Controlling high blood pressure is a good thing—unless you are a frail older person. Then it might be harmful. That’s the surprising finding of a study of more than 2,000 seniors published online in the Archives of Internal Medicine. In the study, high blood pressure was linked to an increased risk of dying only among older adults who were relatively fit. Among those who couldn’t walk 20 feet, those with high blood pressure were less likely to have died. It’s possible that frail older adults benefit from having higher blood pressure. It’s also possible that using multiple medications drive down blood pressure in older, frail adults may do more harm than good.
Hypertension and Stroke
Most of the changes that come with pregnancy—growing a belly “bump,” being tired, mood swings, cravings for particular foods, and the like—are normal, temporary, and harmless. Two other changes, pregnancy-related high blood pressure and diabetes, may have long-lasting implications for heart health. The development of high blood pressure during pregnancy is known as preeclampsia; pregnancy-related diabetes is called gestational diabetes. They are different from “regular” high blood pressure and diabetes because both are “cured” by delivery. A new study published this week in the journal Circulation suggests that these complications boost a woman’s risk of cardiovascular disease during middle age.
A new report from the Centers for Disease Control and Prevention (CDC) shows that just 10 types of deliver almost half of the average American’s daily sodium. Topping the list are breads and rolls, cold cuts, pizza, poultry, and soups. Almost two-thirds of our daily sodium comes from food bought in stores, and one-quarter comes from food bought in restaurants (which includes fast-food shops and pizza places).The report also showed that Americans take in an average of 3,266 milligrams of sodium a day (about 1½ teaspoons of salt), well above the healthy target of 2,300 milligrams a day. As a nation, cutting back on salt by an average of 400 milligrams a day could prevent 28,000 deaths a year and save $7 billion in health care costs.
Most doctors and nurses measure blood pressure in one arm. A new British study published in The Lancet suggests that measuring it in both arms may be better. A difference in the arm-to-arm readings of 10 points or more can signal circulatory problems that may lead to stroke, peripheral artery disease, or other cardiovascular problems. In older people, an arm-to-arm difference in blood pressure is usually due to a blockage arising from atherosclerosis, the artery-clogging disease process that is at the root of most cardiovascular conditions. Next time you have your blood pressure checked, ask the doctor or nurse to do it on both arms. If there’s a difference greater than 10 point, another test called the ankle-brachial index might be in order to check for peripheral artery disease.
A bold initiative called Million Hearts aims to prevent one million heart attacks and strokes from happening over the next five years. As explained in the Harvard Heart Letter, the initiative is spearheaded by the federal Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services. Its main focus is to encourage more widespread and appropriate use of simple, effective, and inexpensive heart-protecting actions, dubbed the ABCS. These include taking daily low-dose Aspirin, if prescribed; managing Blood pressure and Cholesterol levels; quitting Smoking. The Harvard Heart Letter adds D for Diet and E for Exercise.
“Limit salt” has been a key part of dietary advice for decades. Once aimed at individuals, the FDA is hoping to persuade food companies to cut back on salt added to prepared foods. That’s probably a good idea, since the average American gets more salt—and thus sodium—than needed, most of it from prepared foods. But the question of how low we should go with sodium hasn’t been answered. Two studies suggest that getting too little sodium could pose problems, just as eating too much does. Trials to determine the safest range for sodium aren’t in the offing. What to do in the interim? Aiming for the recommended target of 2,300 milligrams per day from all sources is probably good for most people.
In most people, blood pressure begins to rise just before getting out of bed in the morning, and reaches its peak around mid-day. It falls during sleep, reaching its lowest point of day between midnight and 3:00 or 4:00 am. This drop is sometimes called “dipping.” But people with high blood pressure often have little or no decrease in their blood pressure at night. One possible reason for this is blood pressure medicines taken around breakfast time have worn off. That oft-quoted passage doesn’t A new study suggests that taking blood pressure drugs at night might improve blood pressure and prevent more heart attacks and strokes than taking the same medications during the day.
Heart disease, stroke, diabetes, asthma, osteoporosis and other common chronic diseases are often blamed on genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. An intriguing hypothesis is that these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta. During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows, so the thinking goes, programs a child’s development and sets the stage for health or disease.
The combination of brutal heat and humidity can be downright dangerous to people with heart disease and other chronic conditions. They may have trouble getting rid of extra body heat, or the process may strain the already–overworked heart and arteries. Taking it easy, finding air conditioning, and drinking plenty of water (not sugary soda or fruit juice or caffeinated beverages) can help beat the heat. It’s also important to be aware of the warning signs of heat illness—nausea or vomiting, unusual fatigue, headache, disorientation or confusion, or muscle twitches—and call for help right away.
Millions of people take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), and celecoxib (Celebrex) to relieve pain and inflammation. During the last few years, researchers have raised concerns that taking these drugs often may be hard on the heart as well. The latest study, published in the July 2011 issue of the American Journal of Medicine, suggests that regular use of NSAIDs poses a special problem for people who already have heart disease, boosting their chances of having a heart attack or stroke. This research doesn’t mean that people with high blood pressure and heart disease should stop taking NSAIDs, especially if they are used to ease pain from a chronic condition like arthritis. But it may make sense to try an alternative first.