Is it okay for patients with uncomplicated hypertension to take NSAIDs such as ibuprofen, naproxyn, celecoxib, etc? Continue reading
CocoaVia and Cirku are new supplements used for high blood pressure and cardiovascular health according to the Natural Medicines Comprehensive Database (NMCD). These products are flavored powders that can be added to a beverage. Each packet contains a cocoa extract providing 350 mg of cocoa flavanols. Those selling the supplements say they may reduce heart disease, but do they? Continue reading
If you could do four things to dramatically reduce your risk of brain shrinkage (especially that caused by dementia, vascular dementia, Alzheimer’s disease, or stroke), would that be of interest to you? Continue reading
Last week my blog, Diet soda consumption may be linked to increased heart attacks and strokes, was one of my most read postings in some time. Some commented that perhaps they would switch from diet to regular soda. NOT a good idea at all, and here’s another reason why:
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.
Finally some good news in the recognition and treatment of high blood pressure (hypertension). The AP reports that, according to a report released by the Centers for Disease Control and Prevention (CDC), “more American adults are aware they have high blood pressure, and more are taking medicine to try to control it.”
The report, which included 24,000 adults who underwent blood pressure checks during the period from 1999 to 2008, also revealed that “the proportion of US adults with high blood pressure has actually been holding steady at about 30% for a decade.”
HealthDay reported that “part of the reason that treatment and awareness of hypertension has increased while the prevalence of the condition remains stagnant is the ongoing obesity epidemic and the aging population, both of which tend to produce more hypertensives,” explained the report’s lead author, epidemiologist Sarah Yoon, PhD, of the CDC’s National Center of Health Statistics.
The report also revealed that the percentage of people who were aware of having hypertension “increased from 69.6 percent in 1999-2000 to 80.6 percent in 2007-2008.”
Along with the increase in patient awareness of hypertension, “the percentage of people with high blood pressure taking medications for the condition increased from 60.2% in 1999-2000 to 73.7% in 2007-2008,” WebMD reported.
Yet, although “medication is helping people control blood pressure, the prevalence of adults with the condition has held steady in the past 10 years for men and women, all adult age groups, non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans.
What’s more, “the percentage of people with high blood pressure taking medication to lower it increased for those 18 to 39 and 60 and over, but not for people 40 to 59, the CDC report says.”
So, be sure to get your blood pressure checked at least once a year.
- If it’s less than 120/80, you’re in great shape. Check it again next year.
- If the upper number is 120-139 OR the lower number is 80-89, check it a couple of other times. If it stays in this range, you have “pre-hypertension” and need to see your doctor about this (although you likely will not need medicine).
- If the upper number is 140 or higher OR the lower number is 90 or higher, it’s time to see your doctor about this (and, you may need medicine).
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.
Tests for a blood-pressure regulating hormone called renin may help doctors decide which blood pressure drugs their patients should take, researchers announced recently. These data are a practice changer for me. Bottom line, if I can’t control someone’s hypertension with one or two drugs, I’ll be ordering this blood test. Here are the details from ABC Health:
They said a mismatch between drugs and patient characteristics may help explain why many people do not benefit from blood pressure drugs, and testing for renin levels may help.
“The one-size-fits-all approach must be abandoned,” said Dr. Curt Furberg of Wake Forest University School of Medicine in North Carolina, who wrote a commentary on the studies in the American Journal of Hypertension.
Currently, fewer than half of patients are helped when they take just one blood pressure drug, and many must take more than one to keep blood pressure down.
A study in the Journal of the American Medical Association found that about half of the 65 million people in the United States with high blood pressure have it under control.
Furberg said researchers have known for years that patients respond differently to different drugs for high blood pressure, yet this has not translated into tests and strategies that help find the best treatments for individual patients.
In a series of studies in the American Journal of Hypertension, three research teams looked at different aspects of this problem.
Stephen Turner and colleagues of the Mayo Clinic in Rochester, Minnesota, found that blood tests measuring for renin, a hormone produced in the kidney, can help guide doctors in selecting blood pressure drugs.
Patients who had high levels of renin were more likely to respond to the common beta blocker atenolol and less likely to respond to hydrochlorothiazide, a diuretic used to rid the body of unneeded water and salt.
A team led Michael Alderman of Albert Einstein College of Medicine in New York and colleagues found that some people taking blood pressure drugs actually have an increase in their systolic blood pressure — the top blood pressure reading.
This was more common in people with low renin levels who were given a calcium channel blocker or an ACE inhibitor.
And a third study by Ajay Gupta of Imperial College London found that blacks were less likely than whites to respond to anti-renin drugs.
Furberg says the findings suggest the need for new guidelines for treating high blood pressure that incorporate tests to measure a patient’s renin levels.
Morris Brown of Britain’s University of Cambridge said in a commentary that it may be useful to identify patients with extremely high or low renin levels who may not benefit from standard combination of drugs.
Brown said it may be time to consider measuring renin as a part of routine care for high blood pressure.
High blood pressure, or too much force exerted by blood as it moves against vessel walls, is the second-leading cause of death in the United States. About $73 billion is spent per year in the United States treating it.
- The time has come for classification of hypertensive type based on underlying pathophysiology. New national and international treatment guidelines should recommend stratification of hypertension based on plasma renin activity, preferably prior to initiation of treatment.
- Plasma renin activity during treatment should also factor into decisions regarding subtracting or adding drugs.
- Prescription of the “wrong” drug (e.g., a renin blocker for low-renin patients) can trigger a pressor response that could undermine the whole premise of antihypertensive treatment.
- A renin test–guided treatment strategy is rational and has shown that better blood pressure control can be achieved without increasing the number of antihypertensive agents.
- The initiation of treatment with fixed-drug combinations may be of limited value for individualized antihypertensive treatments. A pressor response to one of the components might interfere with the antihypertensive effect of the other, leading to the further addition of unnecessary drugs.
A new study is reporting what I’ve been telling my patients for years: generic blood pressure medications are as good as the far more costly brand name medications — plus, fewer deaths seen in the group taking no-brand-name diuretics after 8 to 13 years. Here are the details from HealthDay News:
Costly, brand-name blood pressure-lowering drugs are no better at preventing cardiovascular disease than older, generic diuretics, reveals long-term data from a large study.
It included more than 33,000 patients with high blood pressure who were randomly selected to take either a diuretic (chlorthalidone) or one of two newer drugs — a calcium blocker (amlodipine) or an ACE inhibitor (lisinopril).
Data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) released in 2002 showed that after four to eight years of follow-up, the diuretic was better than the calcium blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.
Differences between the drugs narrowed after eight to 13 years of follow-up, the findings show. However, the diuretic was still better in two areas. Compared with patients taking the diuretic, those in the ACE inhibitor group had a 20 percent higher death rate from stroke, and those in the calcium channel blocker group had a 12 percent higher rate of hospitalization and death because of heart failure.
The results were presented Friday at the China Heart Congress and International Heart Forum in Beijing last month.
“We are continuing to mine data that we collected during the trial,” Dr. Paul Whelton, president and CEO of Loyola University Health System and chairman of ALLHAT, said in a university news release.
ALLHAT is sponsored by the U.S. National Heart, Lung and Blood Institute.
More information: The American Academy of Family Physicians has more here about blood pressure medicines.
Think you need to go to the doctor’s office to check your blood pressure? Think again. For years I’ve had my patients monitor their blood pressure at home. I do NOT rely solely upon blood pressure readings in the office. Now comes a new study saying the best way to predict your risk of stroke or heart attack due to high blood pressure is through systematic monitoring at home rather than periodic checks in the doctor’s office.
Here are more details from Reuters Health: “With home blood pressure monitoring you get a greater number of measurements and there is no white-coat effect,” lead author Dr. Teemu Niiranen told Reuters Health, speaking of the tendency for anxiety to drive up blood pressure. “At home the patient is more relaxed and this seems to provide blood pressure values that reflect the patient’s true blood pressure better.”
Writing in the American Heart Association’s journal Hypertension, Niiranen and colleagues at Finland’s National Institute of Health and Welfare concluded that home-measured blood pressure is a better predictor of heart disease-related problems than office-measured blood pressure.
High blood pressure is a major risk factor for heart disease, stroke, and kidney disease, and nearly one in three Americans have high blood pressure, according to the Centers for Disease Control. In 2006 it contributed to the deaths of 326,000 Americans.
The researchers used data on more than 2,000 Finns, 45 to 74 years old, gathered between 2000 and 2001. Participants agreed to be interviewed, undergo medical exams and monitor their blood pressure at home on well-calibrated monitoring devices.
At follow-up nearly 7 years later, 162 participants reported at least 1 non-fatal heart disease-related event such as a heart attack, stroke, or hospitalization due to heart failure. Among the 2,081 participants, 37 heart disease-related deaths were reported.
After analyzing the data, the Niiranen group concluded that the best predictor of heart attacks, strokes, and related deaths was home blood pressure monitoring.
The home blood pressure readings, because there were more of them and they weren’t affected by the “white coat effect,” were more accurate, the authors found.
The home blood pressure monitor used in the study – Omron’s HEM-722c, comparable to the HEM-712c in the U.S. — costs about $70. Niiranen said 60 percent of Finnish patients with high blood pressure have home monitors.
While the study was done in Finland, Niiranen said there’s no reason to believe these results would not also apply to the populations in other countries.
The study could not determine whether home monitoring could save lives, however, since it was only observational, Niiranen said.
Almost half of American adults, 45% of us, now have high blood pressure, high cholesterol, or diabetes, according to a report from researchers from the national Centers for Disease Control and Prevention.
The Los Angeles Times reports that “one in eight Americans has at least two of the conditions and one in 33 has all three, sharply increasing their risk.” These “data come from the ongoing National Health and Nutrition Examination Survey.”
While “researchers should be able to use the new data to plan interventions, ‘the main thing here is for people to be aware that they have these conditions and know that lifestyle modifications and medications can control them and reduce their risk for cardiovascular disease,’ said epidemiologist Cheryl D. Fryar of the CDC’s National Center for Health Statistics, one of the study’s authors.”
WebMD reported that “the study shows that about 8% of adults have undiagnosed high blood pressure, 8% have undiagnosed high cholesterol, and 3% of have undiagnosed diabetes.”
HealthDay reported that “blacks had a particularly high incidence of hypertension, 42.5 percent, compared to 29.1 percent of non-Hispanic whites and 26.1 percent of Mexican-Americans.”
The report indicated that “high blood cholesterol was more common among non-Hispanic whites (26.9 percent) than among blacks (21.5 percent) and Mexican-Americans (21.8 percent), while diabetes was more common among blacks (14.6 percent) and Mexican-Americans (15.3 percent) than among non-Hispanic whites (8.3 percent).”
“The number that really surprises me is the penetration of these conditions into the U.S. population,” Dr. Clyde Yancy of Baylor University Medical Center, president of the American Heart Association, told the LA Times.
“When that number is nearly 50%, that’s a huge wake-up call.” It means there are a large number of people “who think they are healthy…but are working under a terrible misconception.”
“This report is so timely and important because it crystallizes exactly what the burden is,” Yancy said. “It tells us the challenge we now face that could stress and potentially defeat any healthcare system we could come up with.”
Personal responsibility plays a big role in creating these three health problems, he said. “This trio begins with a quartet of smoking, a junk diet, physical inactivity and obesity. Those are all things we can do something about.”
According to a report in HealthDay, the CDC survey doesn’t attempt to learn the reason why the incidence of these major risk factors is so high.
Dr. Clyde W. Yancy, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center, and president of the American Heart Association, told HealthDay he thinks he knows the reason: obesity.
“The burden of risk is directly related to the burden of obesity,” Yancy said. “Obesity is directly related to high blood pressure, directly related to diabetes, directly related to an abnormal lipid profile.”
And with 60 percent of adult Americans and 30 percent of younger Americans overweight or obese, the burden threatens to become worse, he said.
While the message about obesity and what causes it – lack of exercise, poor diet, overeating – is sent repeatedly, “people don’t get it,” Yancy said. “They are putting us at the risk of having a generation of Americans that has worse health than the previous generation, which has never happened before,” he said.
The CDC report is “a call to arms,” Yancy said. “Targeting obesity should now be on the top of the radar screen for everybody.”
So, what should you do about this?
This is what I recommend to my adult patients: Have a preventive medicine visit every 3-5 years in your 20’s, every three years in your 30’s, every two years in your 40’s, and every year after age 50.
As far as these disorders, be sure at each of these visits to have the following items checked:
- Your blood pressure. (to screen for hypertension)
- Your fasting blood sugar and A1C. (to screen for diabetes)
- Your lipid profile. (to screen for cholesterol and lipid problems)
- Your body mass index (BMI – to screen for overweight and obesity)
Churches and parish nurse programs have proven to be essential to the physical, emotional, relational, and, of course, spiritual health of their congregants. Now, new research shows that church health fairs are an effective way of identifying people with high blood pressure and making sure they get treatment. Here are the details in a report from Reuters Health:
These fairs are a venue to get people from low-income immigrant communities into medical care, Dr. Arshiya A. Baig of the University of Chicago told Reuters Health.
Baig and her team worked with a faith community nurse program in Los Angeles that runs clinics and provides community outreach. Registered nurses also partner with churches, holding office hours there and providing services.
Baig and her team visited 26 health fairs in Los Angeles County from October 2006 to June 2007, testing blood pressure in 886 people aged 18 and older.
They randomly assigned 100 people with high blood pressure to a referral to the nurse at the church holding the health fair, or to get help making an appointment with a doctor by telephone.
People in the first group were introduced to the nurse at the health fair, and instructed to make an appointment with the nurse within the next two weeks. The nurse would provide counseling and help them set up an appointment with a physician.
People in the doctor referral group didn’t meet with a nurse. If they didn’t already have a primary care physician, Baig and her colleagues would find a clinic nearby and make an appointment with them.
Four months later, the researchers were able to follow up with 41 people in the nurse group and 44 in the physician referral group.
They found that 68 percent of the nurse group had seen a physician during that time, compared to 80 percent of the doctor referral group. This difference was not statistically significant, meaning it could have been due to chance.
The average systolic blood pressure drop (the top number) in the community nurse group was 7 mm Hg, compared to 14 mm Hg in the physician referral group.
Twenty-seven percent of the patients in the nurse group had their medications changed during follow up, while 32 of the telephone referral group did.
The telephone referral group may have fared better because they saw a doctor earlier, Baig noted; she also pointed out, however, that patients in the nurse group were more likely to get counseling on lifestyle changes to help lower their blood pressure, which probably wouldn’t have had an effect within four months.
The findings shouldn’t be interpreted as meaning that telephone referrals to a physician are more effective than faith community nurse referrals, Baig added. “I think at four months you can’t say one is better than the other.”
The important thing, she added, is that both nurses and telephone-assisted appointments were an effective way to get people in to see a doctor. And without faith community nurses, Baig said, “There wouldn’t be health fairs, we wouldn’t be finding people who have undiagnosed or poorly controlled (high blood pressure).”
So, the bottom line is that we in faith communities can and should think of the physical, and not just the spiritual, health of our fellow parishioners.
SOURCE: Journal of General Internal Medicine, online March 27, 2010.
When I speak on natural medications (herbs, vitamins, and supplements), I tell folks that my favorite natural medicines website is the Natural Medicines Comprehensive Database which has new information about Hibiscus (Hibiscus sabdariffa). NMCD says, “Hibiscus is getting more attention as a potential treatment for hypertension. New clinical research shows that drinking a specific hibiscus tea (Celestial Seasonings) three times daily for 6 weeks significantly lowers blood pressure by about 7 mmHg in patients with pre-hypertension or mild hypertension.”
According to NMCD, “This is promising, but preliminary.”
Also, I suspect most people could not (and would not) be compliant with drinking the tea three times a day every single day for years at a time.
So, the Database encourages us physicians to “explain to patients that drinking hibiscus tea might help, but it’s no substitute for conventional treatments that are proven to improve cardiovascular outcomes.”
In my newest book, 10 Essentials of Happy, Healthy People, I teach people how to utilize the ten essentials that are necessary to live a happy and highly healthy life. Under The Essential of Self-Care, I’ve developed a list of what I call “The 10 Commandments of Preventive Medicine.” Here’s the second installment of this ten-part series.
More information: Continue reading
In the past I’ve discussed the studies showing that the more screen time kids have (TV, Internet, video games, cell phone), the more likely they are to be overweight or obese, the less sleep they will get, and the less well they will do in school. Now, new research is showing that children who spend a lot of time watching television have higher blood pressure than those who watch less, even if the children are thin and get enough exercise.
More Information: Continue reading
Reuters Health is reporting that vibrating exercise platforms, which are increasingly found in commercial gyms in Europe and elsewhere, may indeed help people lose a particularly harmful deep “hidden” fat that surrounds the abdominal organs and is linked to type 2 diabetes, high blood pressure, and heart disease.
More Information: Continue reading
Hidden behind all of the Swine flu news stories is this one – which I feel is significantly more important when it comes to public health. The FDA just gave its official thumbs-up to an antihypertensive polypill. Could this pave the way for a preventive medicine polypill? And, should you consider taking a polypill?
More Information: Continue reading
A striking new study says almost one in five American four-year-olds is obese, and the rate is alarmingly higher among American Indian children. What did the study find and what can you do to protect your children?
More Information: Continue reading
Here’s a fact that most people do not know – when the temperature drops outside, blood pressure appears to rise. This information is critical for those with high blood pressure, a family history of high blood pressure, and for older adults. It means that people in both of these groups should have their blood pressure checked once or twice a month during cold weather months.
More Information: Continue reading
HealthDay News is reporting a stunning study from the Boston University School of Medicine finding that the use of a particular class of blood pressure drugs called angiotensin receptor blockers (ARBs) is associated with lower incidence and slower progression of Alzheimer’s disease.
My Take? Continue reading