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Shed Pounds to Prevent Hypertension

September 13, 2010

A new study from the University of Texas Southwestern Medical Center, in Dallas, seems to run counter to the widely-held assumption that a more intense workout will result in greater reductions in blood pressure. In fact, the number of push-ups you can do or the number of miles you can run may be less important than how much you weigh.

Researchers analyzed data from the Cooper Center Longitudinal study, a large-scale study that included over 35,000 predominantly Caucasian men and women. All participants went to the same local clinic for a regular check-up where they had their body mass index (BMI) and systolic blood pressure measured by a doctor or other health care professional. Physical fitness was also assessed by timing how long each participant could exercise at maximum intensity on a treadmill.

Results, published in the American Heart Journal, showed that normal weight people had an average systolic blood pressure 12 mm Hg lower than obese individuals, while the blood pressure for the most fit people was only 6 mm Hg lower than least fit participants. When analyzing the relationship between fitness level, BMI and blood pressure, researchers found that being physically fit had a greater impact on blood pressure in people who were a normal weight.

This certainly doesn't mean that it's pointless to try to lower your blood pressure by exercising. But overweight may be such an important factor in hypertension that you'll have to exercise and cut calories to reach a normal weight before you start to enjoy lower blood pressure.

Source: Chen, et al. "Fitness, Fatness, and Systolic Blood Pressure," American Heart Journal, July 2010. DOI: 10.1016/j.ahj.2010.04.014

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Is Your Hypertension Drug Raising Your Blood Pressure?

September 13, 2010

Why do some people experience higher blood pressure after starting on a blood pressure drug? Sometimes it's a simple anomaly. Other times it's a result of forgetting to take medication. However, as new research coming out of the Albert Einstein College of Medicine of Yeshiva University in New York City suggests, the culprit may actually be the drug you're taking.

The study involved 945 men and women with high blood pressure who had enrolled in a hypertension treatment program. None of the participants were being treated for hypertension at the start of the study and all were prescribed one of several medications: a diuretic, a calcium channel blocker, a beta-blocker or an ACE inhibitor. These drugs treat blood pressure differently depending on whether hypertension is believed to be the chiefly caused by high blood fluid levels in your arteries—more volume equals greater pressure—or the overproduction of renin, an enzyme produced in the kidneys that can cause the restriction of blood vessels. Diuretics and calcium channel blockers lower blood pressure by reducing blood volume, while beta-blockers and ACE inhibitors lower renin levels.

Results, published in the American Journal of Hypertension, showed that approximately eight percent of the participants experienced a 10 mm Hg or greater rise in systolic blood pressure after receiving treatment. The highest percentage of rising blood pressure after treatment occurred among people who were prescribed an ACE inhibitor or a beta-blocker, perhaps because these people had normal renin levels and should have been taking a volume lowering medicine like diuretic or calcium channel blocker instead.

The problem is that doctors don't always measure renin levels before treating hypertension—the test used to be expensive and not altogether reliable. That's changed in recent years, so if you are taking a renin-blocking drug and your blood pressure remains high or is getting higher, talk to your doctor about measuring your plasma renin activity (PRA). It's a simple blood test that can more accurately pinpoint the cause of your hypertension and get you on the road to more successful treatment.

Source: Alderman, Cohen, Sealey and Laragh. "Pressor Responses to Antihypertensive Drug Types." American Journal of Hypertension, September 2010.

Light Exercise Keeps Arteries Healthy

August 3, 2010

A new study suggests that for older adults light exercise can go a long way. One of the chief causes of hypertension (high blood pressure) is stiff arteries. Moderate-level exercise helps prevent this gradual stiffening from occurring. But if you're older and less mobile due to illness or disability, frequent light exercise also may do the trick.

Researchers in Japan asked 538 men and women to wear a small device that measured activity over a period of 20 days. Participants also had their blood flow measured at the femoral artery using pulse wave velocity—a simple ultrasound test that helps doctors estimate arterial stiffness. Results, published in Hypertension, The Journal of the American Heart Association, showed that, overall, people whose recorded movements corresponded to moderate-level exercise (such as yard work) or vigorous exercise (such as jogging), had healthier arteries than those whose movements pointed to light activity, like housework. But for adults over 60, regular light activity seemed to make a big difference. Their pulse wave velocity was eight percent lower than inactive older adults indicating substantially healthier arteries and blood flow.

The bottom line: Virtually all fitness guidelines from major health organizations recommend that older adults get 30 minutes of moderate-intensity exercise on all or most days of the week. If you're saddled with an illness or disability, and you can't perform activities on this level, make light activities like watering the plants, washing the dishes, and sweeping the porch a part of your daily routine. The more time you spend doing these light activities, the greater the health benefits.

Source: Gando, et al. Longer Time Spent in Light Physical Activity is Associated With Reduced Arterial Stiffness in Older Adults

Cut Carbs or Slash Fats? What's Best for BP

August 3, 2010

In the ongoing saga of whether it's better to cut carbohydrates or fats from your diet, score one for carbohydrates, at least when it comes to lowering blood pressure. Researchers from the Department of Veterans Affairs in North Carolina randomly assigned 146 obese men and women with an average Body Mass Index (BMI) of 39.0 to follow either a low carbohydrate diet or a low fat diet. Participants on the low fat diet also took a daily dose of the drug orlistat, which blocks the absorption of fat in the large intestine. Everyone had their weight, blood pressure, cholesterol levels, and blood sugar levels measured at the beginning of the study and again after 48 weeks.

Results, published in Annals of Internal Medicine, showed that those who cut carbs and those who cut fat both lost about 9% of their initial body weight, while cholesterol levels only improved in low fat dieters.

In contrast, the average systolic blood pressure (the top number in a blood pressure reading) of carb-cutters dropped about five points. Not so for low-fat dieters; their blood pressure increased about one point on average.

Traditional wisdom says that a low-fat, low salt diet is the best way to lower blood pressure. What this study draws attention to is that carbohydrates also matter. Other studies have linked the consumption of sugary beverages to higher blood pressure independent of salt intake.

Bottom line: Your best bet isn't a low fat or a low carb diet; it's a low fat diet that is also carbohydrate conscious. Try the modified DASH diet—it's a newer version of the original DASH (Dietary Approaches to Stop Hypertension) diet that places greater emphasis on replacing carbohydrates with protein.

Sources: Yancy, et al. A Randomized Trial of a Low-Carbohydrate Diet vs. Orlistat Plus a Low-Fat Diet for Weight Loss. Archives of Internal Medicine, 2010 Jan 25;170(2):136-45. and
National Heart, Lung and Blood Institute

Variable BP Predicts Stroke

July 2, 2010

You may already know that hypertension (high blood pressure) is the leading cause of stroke. That's why you should always have your blood pressure checked when you go to the doctor. But regular home monitoring may be just as important, because so many factors—including nervousness you may feel while in the doctor's office—can influence readings. In fact, for people at risk of developing hypertension, it's standard practice for doctors to take an average of several readings before issuing a diagnosis. However, new research now suggests that high average blood pressure may not tell the whole story.

In analyzing blood pressure data from several major clinical trials, researchers at Oxford University found that people with high blood pressure variability were more likely to suffer a transient ischemic attack (TIA), often referred to as "mini-stroke" than those with high average, but stable, blood pressure. This suggests that wide fluctuations in blood pressure are even more dangerous than having high average blood pressure.

What does this mean for you? For one, if your blood pressure consistently varies more than 10 mm HG from visit to visit, you may need to take aggressive steps to get your blood pressure stabilized—by exercising more often, eating more healthfully, or taking medication.

It's important to note that this analysis looked at people who were already at very high risk for stroke. It's not completely clear if blood pressure variability can be considered a red flag for everyone else. The study was also a meta-analysis (a summary of data from other studies that were not specifically designed to test the merits of blood pressure variability), so more research is definitely needed before variability makes it into you doctor's office.

Nonetheless, it certainly doesn't hurt to ask your doctor to check your blood pressure variability. Or to track it yourself. Blood pressure variability can be measured using a statistic called standard deviation. To calculate it, go to Descriptive Statistics and plug in your most recent blood pressure readings.

Source: National Center for Biotechnology Information, U.S. National Library of Medicine

Anxiety Ups CVD Risk

July 2, 2010

Although people diagnosed with an anxiety disorder do not necessarily develop sustained hypertension, acute episodes of anxiety—bordering on an anxiety attack, for instance—do raise your blood pressure. If this happens repeatedly it can have the same negative effects as having sustained hypertension. As two new studies published in the Journal of the American College of Cardiology suggest, this can wreak havoc on your heart.

Researchers in the Netherlands analyzed data from 20 studies that included over 250,000 people from United States and Europe. Results showed that people who reported symptoms of anxiety disorder or were formally diagnosed with anxiety at the start of the study, were 26 percent more likely to develop heart disease and 48 percent more likely to die from a heart attack over a period of 11 years than people without anxiety. In a second study researchers in Sweden followed 50,000 men for an average of 37 years. They found that men diagnosed with anxiety between age 18 and 20 were over twice as likely to go on to develop heart disease or experience a heart attack. People with anxiety in both studies were also more likely to develop high blood pressure (hypertension).

Because of the link between anxiety and heart disease, it's important to seek treatment. By treating your anxiety with anti-anxiety medication, you may be able to help reduce your risk of heart attack. Anxiety, like depression to which it is closely tied, is frequently treated with a class of antidepressants called SSRIs. Antidepressants can increase blood pressure in some people.

Source: Journal of the American College of Cardiology

Cutting Sugary Drinks Lowers Blood Pressure

May 28, 2010

Experts have long cautioned that regular consumption of sugary drinks—soda or sugar-sweetened juices, for instance—ups your risk for obesity and diabetes. Now a new study in Circulation, The Journal of the American Heart Association implicates sugary beverages as a risk factor for hypertension (high blood pressure). Here's why you should try to cut them from your diet.

A team of researchers from Johns Hopkins Bloomberg School of Public Health and elsewhere, looked at 810 men and women enrolled in PREMIER—a large-scale study of blood pressure and lifestyle factors. All participants had higher than normal blood pressure (greater than 120/80 mm Hg), pre-hypertension (greater than 140/90 mm Hg), or clinical hypertension (greater than 150/100 mm Hg); all filled out dietary questionnaires and had their blood pressure measured at the beginning of the study, six months later, and then again after 18 months. On average people consumed 2 to 3 sugary beverages daily at baseline.

Results showed that participants who cut their sugary beverage intake by 1 serving per day—the equivalent of one can of soda—enjoyed average drops in blood pressure of 1.8 mm Hg in systolic blood pressure and 1.1 mm Hg in diastolic blood pressure. Of particular note, many participants who consumed fewer sugary beverages enjoyed lower blood pressure even though they didn't lose any weight—suggesting that sugar may play an independent role in raising blood pressure. One possibility is that sugar amps up the nervous system much like caffeine. Another is that it encourages the retention of sodium, a major contributor to high blood pressure (hypertension).

Polypill Shows Promise in Clinical Trials

May 28, 2010

People with multiple risk factors for cardiovascular disease often have to adhere to a complex regimen of pills, including one or more anti-hypertensive drugs, a cholesterol lowering therapy—most likely a statin—and a daily low-dose aspirin. That's why it's so common for patients to forget to take all their medications regularly. One promising development is to combine everything into one easy-to-take "polypill." The hope is that this approach may offer more than just convenience.

Theoretically, people should derive the exact same benefits from a polypill that they would from taking each drug separately. But that doesn't seem to be the case. Take for instance The Indian Polycap Study (TIPS). Researchers found that people who took polycap—a one pill combination of three different blood pressure drugs, 20 mg of simvastatin, and 100 mg of aspirin—experienced greater improvements in blood pressure than projected by adding the individual benefits of each blood pressure drug. This "synergistic effect" on blood pressure, however, seems to have come at the expense of cholesterol. Reductions in cholesterol were actually lower than recorded in clinical trials for simavastin.

What researchers are finding is that polypills produce an effect that is different than their constituent parts. They key is to harness that power to provide more benefit, as opposed to less—and to do that safely. TIPS II is currently under way and will test a polypill with a higher dose of cholesterol medication. Interested readers should also keep an eye out for the Use of a Multidrug Pill in Reducing Cardiovascular Events (UMPIRE). Participants in TIPS were essentially healthy—most had just one risk factor for cardiovascular disease—while UMPIRE includes people who have experienced a heart attack or stroke, or have multiple risk factors for heart disease.

Brown Rice Lowers Blood Pressure

May 4, 2010

Adopting a healthy diet is an important component of an overall heart-healthy lifestyle. And one choice you can make is to consume more brown rice. New research suggests that it may play a direct role in helping ward off hypertension (high blood pressure).

First the basics: Brown rice is essentially unprocessed, meaning that the outermost layer of the rice grain is left intact. White rice is "washed"; it's what's left of the grain after the brown outer layer has been removed. Experts have long maintained that this outer most layer, which is rich in dietary fibers and other nutrients, is what makes brown rice the healthier alternative. Now scientist think brown rice may have some distinct cardio-protective properties.

Using chemical processes, researchers at the Cardiovascular Research Center Department of Physiology at Temple University School of Medicine in Philadelphia, in partnership with a Japanese team of scientists, stripped off the subaleorone (brown) layer of several common varieties of Japanese rice. After exposing these isolated compounds to vascular tissue samples of human arteries, they found that muscle cells exposed to brown rice compounds activated to cause the widening of arteries.

What's going on? The compounds in brown rice may block the enzyme angiotensin, which is known to cause arterial constriction and high blood pressure. But there is also some compelling cultural evidence in favor of brown rice. Unlike most Americans, who rarely eat brown rice, people in Japan eat it for at least one meal per day on average. Researchers think this may help explain why fewer Japanese people suffer cardiovascular disease than their American counterparts.

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Doctors Overlooking Pediatric Hypertension

May 4, 2010

Hypertension is certainly not as prevalent among children as it is among adults, but children do get high blood pressure. That's why, like adults, they should have their BP checked regularly at doctors visits. However, a new study from the Johns Hopkins Children's Center says that this isn't happening.

In a study published in the June issue of Pediatrics, Hopkins researchers analyzed 2,500 visits to pediatrician's offices and found that medical staff did not check blood pressure in 500 cases. And when elevated blood pressure was recorded—which it was upon 726 visits—it was not recognized or noted as potential problem 87% of the time. In many instances, doctors may not have suspected high blood pressure in children of normal weight with no other risk factors for cardiovascular disease, like family history. But, another problem is that what's considered normal for adults—120/80 mm HG or lower—may not be normal for children.

Unfortunately, blood pressure parameters are not clearly defined in children, but adjusted for height, weight and age, a measurement of 120/80 may actually be high for kids. Your best bet: Always ask your doctor or nurse to check your child's blood pressure—even if he or she is just in for a common cold. High readings on three successive visits may mean that treatment is warranted. The good news is that if hypertension is caught early and treated, it can be reversed so that it does not lead to serious cardiovascular problems in adulthood.

New Generic Drugs for Treating Hypertension

April 16, 2010

If you are taking Cozaar® or Hyzaar® for high blood pressure (hypertension) you'll likely be saving some money on prescription drugs in the near future. Why? The Food and Drug Administration (FDA) has recently approved the first generic versions of these two commonly prescribed medications.

Cozaar is an angiotensin II receptor blocker; it blocks the action of the hormone angiotensin, which contributes to high blood pressure by causing the constriction of arteries. Cozaar in generic form, losartan potassium, will be available in 25 milligram, 50 milligram and 100 milligram strengths. Hyzaar is a combination drug that contains Cozaar plus a thiazide diuretic. Diuretics are drugs that attack hypertension by preventing fluid retention. They are one of the oldest treatments for hypertension and are still commonly prescribed in conjunction with newer anti-hypertensive drugs for people who need some extra help lowering blood pressure. Hyzaar will be available in generic form as losartan potassium hydrochlorothiazide and will come in dosages of 50 mg/12.5 mg, 100 mg/12.5 mg, and 100 mg/25 mg strengths.

One common concern is that generic medicines may not work as well as brand name drugs. However, while there may be some slight variations in the inactive ingredients between generics and their brand name counterparts, generics must be "bio-identical" to be granted FDA approval. And, word to the wise, if you want to save even more money on generics, ask your doctor about upping your dose and splitting the pill in half—you may be able to cut your drug costs in half too.

Vitamins C, E Show No Benefit for Preeclampsia

April 16, 2010

Pregnant women are frequently advised by their doctor to take prenatal supplements containing essential vitamins and minerals But doctors have long-wondered whether high-doses of vitamins C and E in particular could prevent the onset of preeclampsia—a life threatening complication of pregnancy characterized by hypertension, fluid retention, and excess protein in the blood stream.

Over a period of 6 years, researchers from the University of Pittsburgh and elsewhere randomly assigned 9,969 pregnant women in the 9th to 16th week of pregnancy to take 1,000 mg of vitamin C plus 400 IU of vitamin E daily or matching placebos. Results, published in the New England Journal of Medicine, showed no significant difference in preeclampsia rates—women in both groups had about a 7% chance of experiencing preeclampsia, which is about normal.

Because research has suggested that oxidative stress plays an important role in causing preeclampsia, experts hoped that the strong antioxidant properties of vitamin C and E would prevent it, particularly since these vitamins were given at such high doses. Still, despite the results of this study, the authors stress that women shouldn't be discouraged from taking prenatal supplements altogether since they have other important health benefits. And vitamins C and E didn't cause any apparent harm to any of the participants.

Preeclampsia can occur anytime after the 20th week of gestation and can be fatal to both mother and child. It's characterized by unusual swelling (typically in the hands, feet, and face), 2 consecutive blood pressure readings above 140/90 mm HG, and protein levels higher than 300 mg as determined 24-hr urine collection test. The only treatments are abortion, the immediate induction of labor, or cesarean delivery.

Higher BP Better for People Admitted to the Hospital for Chest Pain

April 1, 2010

File this one under counterintuitive. A Swedish study just published in the Journal of the American Medical Association looked at the hospital records of over 119,000 people admitted to the intensive care unit and found that those with higher blood pressure actually fared better upon being released. Surprisingly, many hypertension experts were not very surprised by these findings. Here's why.

Specifically, researchers found that people with systolic blood pressure of 200 mm Hg or more—,well above the crisis threshold of 180 mm Hg set by the American Heart Association—, were actually more likely to be alive one year later than people whose blood pressure was at the non-emergency high blood pressure range of 150 mm Hg to160 mm Hg. There was no problem with the collection of the data (health records in Sweden are notoriously accurate) so what's the explanation?

One possibility is that people with chest pain as a result of heart failure skewed the data. Heart failure is a serious condition characterized by a weakening of the heart's pumping capacity; it typically results in dangerously low blood pressure. However, researchers factored out people with heart failure and found that the relationship still held. The more likely explanation is that people who are taken to the hospital with chest pain are under tremendous stress because they are afraid that they might be experiencing a heart attack—so naturally their blood pressure is going to be elevated. People whose blood pressure does not dramatically elevate in such situations may not be capable of achieving a normal stress response, which is a likely indication that they have more serious cardiovascular disease.

Chocolate Consumption Lowers BP

April 1, 2010

Chocolate contains an abundance of flavanoids—antioxidants that help widen arteries by stimulating the release of nitric oxide. Wider arteries result in improved blood flow and lower blood pressure. By just how much chocolate should you eat? And will improvements in blood pressure translate into real protection from heart attack and stroke? A new study has some answers.

In what amounts to the largest chocolate study ever, researchers in Germany asked 19,357 participants in the European Prospective Investigation into Cancer (EPIC) study to report on their daily chocolate eating habits over a period of approximately eight years. Researchers found that those who ate the most—around 7.5 grams per day—cut their stroke risk by 48% and heart attack risk by 27% compared to those who rarely ate chocolate. In absolute terms researchers estimated that if people who rarely ate chocolate increased their consumption to the recommended 6g per day, there would be 85 fewer strokes per 10,000 people within a decade.

How much is 6 grams? A typical chocolate bar is about 100g and contains 500 calories; one small square is approximately 6 grams, and contains about 30 calories, which is all you need. More is okay too, but if you do indulge—you eat the whole of chocolate bar for instance—be sure to cut back on your calories in other ways throughout the day. Too much could cause you to gain weight, thereby negating the cardiovascular benefits of chocolate.

For Diabetes, Lower BP May Not Be Better

March 18, 2010

The risk of heart attack among people with diabetes is roughly equivalent to a person without diabetes who has already suffered a heart attack. Thus blood pressure goals for people with diabetes and hypertension (high blood pressure) are very stringent—130/80 mm Hg, which is 10 mm Hg lower than target goals for people without diabetes who have already experienced a heart attack. The question: Should people with diabetes go even lower than 130?

Researchers with the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial randomly assigned 4,733 people with type 2 diabetes and high risk for heart attack or stroke to undergo intense blood pressure lowering therapy or standard therapy. The intense therapy group took an average of 3.4 anti-hypertensive drugs to get their blood pressure to 120 or lower, while the standard group took only 2 medications on average to reach a target goal of 140 or lower.

Results showed that after one year the standard therapy group—average blood pressure 133.5—were not more likely to experience a fatal or non-fatal heart attack or stroke than the intense therapy group. But the intense therapy group was more than twice as likely to develop serious side effects from blood pressure drugs, including high potassium levels, which can cause arrhythmia and even cardiac arrest.

It's important to note that previous data from the ACCORD trial showed that taking aggressive steps to lower blood sugar levels in people with diabetes actually increased the risk of heart attack and stroke. Bottom line: Research is increasingly showing that lowering existing treatment goals for diabetes may actually do more harm than good.

Benefits of Blood Pressure Drugs in Obese Patients

March 18, 2010

Your weight is a very strong predictor of your overall health. Obesity—having a body mass index (BMI) of 30 or greater—tends to coincide with a number of cardiovascular risk factors, including hypertension. The good news, according to a new French study, is that the heavier you are the more you'll benefit from antihypertensive drugs.

Researchers with the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) divided 6,105 participants with a history of stroke into 4 different BMI groupings from lowest to highest. They found that while patients of all BMIs taking the ACE-inhibitor preindopril experienced fewer heart attack and strokes than those taking a placebo, obese patients seemed to benefit from the most protection.

In the obese group, participants were 30% less likely to suffer a major cardiovascular event than those taking placebo over a 5-year period. In the lowest BMI group, participants taking preindopril were 20% less likely to suffer a heart attack or stroke than the placebo group. Why did obese people benefit more? Researchers say that because heavier people tend to have greater cardiovascular risk to begin with—higher blood pressure and higher cholesterol, for instance—they have more room for improvement than normal weight individuals.

Hypertension Remains a Neglected Disease

March 5, 2010

Given the widely recognized importance of preventive medicine, it's surprising to learn of a recent report issued by the Institute of Medicine's Committee on Public Health Priorities to Reduce and Control Hypertension. They found that even though most Americans recognize the importance of getting their blood pressure checked, this awareness isn't translating into sustained reductions in our national blood pressure. A high sodium diet is partially to blame, but it's not only about salt.

The IOM looked at health data registries for the years 1995 to 2005 and found that although 25% fewer people died from hypertension, the percentage of people with high blood pressure is rising. Part of the problem, the committee notes, is that 87% of Americans consume almost 1,000 excess milligrams of salt daily (1,500 mg is the recommended limit). Sodium encourages fluid retention and is a known-contributor to high blood pressure. A lesser-known but also important finding is that most people are lacking in potassium.

Potassium is important because it blunts the effect of salt, thereby maintaining a healthy balance of fluids and electrolytes in the body. In fact, the IOM estimates that if every adult consumed about 4,700 mg/day of potassium hypertension could be reduced by 7%. Most adults consume a fraction of that amount. Where do you find it? Look no further than leafy greens, root vegetable like beets and sweet potatoes, fruits including apples and bananas, and even milk and yogurt. (A high potassium diet may not be recommended for people with chronic kidney disease).

FDA Approves Blood Pressure Drug for Children

March 5, 2010

Prescribing medication to children with "adult" conditions like hypertension can be a risky endeavor. The majority of people with hypertension are over 35—the age at which blood pressure begins to creep up—so clinical trials for the FDA approval of antihypertensive medications tend to exclude children (not to mention the ethical issue involved in children participating in clinical trials). The result is that doctors can't be certain that an antihypertensive drug is safe for treating younger people with high blood pressure, which strikes 5% of American children.

At least one exception to this rule now comes in the form of Benicar® (omesartaran medxomil). Benicar is an angiotensin II receptor blocker (ARB), which means that it works by blocking angiotensin—a hormone that causes arteries to constrict. Benicar was approved in 2002 for use in adults and was recently approved by the FDA for the treatment of pediatric hypertension after Phase III clinical trials showed that it was safe and effective for treating hypertension in children ages 6 to 16. The magnitude of blood pressure reduction and reported side effects such as dizziness and nausea were similar in adults and children.

It's important to note that even with Benicar's approval, pediatric hypertension is still likely to be treated "off label"—when a drug is prescribed for a use other than its FDA approved indication. Because clinical trials are so highly restricted to narrowly defined groups, off-label prescribing of blood pressure drugs and other medications to adults and children is widespread, and absolutely necessary. Many see it as the "art" of medicine. Still, it's clear that owing to size alone children metabolize drugs differently than adults, raising a number of important issues related to drug dosing in particular. Always talk to your pediatrician about a drug's safety profile.

Hypertension Predicts Dementia in People with Cognitive Dysfunction

February 22, 2010

Research shows that having hypertension (high blood pressure) in mid-life is an important risk factor for developing dementia later in life. But, scientists have also been interested in the role that blood pressure plays for people already experiencing mild cognitive problems. One concern is that someone with mild cognitive impairment may be tipped into dementia by hypertension, whereas given normal blood pressure they may have developed the disease more slowly—if at all. Now a new study says that hypertension (high blood pressure) seems to have the most detrimental effect on people experiencing a specific set of cognitive problems.

The news comes from the Canadian Study of Health and Aging, a large community-based study that recruited of over 990 older adults with cognitive impairment but no dementia. Researchers found that over the course of 5 years, people with hypertension and cognitive impairment were no more likely to develop dementia than those with normal blood pressure. However, when they looked at the specifics of cognitive decline, they found that 57.7% of older adults with hypertension and executive cognitive dysfunction—problems with planning, initiating action, and inhibition—developed dementia, compared to just 28% of older adults with executive dysfunction and normal blood pressure. (Hypertension did not increase dementia risk in people with short or long-term memory loss).

Why did hypertension seem to have such a selective effect? The authors say that high blood pressure does the most damage to blood vessels in frontal lobes, the region of the brain that governs executive functions. The hope is that by treating blood pressure more aggressively with medications and other strategies it may be possible to prevent or delay dementia.

Drug Combination for Treating Hypertension Increases Heart Attack Risk

February 22, 2010

Many patients diagnosed with hypertension (high blood pressure) take a diuretic—medication that lowers blood pressure by reducing fluid retention. For further help, doctors may add a second—or third—drug to fight hypertension along a different molecular pathway. But all drug combinations may not be created equal. In fact, results from a new study suggest that adding a calcium channel blocker to a diuretic may do more harm than good.

Researchers at the University of Washington, Seattle identified 1,305 patients with hypertension enrolled in the Group Health Cooperative, a large health maintenance organization. All were taking two-drug combinations that included a diuretic with the addition of a beta-blocker, angiotensin receptor blocker (ARB), ACE-inhibitor, or calcium channel blocker. Researchers found that those taking a diuretic and calcium channel blocker were almost twice as likely to experience a heart attack compared to those taking a diuretic and a beta-blocker. Differences between other drug combinations were not significant; and there was no increase stroke risk associated with taking a diuretic and calcium channel blocker.

This study is important in that looks at the effects of taking a second drug for hypertension on top of a diuretic—a ubiquitous practice that is, nonetheless, poorly studied. However, as critics have pointed out, calcium channel blockers are rarely considered as a second-line of defense for hypertension. Most doctors would choose an ACE-inhibitor or ARB instead because research shows that they are much more effective. And other studies on calcium channel blockers have shown that they are very beneficial for preventing heart attack and stroke. Still, if you are taking a calcium channel blocker on top of a diuretic, it doesn't hurt to raise the issue of safety with your doctor.

Women with Hypertension Face Elevated Risk of Dementia

February 8, 2010

You don't have to experience an incapacitating stroke to be affected by the consequences of high blood pressure (hypertension) on the brain. Many studies have shown that compared to people with normal blood pressure, people with hypertension score worse on cognitive tests, and are at a higher risk of developing dementia-related illnesses—like Alzheimer's disease. Now, a new study conducted by researchers affiliated with the landmark Women's Health Initiative (WHI), provides an important glimpse into the detrimental processes at work in the brains of people with hypertension.

Scientists analyzed a subgroup of 1,403 WHI participants age 65 or older who agreed to participate in a separate WHI Memory Study (WHIMS). All participants had their blood pressure measured upon enrolling in WHIMS, and all were subjected to a series of cognitive tests in addition to MRI scans to confirm that they had no cognitive impairment or extensive pre-existing brain lesions. Eight years later, another MRI scan revealed that women who had high blood pressure at the beginning of the study developed significantly more white matter lesions than women with normal blood pressure.

White matter is important because people with extensive white matter lesions are at high risk for developing dementia. Indeed, women in this study with extensive lesions were more likely have dementia or significant cognitive impairment. White matter is comprised of interconnected nerve cells that convey electric impulses along neural pathways—the foundation of memory and cognitive function. The whole process is dependent on sustenance from tiny blood vessels that deliver oxygen and nutrients into the white matter region of the brain. Hypertension damages these delicate blood vessels, effectively starving the white matter and killing off neural pathways.

Fewer Strokes Among New Immigrants

February 8, 2010

Most people agree that immigrating to a new country is exceedingly stressful. And people who lead stressful lives are more likely to develop high blood pressure (hypertension)—which is the leading cause of stroke. Why then are researchers finding that recent immigrants tend to experience fewer strokes?

A new study published in the journal Neurology looked at 966,000 new immigrants to Ontario Canada; all had lived there for at least 5 years and all were compared to a separate group of over 3 million native Canadians of the same age and sex. Researchers found that over a period of 12 years, new immigrants were about 30% less likely to experience a stroke than native residents, suggesting that the social and psychological stress of adapting to a new environment doesn't have much of a detrimental effect on health. In fact, immigrants seem to be healthier than native citizens.

But, why? It may be that immigrants are resistant to adopting a high-fat, high calorie western diet. They therefore are less likely to suffer the consequences of obesity, including high blood pressure and stroke. Researchers didn't look at diet in particular, but they did match immigrants to native Canadians with similar health problems such as diabetes and hypertension and found that immigrants still came out ahead.

Another thing to consider is that people up to the task of immigration may be atypically healthy and strong to begin with. One potential problem: The average age of people selected for the analysis was only 34; therefore, stroke incidence may not be the best indicator of good health because it is such a rare event in younger people.

Cutting Salt Saves Lives

January 25, 2010

Lately it seems that salt is on the chopping block—which is good news for people with hypertension. New York City has announced an initiative that would urge food manufacturers and restaurants to reduce sodium levels in their products by 25% over the next 5 years. And, the Food and Drug Administration (FDA) is currently considering reclassifying salt into a category of food additives that would ultimately require companies to provide a warning level on foods that are high in sodium. Adding fuel to the fire, a new study, published in the New England Journal of Medicine, just announced that even minor reductions in salt could save thousands of lives.

Based on the known health risks posed by a high-salt diet, and the estimated daily consumption of salt in the United States, researchers at the University of California San Francisco, Stanford University Medical Center, and Columbia University Medical Center used complex computer modeling to predict the widespread effect of cutting salt consumption. They found that if everyone consumed 3 grams less salt per day—about half a teaspoon—there would be between 54,000 and 99,000 fewer heart attacks each year and between 44,000 and 92,000 fewer deaths.

Why is salt so unhealthy? Salt encourages fluid retention, which is one way it may contribute to high blood pressure, but there is also some evidence that sodium is linked to cardiovascular disease independently of blood pressure. The best way to avoid salt is to stay away from processed foods, such as canned foods and prepackaged snack foods.

Long Term Risk of White Coat and Masked Hypertension

January 25, 2010

Doctors suspect masked hypertension when someone has normal blood pressure but one or more conditions that are strongly associated with hypertension such as chronic kidney disease, diabetes, and cardiovascular disease. In contrast, white coat hypertension occurs when blood pressure is consistently high at the doctor's office—possibly due the anxiety of being there—but normal in every day life. It has been unclear if these conditions are potential precursors to sustained or clinical hypertension. A new study may provide some answers.

Researchers in Italy measured the blood pressure 1,412 people ages 25 to 74, on two successive days in an office setting. To diagnose potential masked or white coat hypertension, patients also wore an ambulatory blood pressure monitor—which measure blood pressure at consistent intervals for 24 hours—and took two blood pressure readings at home using an at-home blood pressure monitor. The same process was repeated 10 years later. Results, published in Hypertension: The Journal of the American Heart Association, showed that people with masked hypertension were 47% more likely to develop sustained hypertension than people whose blood pressure was consistently normal at all initial readings. People diagnosed with white coat hypertension where also 42% more likely to develop sustained hypertension.

Once diagnosed, masked hypertension is usually treated with blood pressure medications—not so for white coat hypertension; typical course of action is to do nothing. However, this study suggests that because white coat hypertension is a strong indicator of future sustained hypertension, people with the condition should be monitored more closely.

Ambulatory BP Monitors Overestimate Blood Pressure

January 11, 2010

One of the most important benefits of ambulatory blood pressure monitors (also called 24-hour blood pressure monitors) is that they give doctors an understanding of what's going on at night. In healthy people, blood pressure dips significantly during sleep—if it doesn't, this indicates that a person is at much greater risk of heart attack or stroke. In fact, research suggests that nighttime blood pressure is a better predictor of heart attack and stroke risk than a one-time doctor's office reading. However, a new study indicates that ambulatory monitors may be overestimating blood pressure in some patients. Here's why.

Researchers at Indiana University analyzed results of 24-hour blood pressure monitoring in 103 people with chronic kidney disease—which often causes hypertension. In addition to being monitored, participants were asked to report on their quality of sleep. Results, published in the Clinical Journal of the American Society of Nephrology, showed that people who awoke frequently while being monitored were ten times less likely to have a healthy nighttime dip in blood pressure compared to those who slept soundly. This suggests that people who don't sleep well during blood pressure monitoring might receive an artificially inflated blood pressure reading, which could lead to unnecessary or aggressive treatments that might be harmful.

The take home message: always tell your doctor if you've had difficult sleeping while undergoing 24-hour blood pressure monitoring. He or she can suggest ways to make sure that get you get a good night's sleep—and an accurate reading. For instance, if a clumsy, old-fashioned ambulatory monitor is keeping you awake, you can try one of the newer models. Some monitors are no bigger and no more obtrusive than a wristwatch.

New Developments in Pulmonary Hypertension

January 11, 2010

Doctors know to look out for pulmonary hypertension, high blood pressure in the artery that carries blood from the heart to the lungs, which is often found in people with serious cardiovascular disease, such as heart failure, and those born with certain heart defects. But a form of the condition called idiopathic pulmonary hypertension—IHP for short—remains difficult to diagnose. As the term "idiopathic" suggests, there is no known cause for IHP, which strikes otherwise healthy children and adults tends to get worse over time. The good news: experts may be on the verge of catching this silent killer.

Currently, the only way to detect IPH is through ultrasound, a non-invasive imaging test that converts sound waves into images. But ultrasound tends to be inaccurate. Plus, it's not very reliable for determining whether or not someone with IHP is responding to vasodilators—medications that help lower blood pressure by widening arteries and improving blood flow.

Researchers at Johns Hopkins Children's Center have recently discovered several different proteins that they think may be important "biomarkers" for diagnosing and treating IHP. Studies are now underway to see if people with IHP have higher levels of these proteins in their blood stream and whether or not these proteins levels drop in response to treatment with blood pressure medications. The results are much anticipated: research shows that upwards of 70% of people with IHP who don't respond to medication die within 5 years of being diagnosed.

More Salt Ups Stroke Risk

December 14, 2009

It's always a good idea to cut down on salt (sodium). The reason? Sodium causes you to retain fluid, and more fluid circulating through your arteries translates into higher blood pressure. With hypertension being the leading risk factor for stroke, logic dictates that cutting sodium can also reduce your risk of stroke. Still, there are questions concerning whether the link between salt and stroke is as direct as it may seem.

Researchers in Italy may have some answers. They analyzed data on salt consumption and cardiovascular disease from 13 studies with a combined total of 177, 025 participants who were followed anywhere from 3.5 to 19 years, depending on the study. Results, published in BMJ, showed that people who consumed an average of 10g of salt daily—double the recommended level set by the World Health Organization (WHO)—were 23% more likely to suffer a stroke than people who consumed less than 5g daily. People who consumed 10g of salt per day were also 17% more likely to suffer a heart attack.

Unfortunately, 10g of salt daily is the norm for most people in Western countries—the United States included. This means that most of us have to cut our salt level in half to reduce our risk of stroke. On positive note, this study may help us do that in more ways than one. Researchers summarized vast amounts of data to help validate the direct link between salt and stroke, which means that this study likely to be a powerful weapon for public health officials to pressure manufacturers to place limits on sodium levels in foods.

Bone Growth Predicts Hypertension in Kids

December 14, 2009

The growing epidemic of hypertension (high-blood pressure) among children has become a pressing concern as of late. Not only have health organizations issued guidelines for treating pediatric hypertension, but also scientists have been on the hunt for clues that can help physicians spot at-risk children. Obesity is one risk factor and chronic kidney disease (as discussed in a previous alert) is another. Now, a new study finds a potential red flag in skeletal maturation or bone age.

Doctors typically use changes in bone shape and size as way of determining whether or not a child is developing normally for his or her age group. Bone age is also used to predict how tall a child is likely to be in adulthood.

Researchers in Poland measured the bone age of 54 children with hypertension by taking an x-ray of their left wrists. They then compared results to the x-rays of a similar group of children without hypertension. Results published in the journal Hypertension showed that the bone age of hypertensive children was roughly 2 years ahead of their chronological age—the wrist of a 6 year old with hypertension was roughly the size of most 8 year-olds. The bone age of children without hypertension was the same as their chronological age.

Scientists have long hypothesized that children who grow at an accelerated rate face an increased risk of developing hypertension. It may be that a faster biological tempo is linked to hormonal and metabolic abnormalities associated with obesity. But this study compared children with normal blood pressure and hypertensive children with similar BMIs (body mass index is comparison of weight related to height that's used to determine obesity), and still found accelerated bone growth among kids with high blood pressure.

This was a small study and it certainly doesn't mean that a child who is tall for his or her age has hypertension. But it certainly doesn't hurt to keep high blood pressure in mind next time your pediatrician or family doctor brings up bone age.

Exercise Harder to Prevent Stroke

November 30, 2009

Along with lifestyle changes such as eating healthfully and not smoking, regular exercise is crucial for controlling hypertension (high blood pressure), which is the number one cause of stroke. Most reputable agencies, including the American Heart Association, recommend 30 to 60 minutes of exercise daily at a moderate intensity level. This includes activities such as walking or biking at a pace where it is still possible to maintain a conversation. However, new research suggests that exercising harder is better for reducing stroke risk.

The news comes from the Northern Manhattan study, a large-scale epidemiological study analyzing the myriad factors that help explain why someone does or does not experience a stroke. Researchers looked at just over 3,000 people, average age 69, and found that those who reported engaging in moderate-to-heavy intensity activities like tennis and swimming were 35% less likely to suffer a stroke over a nine-year period than patients who didn't exercise. People who exercised only lightly, such as an occasional walk at a slow pace, were only 6% less likely to suffer a stroke than non-exercisers.

The fact that people who exercise harder are afforded more protection may not seem very revolutionary, but these results do fly in the face of previous research. Other large-scale studies that have influenced current recommendations on exercise, including the Nurses' Health Study and the Women's Health Initiative, suggested that high-intensity may only increase the risk of injury or cause chronic conditions such as arthritis without producing any added cardiovascular benefits when compared to moderate intensity activity. This study says otherwise and suggests that it may be a good idea to bump up the rigors of your exercise program. Just be sure to talk to your doctor first.

U.S. Hypertension Risk Not Improving

November 30, 2009

Fewer people today smoke or have high cholesterol than 20 years ago. But, confounding the expectations of health officials, the overall risk of developing cardiovascular disease in the United States in the last two decades has remained virtually unchanged. Part of the reason likely has to do with a persistent inability to control high blood pressure on a national scale.

Researchers from the University of Texas and elsewhere looked at data from the landmark National Health and Nutrition Examination Survey (NHANES), which includes vital health information on thousands of people ages 20–75 that was collected between 1994 and 1998 and then again in 2005 and 2006. Results, presented at the American Heart Association's 2009 Scientific Sessions, showed that approximately 53% of people faced an elevated risk of cardiovascular disease in the earlier portion of the study compared to 55% in the most current analysis. (The apparent 2% increase was determined to be statistically insignificant.)

Researchers say that the lack of positive change has to do with two alarming countertrends: blood glucose levels (an indicator of diabetes) and blood pressure have not dropped along with smoking and cholesterol. In fact these indicators have increased and are off-setting many of the gains made by the apparently effective large-scale public service campaigns against smoking. Plus, even with lower cholesterol levels, the average national body mass index (BMI, a measure of weight in relation to height) has actually increased. All in all, the data can serve as a good reminder of how important blood pressure control is to reducing your overall cardiovascular risk and of how far we have yet to go in meeting our national blood pressure goals.

Hidden Hypertension in Children with Chronic Kidney Disease

November 20, 2009

Anxiety about being at the doctor's office may result in patients having artificially inflated blood pressure—a phenomenon aptly named white coat hypertension. The reverse is also possible: people with true hypertension can end up with a normal blood pressure reading. This problem, called masked hypertension, seems to be especially prevalent among children with chronic kidney disease (CKD) and it requires prompt attention to prevent the early onset of cardiovascular disease.

Researchers at the Cincinnati Children's Hospital Medical Center recently asked 200 children with CKD to wear a 24-hour blood pressure monitor—a portable electronic device that takes a continuous series of blood pressure measurements. All patients' blood pressure had previously tested normal at their doctor's office, but 24-hour monitoring revealed that almost 33% of the children in the study had hypertension. Most disconcerting, children with CKD and masked hypertension were also four times more likely to have a condition called left ventricular hypertrophy (LVH) than children with CKD and normal blood pressure.

LVH is a common outcome of untreated hypertension; it's characterized by thickening of the left ventricle, the heart's main pumping station, and results from the muscle having to work harder (think of how other muscles respond to weight-lifting). It can also lead to a number of potentially life threatening problems such as heart failure—when the heart becomes to weak pump blood to the body’s vital organs and tissues.

People with chronic kidney disease usually also have hypertension, so doctors may be leery of a normal blood pressure reading in child with CKD, particularly if the disease is in a more advanced stage. Thus, the majority of children with the condition will be treated before it becomes dangerous. Nonetheless, with potentially one-third of all children with CKD having masked hypertension, this study does provide good justification for everyone to simply assume that one blood pressure reading isn't enough.

Meditating Your Way to Lower Blood Pressure

November 20, 2009

Meditation can be a powerful tool for alleviating anxiety and combating stress. Not only is it clear that people often report simply "feeling better" after meditating, but a new study suggests that the body really does respond physically to meditation. And, the numbers, measured in lower blood readings, may be there to prove it.

Researchers at American University, Washington, D.C., randomly assigned 298 college students to participate in a standardized transcendental mediation program or wait-listed control group for three months. They then identified a subgroup of students who were at risk for hypertension because their blood pressure was higher than normal, but not high enough to be considered hypertensive.

Results, published in the American Journal of Hypertension showed that at-risk students who meditated lowered their systolic blood pressure by 5.0 mm Hg and their diastolic blood pressure by 2.8 mm Hg on average. Improvements of this magnitude, if sustained, could reduce the likelihood of these at-risk students developing hypertension by 52%, according to the authors of the study.

This is encouraging on several levels. For one, meditation had the strongest effect on the people who needed it most. Students who were not at risk for hypertension who meditated also improved, but not as much, while the control group's blood pressure actually increased during the study. Secondly, it shows that, with the help of something as easy and accessible as mediation, you really can exert a measure of direct control over your blood pressure.

Finally, a couple caveats are in order: it's safe to say that, like any other therapy, getting real results from meditation probably requires that you adhere to some sort of formal routine, as the participants in this study did. And, while meditation can be a great adjunctive or "add-on" therapy, it's certainly no substitute for more conventional ones like blood pressure medications, eating healthfully, and regular exercise.

High Blood Pressure and Alzheimer's Disease Linked?

November 9, 2009

Hypertension (high blood pressure) doesn't only impact the heart—it also affects the brain. In fact, studies have linked uncontrolled high blood pressure to memory problems among otherwise healthy people who have not suffered major neurological damage from a stroke or other medical condition. Now, a new family-based study of Alzheimer's disease suggests that hypertension and other major cardiovascular risk factors may be intimately related to the brain disorder.

Researchers at the VU University Medical Center in Amsterdam analyzed blood pressure, cholesterol levels, blood glucose levels, various markers of vascular inflammation, and cardiovascular fitness, among 206 middle-aged men and women whose parents died of Alzheimer's disease. They then compared these risk factors to another group of people without a familiar history of Alzheimer's. Results, published in the Archives of General Psychiatry, showed that the children of Alzheimer's sufferers were not only significantly more likely to have hypertension; they also had higher levels of inflammation in the body and poorer blood circulation than people with no family history of the disease.

Taken separately, cardiovascular disease and Alzheimer's disease are both believed to have a strong genetic component, but it's unclear if the two are linked as part of the same genetic complex. This study says that they may be. On a practical level, the good news is that if you have a family history of Alzheimer's and you take extra precautions to control hypertension and other cardiovascular risk factors, you may be able to stave off the disease.

Sugar May Boost Blood Pressure, Too

November 9, 2009

People with hypertension are bombarded with warnings about salt—and with good reason. Excess salt consumption (more than 1,500 mg daily) increases water retention and raises blood pressure. However, the sweet side of the taste spectrum may also be contributing to high blood pressure. The culprit? High fructose corn syrup.

Over a period of three years, researchers from the University of Colorado's Health Sciences Center analyzed the diets of roughly 4,500 adults ages 18 or older. All had normal blood pressure (< 120/80 mm/Hg) at the beginning of the study. By the end of the study, people who reported consuming more than 74 grams of fructose daily faced a 28% higher risk of developing stage 2 hypertension (160/100 mm/Hg or greater) and had a 87% greater chance of being pre-hypertensive (120–139/80–89 mm/Hg) than those who consumed the least fructose.

Found in everything from soft drinks to dried fruit, high fructose corn syrup has become such a staple of the modern western diet that it may be impossible to avoid. But do your best. For one, it doesn’t seem to take much fructose to have a detrimental effect: 74 grams daily is about the equivalent of three regular soft drinks. Plus, many people in the study who didn't consume much sodium on regular basis still developed hypertension if they indulged in fructose. This indicates that sugar by itself is to blame, and not necessarily unhealthy eating habits in general.

A Natural Way to Keep Your Arteries Healthy

October 19, 2009

As you get older your arteries—like your joints—tend to be come stiffer and less elastic, a process that contributes to high blood pressure (hypertension) and heart disease. The good news: a simple exercise may keep your arteries in tip-top shape.

In a study published in the American Journal of Physiology, researchers in Japan measured trunk flexibility in 526 adults by asking them to touch their toes while sitting with their legs straight. They also took each participants' blood pressure using the brachial ankle pulse wave velocity test—a comparison of blood pressure at the ankle, arm, neck and leg that indicates how well blood is flowing through the body. After analyzing the data, they found that those who could reach the furthest also tended have the lowest blood pressure—and vice versa.

Why are flexible muscles linked to flexible arteries? It may be that people with lower blood pressure are also more likely to exercise, which improves flexibility as well as blood pressure. However, the authors of the study looked at other measures of general fitness, such as muscle strength, and found that people who were flexible but not particularly fit also tended to have lower blood pressure. Researchers suspect that the physiological process unleashed in your body from stretching might also contribute to arterial health.

An Oldie, But Goodie: This Med Benefits Many

October 19, 2009

Most people with high blood pressure, also called hypertension, take multiple blood pressure medications. But finding the right combination of medicines can be difficult. It's not exactly clear what causes hypertension, and different classes of medication attack hypertension along different molecular pathways. However, another study has confirmed that most people with high blood pressure benefit from taking a diuretic.

Researchers with the Cochrane Library analyzed data from 53 clinical trials including over 15,000 patients taking diuretics along with another antihypertensive drug, such as an ACE inhibitor, ARB, or calcium channel blocker. They found that people who took a diuretic in combination with another blood pressure medications experienced a drop in systolic blood pressure between 4–14 mm/Hg. Diastolic blood pressure dropped between 2–6 mm/Hg on average.

Diuretics lower blood pressure by reducing fluid volume (the more fluid you have circulating in your arteries, the higher your blood pressure). These medications have been around since the 1950s, which begs the question: why do researchers still feel the need to prove how well they work? One likely reason is that diuretics often take a back seat to newer and more expensive drugs that aren't necessarily more effective. In fact, other studies have shown that diuretics are as good as or better at lowering blood pressure than newer costlier alternatives. Bottom line: if you're having trouble getting your blood pressure down with your current drug regimen, ask your doctor about diuretics. They're very effective and they won't break the bank.

Blood Pressure and Vitamin D

October 5, 2009

Vitamin D deficiency has been linked to a number of health problems including immune disorders, some cancers, and most notably, bone fractures and osteoporosis. Now, researchers are discovering that vitamin D plays an important role in high blood pressure (hypertension) and maintaining healthy blood pressure in women—and the earlier you start worrying about your vitamin D intake, the better.

These findings come from this year's annual meeting of the American Heart Association in Chicago, where researchers from the University of Michigan presented a study on over 559 women. They began tracking these women in 1992 and subsequently followed them for over 15 years, measuring their vitamin D levels and blood pressure on an annual basis. At the end of the study, over 10% of the women with vitamin D deficiencies went on to develop hypertension, defined as systolic blood pressure levels of 140 mm Hg or greater, compared to just 3.7% of women with healthy vitamin D levels. Put another way, women with vitamin D deficiency were over twice as likely to get hypertension!

More research still needs to be done concerning hypertension and vitamin D deficiency, and it's unclear if the relationship holds for men too, but age is an interesting variable in this study. Participants were between 24 and 44 years old, which means that most were too young to be subject to rigorous health warnings about vitamin D deficiency that older women receive due their heightened risk for osteoporosis. Most reputable health agencies recommend 400 to 800 IU daily for women under age 50 and at least 1,000 IU daily for older women.

Insomniacs Beware of High Blood Pressure

October 5, 2009

If you're not sleeping well, it may be tempting to accept insomnia as a natural part of aging or the inevitable product of an active mind—but don't ignore problems sleeping. Sleeplessness can have profound impact on other aspects of your health, including your blood pressure.

That's the message coming from researchers at Columbia University’s Mailman School of Public Health and the College of Physicians and Surgeons. In a September 2009 study, published in Hypertension: Journal of the American Heart Association, researchers analyzed health information on over 4,800 men and women who participated in the National Health and Nutrition Examination Study (NHANES I). Remarkably, 24% of people ages 32 to 59 who slept five or fewer hours nightly went on to develop high blood pressure (hypertension) over a period of 8 to 10 years, compared to about half as many people who slept 7 to 8 hours per night.

It's important to note that many people with poor sleep habits also had other risk factors for hypertension such as obesity, diabetes, smoking and lack of exercise—but this doesn't discount the impact of sleep. Researchers controlled for these other factors and found that sleep had an "independent effect" on blood pressure. This suggests that even if you do everything else right (e.g., eat well, exercise, drink moderately, cut salt, and not smoke) you could still develop hypertension as a result of poor sleep; and this is all the more reason to talk to your doctor.

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This page last modified: 06 Dec 2010

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