Tag Archives: blood pressure

Blood pressure variation between arms linked to CV risk

MedPage Today reports, “A substantial difference in blood pressure from one arm to the other could be a warning sign for overall cardiovascular and mortality risk,” according to a meta-analysis published online in The Lancet. Continue reading

Pointers for measuring your blood pressure at home

I’m a proponent of my patients monitoring their blood pressure at home. However, there are a couple of concerns when using a home monitoring device to measure blood pressure:

  • which arm to use, and
  • how long to wait before testing.

Recently, the Mayo Clinic and the American Heart Association have some guidance on the subject. Continue reading

Watermelon extract may lower blood pressure

The Los Angeles Times and Orlando Sentinel reported that, according to a study published in the American Journal of Hypertension, there is “evidence that eating watermelon could reduce … blood pressure.”

In fact, “in a small, pilot study led by food scientists at Florida State University, researchers found that eating six grams of watermelon extract a day for six weeks lowered blood pressure in all nine middle-aged subjects with prehypertension.”

The study authors “suggest that watermelon may prevent prehypertension from progressing to full-blown hypertension.”

The Milwaukee Journal Sentinel “Health & Science Today” blog quoted one of the study authors, who explained that “watermelon is the richest edible natural source of L-citrulline, which is closely related to L-arginine, the amino acid required for the formation of nitric oxide (which is) essential to the regulation of vascular tone and healthy blood pressure.”

So, from those of us from the south, this is good news — our beloved watermelon is found to be highly healthy in yet another way.

Largest Study to Date Links Chocolate to Lower Blood Pressure and Cardiovascular Risk

Just in the nick of time — before the Easter chocolate consumption begins, comes a study letting us know that a small amount of that dark Easter chocolate may be heart healthy. Just released is the largest observational study to date looking at the association between chocolate consumption and risk of cardiovascular disease. And the researchers have announced … drum roll please … that those who ate the most chocolate — around 7.5 g (about a quarter of an ounce) per day — had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate.

Here are the details from an article in MedScape:

Lead author Dr Brian Buijsse (German Institute of Human Nutrition, Nuthetal, Germany) told HeartWire, “This shows that habitual consumption of chocolate is related to a lower risk of heart disease and stroke that is partly explained by blood-pressure reduction. The risk reduction is stronger for stroke than for MI, which is logical because it appears that chocolate and cocoa have a pronounced effect on BP, and BP is a higher risk factor for stroke than for MI.”

Buijsse and colleagues report their findings online March 31, 2010 in the European Heart Journal. However, Buijsse cautions that only small amounts of chocolate were associated with the benefits and it is too early to give recommendations on chocolate consumption.

“Maybe it’s a boring message, but it’s a little too early to come up with recommendations, because chocolate contains so many calories and sugar, and obesity is already an epidemic. We have to be careful.”

However, he added, that if people did want to treat themselves, they would be better off choosing small amounts of chocolate, preferably dark chocolate, over other sweet snacks. “We know it is the cocoa content in chocolate that is important, so the higher the cocoa content, the better.”

Dr Steffen Desch (University of Leipzig, Heart Center, Germany), who was not involved with this study but who has performed research on the effects of chocolate on blood pressure, told HeartWire, “This is an interesting study that adds to the growing body of evidence that flavanol-rich chocolate might be associated with health benefits. Several epidemiological studies (including the Zuphten Elderly Study, by the same first author) and even more physiological trials have been published before.”

“What is missing now is a large-scale randomized trial of flavanol-rich chocolate versus control. The most reasonable end point would probably be the change in blood pressure between groups.” However, Desch added, “the major problems in designing such a study are the lack of funding and finding an appropriate control substance. To the best of my knowledge, there is no commercially available flavanol-free chocolate that offers the distinct bitter taste and dark color inherent to cocoa-rich chocolate.”

But, the best news from this study is that the biggest chocolate consumers had the lowest blood pressure and half the risk of stroke.

“Our hypothesis was that because chocolate appears to have a pronounced effect on blood pressure, chocolate consumption would lower the risk of strokes and heart attacks, with a stronger effect being seen for stroke,” explained Buijsse.

The researchers found that lower baseline blood pressure explained 12% of the reduced risk of the combined outcome, but even after taking this into account, those in the top quartile still had their risk reduced by a third (32%) compared with those in the bottom quartile over the duration of the study.

To put this in terms of absolute risk, Buijsse said if people in the group eating the least amount of chocolate increased their chocolate intake by 6 g a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years.

He says it appears that flavanols in chocolate are responsible for the beneficial effects, causing the release of nitric oxide, which contributes to lower BP and improves platelet function.

Dr Frank Ruschitzka (University Hospital, Zurich, Switzerland) agrees. He said in a European Society of Cardiology statement, “Basic science has demonstrated quite convincingly that dark chocolate particularly, with a cocoa content of at least 70%, reduces oxidative stress and improves vascular and platelet function.”

NOTE: Only small amounts of chocolate were beneficial; so don’t eat too much.

Buissje said this work builds on his earlier small trial — the Zuphten Elderly Study — performed in 500 men in Holland, which showed that chocolate consumption lowered overall cardiovascular mortality.

“Due to the small size of this study, we were not able to differentiate between stroke and MI in this, but now we are able to look at stroke and MI separately, so it’s a nice addition,” he notes.

And the findings are in line with an intervention study that showed that eating around 6 g of chocolate a day — one small square of a 100-g bar — might lower CV disease risk, he says. “So the effects are achieved with very small amounts.”

British Heart Foundation dietician Victoria Taylor made the same point in a press statement: “It’s important to read the small print with this study. The amount consumed on average by even the highest consumers was about one square of chocolate a day or half a small chocolate Easter egg in a week, so the benefits were associated with a fairly small amount of chocolate.

“Some people will be tempted to eat more than one square; however, chocolate has high amounts of calories and saturated fat . . . two of the key risk factors for heart disease,” she noted.

Ruschitzka similarly urged caution: “Before you rush to add dark chocolate to your diet, be aware that 100 g of dark chocolate contains roughly 500 calories. As such, you may want to subtract an equivalent amount of calories, by cutting back on other foods, to avoid weight gain.”

April 1, 2010 (Nuthetal, Germany) — The largest observational study so far to examine the association between chocolate consumption and risk of cardiovascular disease has found that those who ate the most chocolate–around 7.5 g per day–had a 39% lower risk of MI and stroke than individuals who ate almost no chocolate (1.7 g per day) [1].
Lead author Dr Brian Buijsse (German Institute of Human Nutrition, Nuthetal, Germany) told heartwire : “This shows that habitual consumption of chocolate is related to a lower risk of heart disease and stroke that is partly explained by blood-pressure reduction. The risk reduction is stronger for stroke than for MI, which is logical because it appears that chocolate and cocoa have a pronounced effect on BP, and BP is a higher risk factor for stroke than for MI.” Buijsse and colleagues report their findings online March 31, 2010 in the European Heart Journal.
However, Buijsse cautions that only small amounts of chocolate were associated with the benefits and it is too early to give recommendations on chocolate consumption: “Maybe it’s a boring message, but it’s a little too early to come up with recommendations, because chocolate contains so many calories and sugar, and obesity is already an epidemic. We have to be careful.” However, he added, that if people did want to treat themselves, they would be better off choosing small amounts of chocolate, preferably dark chocolate, over other sweet snacks. “We know it is the cocoa content in chocolate that is important, so the higher the cocoa content, the better.”
Dr Steffen Desch (University of Leipzig, Heart Center, Germany), who was not involved with this study but who has performed research on the effects of chocolate on blood pressure, told heartwire : “This is an interesting study that adds to the growing body of evidence that flavanol-rich chocolate might be associated with health benefits. Several epidemiological studies (including the Zuphten Elderly Study, by the same first author) and even more physiological trials have been published before.”
“What is missing now is a large-scale randomized trial of flavanol-rich chocolate versus control. The most reasonable end point would probably be the change in blood pressure between groups.” However, Desch added, “the major problems in designing such a study are the lack of funding and finding an appropriate control substance. To the best of my knowledge, there is no commercially available flavanol-free chocolate that offers the distinct bitter taste and dark color inherent to cocoa-rich chocolate.”
Biggest Chocolate Consumers Had Lowest Blood Pressure
Buijsse and colleagues followed 19 357 people, aged between 35 and 65, who were participants in the Potsdam arm of the European Prospective Investigation into Cancer (EPIC). They received medical checks, including blood pressure and height and weight measurements at the start of the study (1994–1998), and they also answered questions about their diet, lifestyle, and health, including how frequently they ate 50-g bars of chocolate.
The research was conducted before the health benefits of chocolate and cocoa were recognized, so no differentiation was made between milk, dark, and white chocolate in the study. But in a subset analysis of 1568 participants later asked to recall their chocolate intake over a 24-hour period, 57% ate milk chocolate, 24% dark chocolate, and 2% white chocolate.
Participants were divided into quartiles according to their level of chocolate consumption. Those in the top quartile, eating around 7.5 g of chocolate a day, had blood pressure that was about 1 mm Hg (systolic) and 0.9 mm Hg (diastolic) lower than those in the bottom quartile.
In follow-up questionnaires, sent out every two or three years until December 2006, the participants were asked whether they had had a heart attack or stroke, information that was subsequently verified by medical records from general physicians or hospitals. Death certificates from those who had died were also used to identify MIs and strokes.
“Our hypothesis was that because chocolate appears to have a pronounced effect on blood pressure, chocolate consumption would lower the risk of strokes and heart attacks, with a stronger effect being seen for stroke,” explained Buijsse.
Those Eating Most Chocolate Had Half the Risk of Stroke
During the eight years, there were 166 MIs (24 fatal) and 136 strokes (12 fatal); people in the top quartile had a 27% reduced risk of MI and nearly half the risk (48%) of stroke, compared with those in the lowest quartile. The relative risk of the combined outcome of MI and stroke for top vs bottom quartile was 0.61 (p=0.014).
The researchers found that lower baseline blood pressure explained 12% of the reduced risk of the combined outcome, but even after taking this into account, those in the top quartile still had their risk reduced by a third (32%) compared with those in the bottom quartile over the duration of the study.
To put this in terms of absolute risk, Buijsse said if people in the group eating the least amount of chocolate increased their chocolate intake by 6 g a day, 85 fewer heart attacks and strokes per 10 000 people could be expected to occur over a period of about 10 years.
He says it appears that flavanols in chocolate are responsible for the beneficial effects, causing the release of nitric oxide, which contributes to lower BP and improves platelet function.
Dr Frank Ruschitzka (University Hospital, Zurich, Switzerland) agrees. He said in a European Society of Cardiology statement [2]: “Basic science has demonstrated quite convincingly that dark chocolate particularly, with a cocoa content of at least 70%, reduces oxidative stress and improves vascular and platelet function.”
Only Small Amounts of Chocolate Beneficial; Don’t Eat Too Much
Buissje said this work builds on his earlier small trial–the Zuphten Elderly Study–performed in 500 men in Holland, which showed that chocolate consumption lowered overall cardiovascular mortality. “Due to the small size of this study, we were not able to differentiate between stroke and MI in this, but now we are able to look at stroke and MI separately, so it’s a nice addition,” he notes.
And the findings are in line with an intervention study that showed that eating around 6 g of chocolate a day–one small square of a 100-g bar–might lower CV disease risk, he says. “So the effects are achieved with very small amounts.”
British Heart Foundation dietician Victoria Taylor made the same point: “It’s important to read the small print with this study. The amount consumed on average by even the highest consumers was about one square of chocolate a day or half a small chocolate Easter egg in a week, so the benefits were associated with a fairly small amount of chocolate.
“Some people will be tempted to eat more than one square; however, chocolate has high amounts of calories and saturated fat . . . two of the key risk factors for heart disease,” she noted in a statement [3].
Ruschitzka similarly urged caution: “Before you rush to add dark chocolate to your diet, be aware that 100 g of dark chocolate contains roughly 500 calories. As such, you may want to subtract an equivalent amount of calories, by cutting back on other foods, to avoid weight gain.”

Dark chocolate Easter eggs good for your heart?

Easter eggs and other chocolate may be good for you – at least in small quantities and preferably if it’s dark chocolate – according to research that shows just one small square of chocolate a day can lower your blood pressure and reduce your risk of heart disease. The study is published online in the European Heart Journal.

Researchers in Germany followed 19,357 people, aged between 35 and 65, for at least ten years, and found that those who ate the most amount of chocolate – an average of 7.5 grams a day – had lower blood pressure and a 39% lower risk of having a heart attack or stroke compared to those who ate the least amount of chocolate – an average of 1.7 grams a day.

The difference between the two groups amounts to six grams of chocolate: the equivalent of less than one small square of a 100g bar.

For those who believe in the Easter bunny (or at least in what he is believed to bring), good news awaits.
Just one small square of chocolate a day might help lower your blood pressure and reduce your risk for heart disease.
After analyzing the diet and health habits of 19,357 people, aged 35 to 65, for at least 10 years, German researchers found that those who ate the most chocolate (an average of 7.5 grams, or 0.3 ounces, a day) had lower blood pressure and were 39 percent less likely to have a heart attack than those who ate the least amount of chocolate (an average of 1.7 grams, or 0.06 ounces, a day).
“To put that in terms of absolute risk, if people in the group eating the least amount of chocolate [of whom 219 per 10,000 had a heart attack or stroke] increased their chocolate intake by 6 grams [0.2 ounces] a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years,” study leader Dr. Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition, said in a news release from the European Heart Journal, which published the findings online Tuesday.
“If the 39 percent lower risk is generalized to the general population, the number of avoidable heart attacks and strokes could be higher because the absolute risk in the general population is higher,” he said.
Six grams of chocolate is equivalent to about one small square of a 100 gram (3.5 ounce) bar, the researchers said.
But Buijsse cautioned that eating chocolate shouldn’t increase a person’s overall intake of calories or reduce the consumption of healthy foods.
“Small amounts of chocolate may help to prevent heart disease, but only if it replaces other energy-dense foods, such as snacks, in order to keep body weight stable,” he said.

According to a report by HealthDay News, “To put that in terms of absolute risk, if people in the group eating the least amount of chocolate [of whom 219 per 10,000 had a heart attack or stroke] increased their chocolate intake by 6 grams [0.2 ounces] a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years,” study leader Dr. Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition.

“If the 39 percent lower risk is generalized to the general population, the number of avoidable heart attacks and strokes could be higher because the absolute risk in the general population is higher,” he said.

Six grams of chocolate is equivalent to about one small square of a 100 gram (3.5 ounce) bar, the researchers said.

But Buijsse cautioned that eating chocolate shouldn’t increase a person’s overall intake of calories or reduce the consumption of healthy foods.

“Small amounts of chocolate may help to prevent heart disease, but only if it replaces other energy-dense foods, such as snacks, in order to keep body weight stable,” he said.

But, for this Easter weekend, my prescription is a little bit of dark chocolate. Consider it doing your heart a bit of good — in more ways than one.

Have a blessed Easter everyone.

Loneliness harms blood pressure

Like happiness, loneliness is contagious

In my book, the 10 Essentials of Happy, Healthy People, one of the ten essentials of health I write about is “avoiding loneliness like the plague.” I say, “Avoiding loneliness and pursuing healthy relationships can increase the likelihood of your becoming a highly healthy person … The absence of loneliness, the fostering of socialization and positive rela- tionships, and the development of constructive and graceful communication styles can increase not only the likelihood that you will be highly healthy but that those around you will be healthy as well.”

There are a number of reasons this is true — not the least of which is the association of loneliness with worsening cardiovascular health outcomes. Commenting on the newest research showing this is the Los Angeles Times “Booster Shots” blog which is reporting that loneliness may “affect blood pressure,” according to a study appearing in the March issue of Psychology and Aging.

“Researchers surveyed 229 people ages 50 to 68 who were part of the Chicago Health, Aging, and Social Relations Study, a longitudinal study of white, black and Latino men and women.” After five years, “researchers noted an association between feelings of loneliness and high blood pressure. People who ranked as feeling most lonely had blood pressure levels 14.4 points higher than those who felt least lonely.”

If you are an angry or hostile person, you can drive people away and increase your personal loneliness. If you are cynical or depressed, you’ll be inclined to withdraw from others and increase your personal loneliness. If you have uncaring relationships or refuse to socialize with others, you may suffer dire health consequences.

If any of this is true for you, I assure you that there is hope. To begin on the journey to becoming a highly healthy and happy person, consider ordering my book, 10 Essentials of Happy, Healthy People. Find the chapter on “Avoiding Loneliness Like the Plague” and begin to fill some of this chapter’s prescriptions for building stronger and healthier relationships. As you do, you will, in turn, avoid loneliness like the life-threatening plague it is.

You can read the Table of the Contents of the book here, and read the first chapter here. Also, the Los Altos United Methodist Church developed a Small Group Study Guide for the book that you can download free here.

Here are some of my other blogs on loneliness:

Study indicates inexpensive polypill pill may significantly reduce risk of heart attack and stroke. Should you consider it?

On the March 30th edition of the ABC World News, Charles Gibson reported, “Some of the country’s leading heart doctors heard results” yesterday at the American College of Cardiology (ACC) conference “about … just one pill that could revolutionize the way heart disease is treated. This pill combines five commonly used medications, and new findings show it to be safe and effective.” Should you get your doctor to prescribe this to you?

More Information: Continue reading

“The Russert Effect”: Docs Report Surge in Appointments

ABC News is reporting a phenomena that family physicians around the country are reporting to me: Tim Russert’s death Friday from sudden cardiac arrest may have hit a nerve deeper than sadness.

Russert’s death may have lead some to fear for their own seemingly healthy bodies, or the health of a loved one – and doctors are seeing the effects. Calls are up dramatically for exams for middle aged men. Continue reading