Hypertension and Stroke
Formally published results of the SPRINT trial confirm the early conclusions released in September. A target systolic blood pressure (the top number) of 120 mm Hg or less offers real health benefits, including a lower risk for cardiovascular problems and even death. Even if you don’t have high blood pressure, the results are so compelling that everyone should know his or her blood pressure and develop a plan with a primary care physician to achieve and maintain the “ideal” blood pressure for them.
The SPRINT study was a large clinical trial involving people with high blood pressure who were at increased risk for heart disease or who already had kidney disease. The results of this study showed that aiming for a systolic blood pressure of 120 mm Hg instead of the current 140 mm Hg target greatly reduced the chances of developing serious cardiovascular problems. On average, reaching the target required 3 blood pressure drugs instead of 2. If you already have well-controlled blood pressure, you don’t need to rush to see your doctor about this, but it’s worth having a conversation with your primary care physician about the potential benefits of a lower blood pressure target.
Young adults with even slightly above-normal blood pressure may be more likely to have heart problems later in life, according to a new study in the Journal of the American College of Cardiology. The study focused on nearly 2,500 men and women who were 18 to 30 years old when the study began and whose health was followed for 25 years. Those with slightly high blood pressure, a condition known as prehypertension, were more likely to have had signs of heart disease in middle age. Echocardiograms showed they were more likely to have developed problems with the heart’s left ventricle.
If you’re among the one in three American adults with high blood pressure, be sure you’re getting plenty of the B vitamin known as folate. Doing so may lower your odds of having a stroke, an often disabling or deadly event linked to high blood pressure. That’s the conclusion of a large trial conducted in China, where many people don’t get enough folate. Most Americans get plenty of folate or its synthetic version, folic acid. That’s largely because grain folic acid is added to most grain products, including wheat flour, cornmeal, pasta, and rice. It’s a good idea for everyone to do a diet check to make sure it delivers enough folate. Good sources include green leafy vegetables, beans, and citrus fruits.
A new report in JAMA Neurology offers yet another reminder why keeping your blood pressure in the healthy range for as long as you can is a good life strategy. Researchers with the long-term Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study found that memory and thinking skills declined significantly more over the course of a 20-year study in middle-aged people with high blood pressure than it did in those with healthy blood pressure. Interestingly, those who had normal blood pressure in midlife but who developed high blood pressure in their late 60s, 70s, and 80s didn’t have similar declines as those who developed high blood pressure earlier. The main take-home lesson from this study? The longer you live with normal blood pressure, the less likely you are to have memory and reasoning problems when you’re older.
A new study that linked eating more protein to lower risk of stroke isn’t the last word on the subject. But that doesn’t make dietary protein any less vital, especially in older adults who are at greater risk for malnutrition and illness. How much protein is enough? Current guidelines for adults of any age recommend 0.8 grams of protein per kilogram of body weight. Do older people need more protein than younger ones? That’s still an open question.
For anyone who has had a stroke, working to prevent a second one should be Job No. 1. Keeping blood pressure under control is an important part of that job. A study published yesterday in the journal Stroke shows that good blood pressure control after a stroke cuts the chances of having a repeat stroke by more than half. But the study also brought some bad news: less than one-third of stroke survivors in the study managed to get their blood pressure under control. Measuring blood pressure at home is one way to help control blood pressure—seeing that it is high can help you take steps to bring it down. These include lifestyle changes and medications.
How bad can a little high blood pressure be? It turns out that it might be worse than we thought. Researchers from Southern Medical University in Guangzhou, China, examined the results of 19 high-quality studies looking at links between prehypertension and stroke. The studies included more than three-quarters of a million people, whose health and wellbeing was followed for 36 years. Those with “high-range prehypertension” (blood pressure between 130/85 and 139/89) had a 95% higher stroke risk compared to people with healthy blood pressures. Those with “low-range prehypertension” (blood pressure between 120/80 and 129/84) had a 44% higher stroke risk. The size of the study and the length of the followup make the results believable. They don’t mean that we should elevate prehypertension to a disease. But they do signal that we need to take it seriously. The best way to treat prehypertension is with lifestyle changes.
The first-ever guidelines for preventing stroke in women don’t fool around. They offer ways to prevent this disabling and potentially deadly event from adolescence to old age. More than half of the 800,000 Americans who have strokes each year are women. Nearly 4 million American women are living with the aftermath of a stroke. And because women live longer than men, their lifetime risk of having a stroke is higher. Those numbers are why stroke prevention is especially important for women. The guidelines cover the use of oral contraceptives, high blood pressure during pregnancy, the use of hormones after menopause, and migraine with aura. They also cover the fundamentals of stroke prevention, like controlling blood pressure, exercising more, eating a healthy diet, and not smoking.
When it comes to your “health numbers,” your two blood pressure values are important to know—and keep under control. New guidelines for managing high blood pressure in adults, released this morning in a report in JAMA, aim to help doctors know when to start treating high blood pressure and how best to do it. The new guidelines recommend different treatment targets for individuals age 60 and older and those under age 60. They also offer doctors advice on the best medications to start with to control high blood pressure. Although the new guidelines address an area of controversy—how low should blood pressure go—they don’t change the basics: Know your blood pressure. Consider high blood pressure to be a reading of 140/90 or greater. Lifestyle changes are important. And tailor treatment to your needs.