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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The Eyes Have Clues for High Blood Pressure

When Dr. William White shines a bright light in his patient’s eye, he’s looking for more than just vision problems.

He’s searching for clues indicating the effects of high blood pressure, or hypertension, and what he finds could help prevent heart attacks, strokes and other serious health problems far beyond the eye.

“We can see changes due to vascular conditions caused by diabetes or hypertension,” said White, an optometrist with Baylor Scott & White Health in Temple, Texas. “The blood vessels in the retina can become a little more stiff and hardened. They’ll push on each other and cross, like two hoses in a confined space.

“When it gets really bad, we’ll see some of the blood vessels start to leak, we’ll see some hemorrhaging. And that can cause a whole range of vision issues.”

Vision symptoms may not show up for years. But ultimately, high blood pressure can result in hypertensive retinopathy, blood vessel damage causing blurred vision or loss of sight; choroidopathy, a buildup of fluid under the retina that can distort or impair vision; or optic neuropathy, a blood flow blockage that can kill nerve cells and cause vision loss.

Similarly, high blood pressure may not reveal itself for decades before causing a heart attack or stroke, which earns its grim description as the “silent killer.”

That is why detecting high blood pressure early and treating it with diet, exercise and medication is crucial, and why White says eye doctors are on the front lines of the battle.

“Sometimes people will say, ‘I’m just here to get my glasses. Why are you checking my blood pressure?'” he said. “We try to inform them about the unique opportunity we have to look at these blood vessels in the eye.”

A 2013 study reported in the journal Hypertension underscored the point. Researchers checked about 2,900 patients with high blood pressure for hypertensive retinopathy, then tracked them for an average of 13 years. They found that those with a mild form of the condition had a 35 percent greater risk of stroke. That increased risk leaped to 137 percent for those with moderate or severe hypertensive retinopathy.

Although more research is needed to confirm the findings regarding stroke risk, White has no doubt about the crucial role of eye doctors to educate patients about the need to control blood pressure.

“You’re not just a pair of eyeballs walking into an exam room,” he said. “We have to look at the entire person and the whole picture. These are things that can impact their lives significantly, and we have a responsibility for their overall health.”

But doesn’t every medical checkup start with a blood pressure check? And doesn’t every pharmacy have a machine to measure it yourself?

White said many people would be surprised how many of his patients rarely see another doctor, or if they do, don’t always follow medical advice or don’t take their blood pressure medication.

“Some people don’t go for a routine checkup every year,” he said. “They tell me, ‘Look, I just don’t like going to the doctor.’ But their eyes are a problem, so they’ll come to us.”

Knowing the risks of high blood pressure, White said, keeps him vigilant.

“It’s so important because of the silent nature of this problem,” he said. “People can feel absolutely fine, but high blood pressure has a cumulative effect. If it’s uncontrolled over years, it’s going to cause damage later in life.”

Source: HealthDay


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Scientists Identify Hormone Link Between Diabetes and Hypertension

Physician researchers with The Ohio State University College of Medicine at the Wexner Medical Center say increased levels of the hormone aldosterone, already associated with hypertension, can play a significant role in the development of diabetes, particularly among certain racial groups.

“This research is an important step toward finding new ways to prevent a major chronic disease,” said Dr. K. Craig Kent, dean of the College of Medicine. “This shows how our diabetes and metabolism scientists are focused on creating a world without diabetes.”

Results of this study were published online today by the Journal of the American Heart Association.

“Aldosterone is produced by the adrenal gland. We’ve known for some time that it increases blood pressure. We’ve recently learned it also increases insulin resistance in muscle and impairs insulin secretion from the pancreas. Both actions increase a person’s risk of developing type 2 diabetes, but the question was – how much,” said Dr. Joshua J. Joseph, lead investigator and an endocrinologist at Ohio State Wexner Medical Center.

Joseph and his team followed 1,600 people across diverse populations for 10 years as part of the Multi-Ethnic Study of Atherosclerosis. They found, overall, the risk of developing type 2 diabetes more than doubled for people who had higher levels of aldosterone, compared to participants with lower levels of the hormone. In certain ethnicities, the effect was even greater. African Americans with high aldosterone levels have almost a three-fold increased risk. Chinese Americans with high aldosterone are 10 times more likely to develop diabetes.

“I looked into this as a promise to my father. He had high levels of aldosterone that contributed to his hypertension, and he thought it also might be linked to his diabetes. As my career progressed, I had the opportunity to research it, and we did find a link to diabetes,” Joseph said.

One question that remains is why there are wide differences in risk among various ethnic groups. Joseph said it could be genetics or differences in salt sensitivity or something else, and it needs further study.

Just over 30 million Americans have diabetes and nearly a fourth of them don’t know it, according to the Centers for Disease Control and Prevention. Another one in three Americans has prediabetes. Despite current preventive efforts, the numbers continue to climb among various racial/ethnic groups.

Next, Joseph will lead a federally funded clinical trial at Ohio State Wexner Medical Center to evaluate the role of aldosterone in glucose metabolism. African American participants who have prediabetes will take medication to lower their aldosterone levels. Researchers will study the impact on blood glucose and insulin in those individuals.

“We know there’s a relationship between aldosterone and type 2 diabetes. Now we need to determine thresholds that will guide clinical care and the best medication for treatment,” Joseph said.

He expects to start enrolling patients in that trial later this year.

Source: The Ohio State University


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