onward for an average 15 years to see who developed dementia.

They found that people with high blood pressure in their 30s did not appear to have any increased risk of dementia.

But women who developed high blood pressure in their 40s did have an increased risk of dementia, even after the researchers adjusted for other factors like smoking, diabetes and excess weight.

However, the study did not prove that early high blood pressure caused dementia risk to rise in women, just that there was an association.

Men did not have a similar risk from high blood pressure in their 40s, but that could be because they were more likely to die before they grew old enough to suffer from dementia, Gilsanz noted.

Other factors such as genetic differences, lifestyle differences and sex-specific hormones also might separate men and women when it comes to dementia risk associated with high blood pressure, Fargo said.

“It’s really interesting to see there was an association among women but not men,” Gilsanz said. “Given that women have higher rates of dementia than men, understanding why this may be is a large area of interest for us. Future research should really look at sex-specific pathways that might be at play, to disentangle the risk factors for men and women.”

Fargo said it makes sense that people with long-term exposure to high blood pressure would be more likely to develop dementia.

“Your dementia risk is really a lifelong thing,” Fargo said. “People think about dementia in late life, because that’s when it’s common to see the clinical symptoms. But everything that is setting you up for cognitive decline is occurring throughout your life.”

But Fargo sees this as an opportunity, given that high blood pressure can be controlled with medication and lifestyle changes.

“These modifiable risk factors are the most powerful weapons we have in our arsenal to fight dementia,” he said. “It’s a target that is addressable.”

The study was published in the journal Neurology.

Source: HealthDay


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Adverse Events Spike after Blood Pressure Medicines Go Generic in Canada

One month after generic versions of three widely-used blood pressure drugs became available in Canada, hospital visits for adverse events spiked in generic drug users, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Researchers in Quebec compared hospital visits and emergency room consultations among 136,177 patients, aged 66 years and older, who took one of three hypertension medications before and after their generic versions became available. The drugs – losartan (Cozaar®), valsartan (Diovan®) and candesartan (Atacand®) – are also used in patients with heart failure.

They found:

  • Before generic versions were commercialized, the average proportion of adverse events was 10 percent.
  • The month when generics were commercialized, the rates of adverse events ranged from 8 percent to 14 percent for patients using generics, depending on the type of drug.
  • The increase was 8 percent for losartan, 11.7 percent for valsartan and 14 percent for candesartan, and the rates for losartan remained consistently higher for the study year.

“Because most users of a brand-name drug are switched to generic versions within two or three years after it becomes available, the observed increase in adverse events could reflect an acute response to equivalent, but not identical, generic drugs for newly switched patients,” said Paul Poirier M.D., Ph.D., FAHA, study author and professor of pharmacy at Laval University in Quebec City.

The immediate increase of adverse events in these three generic drugs could, hypothetically, be explained by differences between drugs. “In our study, patients could have been substituted to a generic version that is pharmacokinetically 6 to 21 percent different from the brand-name version that was used,” Poirer said. “The results must be interpreted cautiously because studies like this assessing adverse events over a fixed time period, combined with differences between patients, make drawing firm conclusions difficult. Also, because the findings were based on medical claims data, there may be inaccuracies.”

After the first month, the difference between brand names and generics narrowed, but some differences persisted – primarily cardiovascular problems, he said. To some degree the findings might partially reflect various demographic differences between generic users, although clinical differences among very sick and lower socioeconomic patients were minimal, according to the authors.

“Although generic drugs are generally considered to be equivalent, patients and their physicians should be aware that they may not have exactly the same effect as their brand-name counterparts, especially during the first month as patients transition to the new medicine,” Poirier said.

Source: American Heart Association


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Frequent Sauna Bathing Keeps Blood Pressure in Check

Frequent sauna bathing reduces the risk of elevated blood pressure, according to an extensive follow-up population-based study carried out at the University of Eastern Finland. The risk of developing elevated blood pressure was nearly 50% lower among men who had a sauna 4-7 times a week compared to men who had a sauna only once a week. These findings were published recently in the American Journal of Hypertension.

The same researchers have previously shown that frequent sauna bathing reduces the risk of sudden cardiac death, and cardiovascular and all-cause mortality. Elevated blood pressure is documented to be one of the most important risk factors of cardiovascular diseases. According to the research group, underlying protective mechanisms may include the beneficial effects of regular sauna bathing on blood pressure.

The Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) involved 1,621 middle-aged men living in the eastern part of Finland. Study participants without elevated blood pressure of over 140/90 mmHg or with diagnosed hypertension at the study baseline were included in this long-term follow-up study. Based on their sauna bathing habits, men were divided into three sauna frequency groups: those taking a sauna once a week, 2-3 times a week, or 4-7 times a week. During an average follow-up of 22 years, 15.5% of the men developed clinically defined hypertension. The risk of hypertension was 24% decreased among men with a sauna frequency of 2-3 times a week, and 46% lowered among men who had a sauna 4-7 times a week.

Sauna bathing may decrease systemic blood pressure through different biological mechanisms. During sauna bathing, the body temperature may rise up to 2 °C degrees, causing vessels vasodilation. Regular sauna bathing improves endothelial function, i.e. the function of the inside layer of blood vessels, which has beneficial effects on systemic blood pressure. Sweating, in turn, removes fluid from the body, which is a contributing factor to decreased blood pressure levels. Additionally, sauna bathing may also lower systemic blood pressure due to overall relaxation of the body and mind.

A recent analysis of the same study also revealed that those taking a sauna frequently have a lower risk of pulmonary diseases.

Source: Science Daily


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