Blood pressure: 100 million Americans may be unnecessarily labeled abnormal

ScienceDaily (Mar. 9, 2011) — As many as 100 million Americans may currently be misclassified as having abnormal blood pressure, according to Dr. Brent Taylor from the Veterans Affairs Health Care System in Minneapolis and the University of Minnesota and his colleagues. Their findings show that these people are not actually more likely to die prematurely than those with 'normal' blood pressure, i.e. below 120/80. Taylor and colleagues' article in the Journal of General Internal Medicine, published by Springer, also shows that in those under 50, diastolic blood pressure* is the more important predictor of mortality, whereas in those over 50, systolic blood pressure* is the stronger predictor. The authors argue it is time to consider a new definition of 'normal' blood pressure.

Taylor and colleagues examined the independent contribution of diastolic blood pressure (DBP) and systolic blood pressure (SBP) on mortality, as well as how these relationships might affect the number of Americans currently labeled as having abnormal blood pressure.

The authors looked at data for 13,792 people from the National Health and Nutrition Examination Survey, which enrolled participants in 1971-76 and followed them up for two decades -- they studied DBP, SBP and long-term survival data specifically. In order to assess the underlying distribution of untreated blood pressure in American adults by age, Taylor and team also looked at data for 6,672 adults from the first National Health Examination Survey carried out between 1959 and 1962.

They found that in people aged over 50, those with SBPs above 140, independent of DBP, were significantly more likely to die prematurely. In those aged 50 or less, DBPs above 100 were linked to significant increases in premature death. The authors' analysis offers alternative cut-off points for the definition of 'normal'.

Dr. Taylor concludes: "Our findings highlight that the choice of approach used to define normal blood pressure will impact literally millions of Americans. If we cannot reliably see an effect on mortality in a large group of individuals followed for nearly 20 years, should we define the condition as abnormal? We believe considering this kind of approach represents a critical step in ensuring that diagnoses are given only to those with a meaningful elevation in risk, and targeted towards individuals most likely to benefit."

* Diastolic blood pressure is the lowest pressure within the bloodstream, occurring between heart beats i.e. when the heart relaxes. Systolic blood pressure is the highest pressure within the bloodstream, occurring during each heart beat i.e. when the heart contracts.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Springer Science+Business Media, via AlphaGalileo.

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Sugar-sweetened drinks associated with higher blood pressure

ScienceDaily (Mar. 1, 2011) — Soda and other sugar-sweetened beverages such as fruit drinks are associated with higher blood pressure levels in adults, researchers report in Hypertension: Journal of the American Heart Association.

In the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP), for every extra sugar-sweetened beverage drunk per day participants on average had significantly higher systolic blood pressure by 1.6 millimeters of mercury (mm Hg) and diastolic blood pressure higher by 0.8 mm Hg. This remained statistically significant even after adjusting for differences in body mass, researchers said.

Researchers found higher blood pressure levels in individuals who consumed more glucose and fructose, both sweeteners that are found in high-fructose corn syrup, the most common sugar sweetener used by the beverage industry.

Higher blood pressure was more pronounced in people who consumed high levels of both sugar and sodium. They found no consistent association between diet soda intake and blood pressure levels. Those who drank diet soda had higher mean BMI than those who did not and lower levels of physical activity.

"This points to another possible intervention to lower blood pressure," said Paul Elliott, Ph.D., senior author and professor in the Department of Epidemiology and Biostatistics in the School of Public Health at Imperial College London. "These findings lend support for recommendations to reduce the intake of sugar-sweetened beverages, as well as added sugars and sodium in an effort to reduce blood pressure and improve cardiovascular health."

In INTERMAP, researchers analyzed consumption of sugar-sweetened drinks, sugars and diet beverages in 2,696 participants, 40- to 59-years-old, in eight areas of the United States and two areas of the United Kingdom. Participants reported what they ate and drank for four days via in depth interviews administered by trained observers, underwent two 24-hour urine collections, eight blood pressure readings and responded a detailed questionnaire on lifestyle, medical and social factors.

The researchers found that sugar intake in the form of glucose, fructose and sucrose was highest in those consuming more than one sugar-sweetened beverage daily. They also found that individuals consuming more than one serving per day of sugar-sweetened beverages consumed more calories than those who didn't, with average energy intake of more than 397 calories per day.

Those who did not consume sugar-sweetened beverages had lower average body mass index (BMI) than those who consumed more than one of these drinks daily.

"People who drink a lot of sugar-sweetened beverages appear to have less healthy diets," said Ian Brown, Ph.D., research associate at Imperial College London. "They are consuming empty calories without the nutritional benefits of real food. They consume less potassium, magnesium and calcium.

"One possible mechanism for sugar-sweetened beverages and fructose increasing blood pressure levels is a resultant increase in the level of uric acid in the blood that may in turn lower the nitric oxide required to keep the blood vessels dilated. Sugar consumption also has been linked to enhanced sympathetic nervous system activity and sodium retention."

The study's limitations include that it was cross-sectional and diet was self-reported.

"This is a population study. It's one piece of the evidence in a jigsaw puzzle that needs to be completed," Brown said. "In the meantime, people who want to drink sugar-sweetened beverages should do so only in moderation."

The American Heart Association recommends no more than half of the discretionary calorie allowance from added sugars, which for most American women is no more than 100 calories per day and for most American men no more than 150 calories per day. Discretionary calories are the remaining calories in a person's "energy allowance" after consuming the recommended types and amounts of foods to meet all daily nutrient requirements.

Co-authors are: Jeremiah Stamler, M.D.; Linda Van Horn, Ph.D., R.D.; Claire E. Robertson, Ph.D., R.Nutr.; Queenie Chan, M.Sc.; Alan R. Dyer, Ph.D.; Chiang-Ching Huang, Ph.D.; Beatriz L. Rodriguez, M.D., Ph.D.; Liancheng Zhao, M.D.; Martha L. Daviglus, M.D., Ph.D.; Hirotsugu Ueshima M.D., Ph.D.; and Paul Elliott, Ph.D. Author disclosures are on the manuscript.

The National Heart, Lung, and Blood Institute, National Institutes of Health, Chicago Health Research Foundation and national agencies in China, Japan and the United Kingdom funded the study.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Heart Association.

Journal Reference:

Ian J. Brown, Jeremiah Stamler, Linda Van Horn, Claire E. Robertson, Queenie Chan, Alan R. Dyer, Chiang-Ching Huang, Beatriz L. Rodriguez, Liancheng Zhao, Martha L. Daviglus, Hirotsugu Ueshima, Paul Elliott, and for the International Study of Macro/Micronutrients and Blood Pressure Research Group. Sugar-Sweetened Beverage, Sugar Intake of Individuals, and Their Blood Pressure: International Study of Macro/Micronutrients and Blood Pressure. Hypertension, February 28, 2011 DOI: 10.1161/HYPERTENSIONAHA.110.165456

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Whey supplements lower blood pressure: Low-cost protein gets big results in people with elevated blood pressure

ScienceDaily (Dec. 13, 2010) — Beverages supplemented by whey-based protein can significantly reduce elevated blood pressure, reducing the risk of stroke and heart disease, a Washington State University study has found.

Research led by nutritional biochemist Susan Fluegel and published in International Dairy Journal found that daily doses of commonly available whey brought a more than six-point reduction in the average blood pressure of men and women with elevated systolic and diastolic blood pressures. While the study was confined to 71 student subjects between the ages of 18 and 26, Fluegel says older people with blood pressure issues would likely get similar results.

"One of the things I like about this is it is low-cost," says Fluegel, a nutritional biochemistry instructor interested in treating disease through changes in nutrition and exercise. "Not only that, whey protein has not been shown to be harmful in any way."

Terry Shultz, co-author and an emeritus professor in the former Department of Food Science and Human Nutrition, said the findings have practical implications for personal health as well as the dairy industry.

"These are very intriguing findings, very interesting," he said. "To my knowledge, this hasn't been shown before."

The study, which Fluegel did for her doctorate in nutritional biochemistry, notes that researchers in a 2007 study found no blood-pressure changes in people who took a whey-supplemented drink. At first, she saw no consistent improvement either. But then she thought to break out her subjects into different groups and found significant improvements in those with different types of elevated blood pressure. Improvements began in the first week of the study and lasted through its six-week course.

The supplements, delivered in fruit-flavored drinks developed at the WSU Creamery, did not lower the blood pressure of subjects who did not have elevated pressure to begin with. That's good, said Fluegel, as low blood pressure can also be a problem.

Other studies have found that blood-pressure reductions like those seen by Fluegel can reduce cardiovascular disease and bring a 35 to 40 percent reduction in fatal strokes.

Health benefits aside, researchers are excited about the prospect of improving the market for whey, a cheese byproduct that often has to be disposed of at some expense. Its potential economic impact is unclear, says Shannon Neibergs, a WSU extension economist, "but any positive use of that product is going to be beneficial."

Several supplement makers contributed product to the study, which was funded in part by the Washington Dairy Products Commission. None of the contributors had a role in analyzing the data or writing the report.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Washington State University.

Journal Reference:

Susan M. Fluegel, Terry D. Shultz, Joseph R. Powers, Stephanie Clark, Celestina Barbosa-Leiker, Bruce R. Wright, Timothy S. Freson, Heidi A. Fluegel, Jonathan D. Minch, Lance K. Schwarzkopf. Whey beverages decrease blood pressure in prehypertensive and hypertensive young men and women. International Dairy Journal, 2010; 20 (11): 753 DOI: 10.1016/j.idairyj.2010.06.005

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Blood pressure breakthrough holds real hope for treatment of pre-eclampsia

ScienceDaily (Oct. 7, 2010) — Scientists have discovered a mechanism which raises blood pressure in pre-eclampsia, a potentially deadly condition which occurs during pregnancy.

After 20 years of research, scientists from the University of Cambridge have now cracked the first step in the main process that controls blood pressure. Their findings, published in the journal Nature, are likely to have significant implications for the treatment of pre-eclampsia as well as high blood pressure (also known as hypertension).

Blood pressure is controlled by hormones called angiotensins, which cause the blood vessels to constrict. These hormones are released by the protein angiotensinogen. Until now, it was not understood how this occurred.

Dr Aiwu Zhou, a British Heart Foundation (BHF) Fellow at the University of Cambridge, who made the breakthrough, said: "Although we primarily focused on pre-eclampsia, the research also opens new leads for future research into the causes of hypertension in general."

To make the discovery, the researchers solved the structure of angiotensinogen with the help of an extremely intense X-ray beam produced by Diamond Light Source, the UK synchrotron. Their results revealed that the protein is oxidised and changes shape to permit ready access to angiotensinogen by an enzyme, renin. Renin cuts off the tail of the protein to release the hormone angiotensin, which then raises blood pressure.

Taking their lab results into the clinic at the University of Nottingham, the research team showed that the amount of oxidised, and hence more active, angiotensinogen was increased in women with pre-eclampsia.

Professor Robin Carrell at the University of Cambridge, who led the 20-year research project, explained: "During pregnancy oxidative changes can occur in the placenta. These changes, the very ones we have found stimulates the release of the hormone angiotensin and lead to increased blood pressure, can arise as the circulation in the placenta readjusts the oxygen requirements of the growing foetus with the delivery of oxygen to the placenta from the mother."

Drugs currently used to treat high blood pressure -- such as ACE inhibitors -- focus on the later stages of the mechanism that controls blood pressure. The latest findings, which give insight into the previously mysterious early stages of the regulation process, provide scientists with new opportunities to research novel treatments for hypertension.

Professor Peter Weissberg, Medical Director of the BHF, which largely funded the study, said: "Every year in the UK pre-eclampsia is responsible for the deaths of around six women and several hundred babies. This research is of the highest quality and offers real hope for developing strategies to prevent or treat this dangerous condition by targeting the process that these scientists have identified. And of course, although the researchers only looked at pre-eclampsia in this study, similar strategies may be useful for those people with high blood pressure that is not effectively controlled by current medicines."

High blood pressure frequently affects pregnancy. However, in 2-7 per cent of pregnancies this develops into pre-eclampsia, which threatens the health and survival of both the mother and child. In Britain, it affects about one in 20 women during pregnancy, and every year 50,000 women and 500,000 infants die globally as a result of pre-eclampsia. There is no treatment for pre-eclampsia and often the mother is either induced early or undergoes a Caesarean.

The research was largely funded by the British Heart Foundation, with additional funding provided by the Medical Research Council, the Wellcome Trust and the Isaac Newton Trust.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cambridge, via EurekAlert!, a service of AAAS.

Journal Reference:

Aiwu Zhou, Robin W. Carrell, Michael P. Murphy, Zhenquan Wei, Yahui Yan, Peter L. D. Stanley, Penelope E. Stein, Fiona Broughton Pipkin, Randy J. Read. A redox switch in angiotensinogen modulates angiotensin release. Nature, 2010; DOI: 10.1038/nature09505

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Lower blood pressure may preserve kidney function in some patients

ScienceDaily (Sep. 2, 2010) — Intensively treating hypertension in some African Americans with kidney disease by pushing blood pressure well below the current recommended goal may significantly decrease the number who lose kidney function and require dialysis, suggests a Johns Hopkins-led study publishing in the New England Journal of Medicine.

"This is not a panacea. We have a lot more to figure out. But our evidence suggests that we have a way to at least delay or possibly even prevent end-stage kidney disease in some patients," says Lawrence J. Appel, M.D., M.P.H., a professor of medicine at the Johns Hopkins University School of Medicine and the study's leader.

End-stage kidney disease is the point at which patients need to be on dialysis or receive a kidney transplant in order to survive.

Still, not everyone in the study was helped by the aggressive blood pressure treatment. Those patients who had little or no protein in their urine -- that is, patients who were not as sick -- saw their kidney disease progress at roughly the same rate regardless of how low they tried to get their blood pressure. It was the sicker patients, that is, those with protein in their urine, who benefited most from the more intensive blood pressure therapy, with roughly a 25 percent reduction in end-stage kidney disease as compared with those who met the standard blood pressure goal. Roughly one-third of the participants had higher amounts of protein in their urine.

"This has always been a hot topic: Is a lower blood pressure goal better at preserving kidney function than the standard goal? The answer is a qualified yes, notably in people who have some protein in their urine," Appel says.

In the National Institutes of Health-sponsored African-American Study of Kidney Disease and Hypertension (AASK), 1,094 hypertensive African Americans with chronic kidney disease were randomized to one of two groups: standard blood pressure goal versus intensive (or lower) blood pressure goal. Both groups needed to get their blood pressure in check -- the first group's goal was a blood pressure of roughly 140/90 (the standard target of doctors when treating hypertensive patients), while the second group's goal was approximately 130/80. Researchers lowered blood pressure through a combination of commonly used drugs. The patients were followed between 8.8 and 12.2 years.

Chronic kidney disease is a major public health problem and one that is only growing, Appel says. In the United States, roughly one-third of cases of end-stage kidney disease -- in which the kidneys no longer function and patients require dialysis or a transplant -- are attributed to hypertension. The burden of kidney disease is especially high in African Americans. Though they constitute only 12 percent of the population, African Americans make up 32 percent of those with end-stage kidney disease. Appel says African Americans are four to 20 times more likely to reach end-stage kidney disease, though researchers remain unsure of the reasons why.

Physicians consider patients with blood pressure over 140/90 to be hypertensive, and they will often put those patients on blood pressure-lowering medication with the goal of getting them back below that hazardous threshold. In recent years, some doctors have suggested that their patients with kidney disease try to get their blood pressure lower than that to stave off the progression of kidney disease, though without much scientific evidence, Appel says.

Appel says his study suggests that physicians should check for protein in the urine before determining the blood pressure goal for African Americans with kidney disease. If the patient has protein in the urine, a lower blood pressure goal has the potential to slow the progression of kidney disease. But if the patient has little or no protein in the urine, Appel says, the study suggests that reaching the lower blood pressure goal is not worth the extra effort, and the standard goal is just as good. Getting hypertensive patients down to 130/80 takes more doctor visits and requires more medication -- on average, one more blood pressure prescription. However, once the lower blood pressure level is achieved, keeping the blood pressure there is not particularly difficult.

Even though the study found a benefit of aggressive blood pressure treatment in one group of hypertensive African Americans with kidney disease, a significant number of those patients still ended up with end-stage kidney disease or worse. While roughly 90 percent of those who were in the standard blood pressure group saw their disease progress, about 75 percent of those in the aggressive therapy arm of the trial still progressed to a poor outcome.

"That's still pretty high," Appel says. "The key is preventing early kidney damage in the first place."

More research is necessary, he says, to identify more factors that prevent early kidney damage, as well as factors that delay kidney disease progression among those who already have chronic kidney disease.

The study was conducted at 20 medical centers in the United States. Along with Appel, other Johns Hopkins faculty and staff involved in the research include Edgar Miller, M.D., Ph.D., Brad Astor, Ph.D., M.P.H., M.S.; Charalett Diggs, R.N.; Jeanne Charleston, R.N.; and Charles Harris.

The National Institutes of Health was the primary sponsor of the study. In addition, King Pharmaceuticals provided financial support and donated antihypertensive medications. Pfizer Inc., AstraZeneca Pharmaceuticals, Glaxo Smith Kline, Forest Laboratories, Pharmacia and Upjohn also donated medication.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Johns Hopkins Medical Institutions, via EurekAlert!, a service of AAAS.

Journal Reference:

Appel et al. Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. New England Journal of Medicine, 2010; 363 (10): 918 DOI: 10.1056/NEJMoa0910975

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Common antibiotics and blood pressure medication may result in hospitalization

ScienceDaily (Jan. 18, 2011) — Mixing commonly used antibiotics with common blood pressure medications may cause hypotension (abnormally low blood pressure) and induce shock in older patients, requiring hospitalization, according to a study published in CMAJ (Canadian Medical Association Journal).

"Macrolide antibiotics (erythromycin, clarithromycin and azithromycin) are among the most widely prescribed antibiotics, with millions of prescriptions dispensed in Canada each year." writes Dr. David Juurlink, Scientist at the Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences with coauthors. "The drugs are generally well-tolerated, but they can cause several important drug interactions."

This study was conducted among Ontarians 66 years and older who were treated with a calcium-channel blocker (drugs often used to treat high blood pressure) between 1994 and 2009. The researchers then identified those who were hospitalized for low blood pressure and, in that group, whether or not a macrolide antibiotic had been prescribed shortly beforehand.

The researchers identified 7100 patients hospitalized for low blood pressure or shock while taking a calcium channel blocker. Treatment with erythromycin was found to increase the risk of low blood pressure almost 6-fold, while clarithromycin increased the risk almost 4-fold. In contrast, azithromycin did not increase the risk of hypotension.

"In older patients receiving calcium channel blockers, the two macrolide antibiotics erythromycin and clarithromycin are associated with a major increase in the risk of hospitalization for hypotension," conclude the authors. "However, the related drug azithromycin appears safe. When clinically appropriate, it should be used preferentially in patients receiving a calcium channel blocker."

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Canadian Medical Association Journal, via EurekAlert!, a service of AAAS.

Journal Reference:

Alissa J. Wright, Tara Gomes, Muhammad M. Mamdani, John R. Horn and David N. Juurlink. The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers. CMAJ, 2011; DOI: 10.1503/cmaj.100702

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Children with high blood pressure more likely to have learning disabilities, study finds

ScienceDaily (Nov. 10, 2010) — Children who have hypertension are much more likely to have learning disabilities than children with normal blood pressure, according to a new University of Rochester Medical Center (URMC) study published in the journal Pediatrics. In fact, when variables such as socio-economic levels are evened out, children with hypertension were four times more likely to have cognitive problems.

"This study also found that children with hypertension are more likely to have ADHD (attention deficit hyperactivity disorder)," said Heather R. Adams, Ph.D., an assistant professor of Neurology and Pediatrics at URMC, and an author of the study. "Although retrospective, this work adds to the growing evidence of an association between hypertension and cognitive function. With 4 percent of children now estimated to have hypertension, the need to understand this potential connection is incredibly important."

Among the study's 201 patients, all of whom had been referred to a pediatric hypertension clinic at URMC's Golisano Children's Hospital, 101 actually had hypertension, or sustained high blood pressure, determined by 24-hour ambulatory monitoring or monitoring by a school nurse or at home. Overall, 18 percent of the children had learning disabilities, well above the general population's rate of 5 percent. But the percentage among those without hypertension was closer to 9 percent, and among those with hypertension, the rate jumped to 28 percent. All of the children were between 10- and 18-years-old, and the children's learning disability and ADHD diagnoses were reported by parents.

This study is part of a series of hypertension studies by Golisano Children's Hospital researchers, led by Principal Investigator Marc Lande, M.D., a pediatric nephrologist, but it was the first that included children with ADHD. Previous studies excluded them because ADHD medications can increase blood pressure. Researchers included them this time because, although it is possible that some of the children's hypertension was caused by medications, it is also possible that the higher rate of ADHD among children with hypertension is a reflection of neurocognitive problems caused by hypertension. Twenty percent of the children with hypertension had ADHD whereas only 7 percent of those without hypertension had ADHD among the study participants. And even when ADHD was factored out of the analyses, there was still a higher rate of learning disabilities in the hypertensive, compared to the non-hypertensive group of children.

"With each study, we're getting closer to understanding the relationship between hypertension and cognitive function in children," Lande said. "And this study underscores the need for us to continue to tease out the potential risk children with hypertension have for learning difficulties at a time when learning is so important. It may be too early to definitively link hypertension and learning disabilities, but it isn't too early for us, as clinicians, to ensure our pediatric patients with hypertension are getting properly screened for cognitive issues."

The study was funded by a grant from the National Institutes of Health. The authors have no conflicts to disclose.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Rochester Medical Center.

Journal Reference:

H. R. Adams, P. G. Szilagyi, L. Gebhardt, M. B. Lande. Learning and Attention Problems Among Children With Pediatric Primary Hypertension. Pediatrics, 2010; DOI: 10.1542/peds.2010-1899

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Blood pressure checks performed by barbers improve hypertension control in African-American men

ScienceDaily (Oct. 26, 2010) — Neighborhood barbers, by conducting a monitoring, education and physician-referral program, can help their African-American customers better control high blood pressure problems that pose special health risks for them, a new study from the Cedars-Sinai Heart Institute shows.

The study -- the first to subject increasingly popular barbershop-based health programs to a scientific scrutiny with randomized, controlled testing -- demonstrates the haircutters' heart health efforts work well enough that they could save hundreds of lives annually, according to results to be published online in Archives of Internal Medicine in the peer-reviewed medical journal's Feb. 28, 2011, print issue.

In the research -- led by Ronald G. Victor, MD, a hypertension expert and associate director of the Cedars-Sinai Heart Institute -- barbers for 10 months offered blood pressure checks during men's haircuts and promoted physician follow-up with personalized health education for customers with high blood pressure. This enhanced screening program markedly improved blood pressure levels among the barbershops' patrons. Although blood pressure levels also fell in a comparison group whose members received only educational brochures about high blood pressure, the improvement was greater in the barber-assisted group.

Uncontrolled hypertension is one of the most prevalent causes of premature disability and death among African-Americans. African-American men have the highest death rate from hypertension of any race, ethnic and gender group in the United States -- three times higher than white men.

"What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become healthcare extenders to help combat this epidemic of the silent killer in their community"," said Victor, the Burns and Allen Chair in Cardiology Research. "Barbers, whose historical predecessors were barber-surgeons, are a unique work force of potential community health advocates because of their loyal clientele."

Since the 1980s, African-American-owned barbershops and hair salons have hosted screening programs for medical conditions that disproportionately affect African-Americans. Victor's study concludes that if hypertension intervention programs were put in place in the estimated 18,000 African-American barbershops in the U.S., it would result in the first year in about 800 fewer heart attacks, 550 fewer strokes and 900 fewer deaths.

Seventeen African-American-owned barbershops in Dallas and approximately 1,300 male patrons with confirmed hypertension participated in this study, which ran from March, 2006, to December, 2008, when Victor was professor of medicine at the University of Texas Southwestern Medical Center in Dallas.

All African-American men patronizing the participating shops were offered baseline blood pressure screenings for hypertension. The shops then were assigned randomly to the intervention or comparison group.

Barbers at the nine shops in the intervention group were trained to measure blood pressure properly and they offered free checks with every cut. If a customer's reading was high, the barber encouraged him to see his doctor, and, if he did not, the barber called the study's nursing staff to arrange a physician visit. The customer, in turn, got a free haircut if he returned to the shop with a doctor-signed referral card.

In the eight shops in the comparison group, customers received a blood pressure check at the study's outset, and then were offered standard educational pamphlets about hypertension.

At the study's conclusion, 20 percent more hypertensive patrons in the intervention group had their blood pressure controlled with medication compared to 10 percent in the control group.

"We need further exploration to make this kind of program scalable and sustainable," said Victor, who is launching a new study with African-American barbershops in Southern California. "If this kind of program could be applied to large numbers of African-American men, that would be an enormous asset in preventing heart attacks, strokes, kidney failure and other serious complications of hypertension,"

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Cedars-Sinai Medical Center.

Journal Reference:

Ronald G. Victor; Joseph E. Ravenell; Anne Freeman; David Leonard; Deepa G. Bhat; Moiz Shafiq; Patricia Knowles; Joy S. Storm; Emily Adhikari; Kirsten Bibbins-Domingo; Pamela G. Coxson; Mark J. Pletcher; Peter Hannan; Robert W. Haley. Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men: The BARBER-1 Study: A Cluster Randomized Trial. Archives of Internal Medicine, 2010; DOI: 10.1001/archinternmed.2010.390

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Smoking around your kindergartner could raise their blood pressure

ScienceDaily (Jan. 11, 2011) — If you smoke around your children, they could have high blood pressure or be headed in an unhealthy direction before learning their ABC's, according to research reported in Circulation: Journal of the American Heart Association.

The study is the first to show that breathing tobacco smoke increases the blood pressure of children as young as 4 or 5 years old.

"The prevention of adult diseases like stroke or heart attack begins during childhood," said Giacomo D. Simonetti, M.D., first author of the study at the University of Heidelberg in Germany and currently assistant professor of pediatrics at the Children's Hospital of the University of Berne in Switzerland. "Parental smoking is not only negative for children's lung function, but poses a risk for their future cardiovascular health."

In an extension of a standard school health exam, 4,236 kindergarten boys and girls (average age 5.7) in the German district that includes Heidelberg had their blood pressure measured. Of parents reporting they smoked, 28.5 percent were fathers, 20.7 percent mothers and 11.9 percent were both parents.

Children with a smoking parent were 21 percent more likely to have systolic blood pressure (the top number in a reading, measured as the heart contracts) in the highest 15 percent, even after adjusting for other heart disease risk factors, such as birth weight, body mass index, and hypertension in the parents.

"Passive smoking increased the risk of having blood pressure at the upper end of normal, and some of these children already had high blood pressure," Simonetti said.

After correcting for other risk factors -- having parents with high blood pressure, being born prematurely or at a low birth weight, being overweight or obese -- blood pressures were significantly higher in the children of smoking parents.

The impact was greater for systolic blood pressure (average increase 1.0 mm Hg) than diastolic blood pressure (average increase 0.5 mm Hg), the lower number in a reading measured when the heart rests between beats.

"Smoking adds to other risk factors," Simonetti said. "Average blood pressure increased in proportion to the cumulative number of risk factors present."

Smoking by mothers had a larger impact than fathers smoking, probably because more of their smoking was done in the home while fathers smoked more at their workplaces, researchers said.

Smoke exposure is likely to have a similar impact on blood pressure in children in the United States, the researchers said.

"Childhood blood pressure consistently tracks into adult life," Simonetti said. "Removing any avoidable risk factors as soon as possible will help reduce the risk for heart disease later on and improve the long-term health of children."

The study findings suggest that encouraging strictly smoke-free environments, specifically at home, may help preserve cardiovascular health not only in adults but also in children, researchers said.

Co-authors are: Rainer Schwertz, M.D.; Martin Klett, M.D.; Georg F. Hoffman, M.D.; Franz Schaefer, M.D.; and Elke Wühl, M.D. Author disclosures are on the manuscript.

The Manfred-Lautenschläger Stiftung, Reimann-Dubbers-Stiftung, Dietmar-Hopp-Stiftung and the Swiss Society of Hypertension AstraZeneca scholarship funded the study.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Heart Association.

Journal Reference:

Giacomo D. Simonetti, Rainer Schwertz, Martin Klett, Georg F. Hoffmann, Franz Schaefer, and Elke Wühl. Determinants of Blood Pressure in Preschool Children: The Role of Parental Smoking. Circulation, 2011; DOI: 10.1161/CIRCULATIONAHA.110.958769

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Tight blood pressure control for patients with diabetes and coronary artery disease not associated with improved cardiovascular outcomes, study finds

ScienceDaily (Sep. 26, 2010) — Patients with hypertension, diabetes and coronary artery disease who maintained their systolic blood pressure at less than 130 mm Hg did not have improved cardiovascular outcomes compared to patients with usual blood pressure control, according to a study in the July 7 issue of JAMA.

"Hypertension guidelines advocate treating systolic blood pressure (BP) to less than 130 mm Hg for patients with diabetes mellitus; however, data are lacking for the growing population who also have coronary artery disease (CAD)," according to background information in the article.

Rhonda M. Cooper-DeHoff, Pharm.D., M.S., of the University of Florida, Gainesville, and colleagues examined whether patients with hypertension, diabetes and CAD who achieved systolic BP of less than 130 mm Hg would have a reduced risk of cardiovascular events compared with those who managed to keep their systolic BP within the range of at least 130 mm Hg to less than 140 mm Hg. The analysis included 6,400 of the 22,576 participants in the International Verapamil SR-Trandolapril Study (INVEST). For this analysis, participants were at least 50 years old and had diabetes and CAD. Participants were recruited between September 1997 and December 2000 from 862 sites in 14 countries and were followed up through March 2003, with an extended follow-up through August 2008 through the National Death index for U.S. participants.

Patients received treatment with either a calcium antagonist or beta-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic, or both to achieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg. Patients were categorized as having tight control if they could maintain their systolic BP at less than 130 mm Hg; usual control if systolic BP ranged from 130 mm Hg to less than 140 mm Hg; and uncontrolled if systolic BP was 140 mm Hg or higher. The primary outcome included the occurrence of all-cause death, nonfatal myocardial infarction (heart attack), or nonfatal stroke.

The primary outcome occurred in 12.7 percent (286 patients) of those in the tight-control group, 12.6 percent (249 patients) of the usual-control group, and 19.8 percent (431 patients) of the uncontrolled groups. When evaluating all-cause mortality for the entire follow-up period, after adjustment, risk of all-cause mortality was significantly greater in the tight-control group (22.8 percent) than in the usual-control group (21.8 percent).

"In this observational study, we have shown for the first time, to our knowledge, that decreasing systolic BP to lower than 130 mm Hg in patients with diabetes and CAD was not associated with further reduction in morbidity beyond that associated with systolic BP lower than 140 mm Hg, and, in fact, was associated with an increase in risk of all-cause mortality. Moreover, the increased mortality risk persisted over the long term," the authors write.

"At this time, there is no compelling evidence to indicate that lowering systolic BP below 130 mm Hg is beneficial for patients with diabetes; thus, emphasis should be placed on maintaining systolic BP between 130 and 139 mm Hg while focusing on weight loss, healthful eating, and other manifestations of cardiovascular morbidity to further reduce long-term cardiovascular risk."

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Journal Reference:

Rhonda M. Cooper-DeHoff; Yan Gong; Eileen M. Handberg; Anthony A. Bavry; Scott J. Denardo; George L. Bakris; Carl J. Pepine. Tight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease. JAMA, 2010; 304 (1): 61-68 [link]

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Sex, race, place of residence influence high blood pressure incidence

ScienceDaily (Dec. 9, 2010) — High blood pressure may help to explain why deaths from heart disease and stroke vary according to geography, race and sex, researchers reported in Hypertension: Journal of the American Heart Association.

"Where you live, your race, and your gender strongly influence your risk of developing high blood pressure as you move from young adulthood into middle age -- and hypertension is a major risk factor for heart disease and stroke," said Deborah A. Levine, M.D., M.P.H., lead study author and assistant professor of internal medicine in the Departments of Medicine and Neurology at the University of Michigan Medical School in Ann Arbor.

Between 1968 and 2006, deaths from heart disease and stroke fell an impressive 65 percent, but everyone didn't share equally in the positive trend, she said. Cardiovascular deaths are still higher in the southeastern United States, in blacks compared with whites, and in men compared with women.

"The gaps may be widening, particularly for blacks," Levine said. "The reasons for the variations are not clear, so we examined whether high blood pressure might help to explain it."

The researchers examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study that followed young people from Birmingham, Ala., Chicago, Ill., Minneapolis, Minn. and Oakland, Calif., from the time they were 18-30 years old. Each center began the study with groups similar to each other for race, sex, and age. Among 3,436 participants who didn't have high blood pressure when the research began, and were followed for 20 years (when average age was 45), hypertension was diagnosed in:

37.6 percent of black women; 34.5 percent of black men; 21.4 percent of white men and 12.3 percent of white women;33.6 percent of Birmingham residents; 27.4 percent in Oakland; 23.4 percent in Chicago and 19 percent in Minneapolis.

After adjusting for multiple risk factors, living in Birmingham significantly increased the chance that a person would develop high blood pressure.

"In addition, independently of where they live, blacks -- especially black women -- are at markedly higher risk of hypertension even after we took into account factors that are known to affect blood pressure, such as physical activity and obesity," Levine said.

More research is needed to understand the geographic and racial differences in high blood pressure documented in this study as well as the potential biological, environmental and genetic mechanisms, Levine said. "In the meantime, people at higher risk can benefit from close monitoring of their blood pressure and paying attention to risk factors such as obesity and physical activity."

Co-authors are: Cora E. Lewis, M.D., M.S.P.H.; O. Dale Williams, Ph.D.; Monika M. Safford, M.D.; Kiang Liu, Ph.D.; David A. Calhoun, M.D.; Yongin Kim, M.S.; David R. Jacobs Jr., Ph.D.; and Catarina I. Kiefe, Ph.D., M.D. Individual author disclosures can be found on the manuscript.

The research was supported in part by the National Heart, Lung, and Blood Institute.

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Researchers find rising levels of hypertension in older Mexican-Americans

ScienceDaily (Jan. 13, 2011) — A new study by researchers at the University of Texas Medical Branch at Galveston reveals that the prevalence of hypertension in older Mexican-Americans living in the Southwest region of the United States has increased slightly in the last decade.

Researchers suspect the rise is due, in part, to the increase in diabetes and obesity.

Although hypertension, or high blood pressure, is one of the most common diseases in the United States, affecting more than 72 million Americans, it is one of the most manageable risk factors for cardiovascular disease.

Advancements in the diagnosis, treatment and control of hypertension have been major contributors to the decline in cardiovascular mortality in recent decades.

"We always expect that things are improving, right?" said Kyriakos S. Markides, co-author and principal investigator of the study, which has been funded by the National Institute on Aging since 1992. "But now we're finding that, in the more recent study participants, they're more disabled, have more diabetes, have slightly more obesity and slightly more hypertension."

The study, which appears in the January issue of the Annals of Epidemiology, looked at 3,952 older Mexican-Americans residing in Texas, New Mexico, Colorado, Arizona and California. A group of 3,050 men and women, 65 and older, were evaluated in 1993-1994, and an additional 902 men and women, 75 and older, were added in 2004-2005. Researchers interviewed the study subjects and took health measurements every two to three years.

The hypertension prevalence rates were significantly different in 1993-1994 compared with 2004-2005 (73 percent vs. 78.4 percent, respectively). The increase in hypertension prevalence was significant for subjects 75 to 79 years, for U.S.-born subjects, for subjects with diabetes and for the obese.

Self-reported hypertension was assessed by asking subjects if a doctor had ever told them that they had high blood pressure. Blood pressure readings were taken by interviewers during in-home visits. Participants were asked to provide the containers of the medications taken in the two weeks prior to the interview, and drug names were recorded.

Subjects were considered hypertensive if they had been told by a physician that they had hypertension, if they had an average systolic blood pressure of 140 mm Hg or higher or an average diastolic blood pressure of 90 mm Hg or higher, or if they were taking antihypertensive medications.

While overall hypertension awareness was significantly higher in 2004-2005 than in 1993-1994 (82.6 percent vs. 63 percent, respectively), diabetic and obese subjects were more likely to be hypertensive in 2004-2005 than in 1993-1994.

There's good news and bad news, said Markides. "The bad news is the prevalence of hypertension went up -- not a huge increase, but up nonetheless -- due in part to obesity and diabetes. The good news is that the hypertension is better controlled because of increased awareness and better management."

Hispanics living in the United States are expected to number 120 million by 2050. "This is a long-living population with increasing rates of disability, diabetes and chronic disease," said Markides.

"More effort should be targeted to reverse trends of both obesity and diabetes as potential causes of increases in hypertension," wrote Markides and his collaborators. "Further investigations should be directed toward providing clear guidelines and goals for hypertension treatment and control in the very old to improve hypertension outcomes in this population."

The study's researchers include Markides, Yong-Fang Kuo, Soham Al Snih, Mukaila A. Raji and Laura A. Ray from UTMB Health, and Majd Al Ghatrif from Union Memorial Hospital in Baltimore, Md., formerly a visiting fellow at UTMB.

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Lowering blood pressure in middle-aged women reduces heart disease risk

ScienceDaily (Jan. 25, 2011) — Large numbers of middle-aged women worldwide could reduce their risk of developing cardiovascular disease (stroke, heart attack and heart failure) and its complications by lowering their blood pressure, researchers report in Hypertension: Journal of the American Heart Association.

Researchers found that high systolic blood pressure (the pressure when the heart contracts) is a powerful risk factor for cardiovascular complications in middle-aged and older women all over the world.

The proportion of potentially preventable and reversible heart disease is almost 36 percent in women compared to 24 percent in men, as measured by 24-hour systolic blood pressure monitoring, researchers said.

Investigators in 11 countries, working on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO), followed 9,357 adults (average age 53; 47 percent women) throughout Europe, Asia and South America for more than 11 years. They analyzed participants for absolute and relative risks of cardiovascular disease associated with systolic blood pressure.

Three major risk factors account for 85 percent of the modifiable (reversible) risk for heart disease in women and men: high systolic blood pressure, high cholesterol and smoking. High systolic pressure is the most important risk factor.

"I was surprised by the study findings that highlight the missed opportunities for prevention of heart disease in older women," said Jan A. Staessen, M.D., Ph.D., director of the Studies Coordinating Center in the Division of Cardiovascular Rehabilitation at the University of Leuven in Belgium. "We found that a 15 mm Hg increase in systolic blood pressure increased the risk of cardiovascular disease by 56 percent in women compared to 32 percent in men."

Researchers estimated the occurrences of cardiovascular disease in women and men that are potentially preventable by lowering blood pressure. The absolute and relative risks associated with high blood pressure were assessed using both ambulatory 24-hour blood pressure monitoring and conventional blood pressure measurements in the doctor's office.

Ambulatory blood pressure monitoring involves measuring blood pressure for 24 hours during participants' daily routine and when asleep. The monitor is a small, portable device programmed to record blood pressures at specific intervals. Ambulatory blood pressure readings have less potential for error and better reproducibility, and provide more accurate estimates of usual blood pressure and prognosis for cardiovascular disease than conventional blood pressure readings.

Ambulatory blood pressure also provides information about blood pressure during nighttime sleep and blood pressure variability. Ambulatory daytime readings are recorded at intervals of about 15 to 30 minutes, while nighttime readings are recorded at intervals of about 30 to 45 minutes. Researchers said that nighttime blood pressure readings are a better predictor of heart disease than daytime readings because readings are more standardized at night than in the daytime. At night, blood pressure is less likely to be influenced by physical activity.

"It is recognized that women live longer than men, but that older women usually report lower quality of life than men. By lowering systolic pressure by 15 mm Hg in hypertensive women, there would be an increased benefit in quality of life by the prevention of cardiovascular disease in about 40 percent in women compared to 20 percent in men," Staessen said.

He recommends that women and physicians become more aggressive in diagnosing and treating high systolic blood pressure.

Researchers are enlarging the database to include other countries and ethnicities. They are developing risk charts based on ambulatory blood pressure recordings to be used by physicians in day-to-day clinical practice.

Co-authors are: José Boggia, M.D., MS.c.; Lutgarde Thijs, M.Sc.; Tine W. Hansen, M.D., Ph.D.; Yan Li, M.D., Ph.D.; Masahiro Kikuya, M.D., Ph.D.; Kristina Björklund-Bodegård, M.D., Ph.D.; Tom Richart, M.D., M.Eng.; Takayoshi Ohkubo, M.D., Ph.D.; Jørgen Jeppesen, M.D., Ph.D.;Christian Torp-Pedersen, M.D., Ph.D.; Eamon Dolan, M.D., Ph.D.;Tatiana Kuznetsova, M.D., Ph.D.; Agnieszka Olszanecka, M.D.; Valérie Tikhonoff, M.D., Ph.D.; Sofia Malyutina, M.D., Ph.D.; Edoardo Casiglia, M.D., Ph.D.; Yuri Nikitin, M.D., Ph.D.; Lars Lind, M.D., Ph.D.; Gladys Maestre, M.D., Ph.D.; Edgardo Sandoya, M.D., Ph.D.; Kalina Kawecka-Jaszcz, M.D., Ph.D.; Yutaka Imai, M.D., Ph.D.; Jiguang Wang, M.D., Ph.D.; Hans Ibsen, M.D., Ph.D. and Eoin O'Brien, M.D., Ph.D. Author disclosures and funding sources are listed in the study. None of the authors has a conflict of interest.

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Journal Reference:

José Boggia, Lutgarde Thijs, Tine W. Hansen, Yan Li, Masahiro Kikuya, Kristina Björklund-Bodegård, Tom Richart, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Agnieszka Olszanecka, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Gladys Maestre, Edgardo Sandoya, Kalina Kawecka-Jaszcz, Yutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A. Staessen, and on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators. Ambulatory Blood Pressure Monitoring in 9357 Subjects From 11 Populations Highlights Missed Opportunities for Cardiovascular Prevention in Women. Hypertension, 2011; DOI: 10.1161/HYPERTENSIONAHA.110.156828

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Two medicines taken together improve control of blood pressure

ScienceDaily (Jan. 13, 2011) — New British-led research shows that starting treatment of blood pressure with two medicines rather than the one produces better and faster results and fewer side effects -- findings that could change clinical practice world-wide.

The study, published in the Lancet, challenges popular medical practice for the treatment of high blood pressure. The research was led by Cambridge in collaboration with the Universities of Dundee, Glasgow and the British Hypertension Society.

Doctors usually start treatment with one medicine and then add others over a period of months, if needed, to control blood pressure. This study shows that it is best to start treatment with two medicines together at the same time -- resulting in much faster and better control of blood pressure and surprisingly fewer side effects than with one medicine alone.

The two medicines can be incorporated into a single pill, simplifying things for patients who will still only have to take one pill. But by including two medicines in the same pill, they are taking a much more effective medicine with fewer side effects.

Professor Morris Brown, of the University of Cambridge and Addenbrooke's Hospital, said, "The ACCELERATE study breaks the mould for treating hypertension. Most patients can now be prescribed a single combination pill and know that they are optimally protected from strokes and heart attacks."

Prof Bryan Williams, of the British Hypertension Society, said, "This study is important and the findings could change the way we approach the treatment of high blood pressure."

Currently there are almost 10 million people in the UK with high blood pressure and effective treatment is known to substantially reduce the risk of stroke and heart disease.

The investigators believe these important findings could change clinical practice and affect the future treatment of blood pressure for millions of people in the UK.

Professor Tom MacDonald, of the University of Dundee, said: "The research is a great result for patients with high blood pressure. Starting with two medicines is clearly better than starting with one and amazingly there were fewer side effects and not more."

Gordon McInnes, Professor of Clinical Pharmacology at the University of Glasgow, said: "The results of this trial are of huge importance to doctors and people treated for high blood pressure. Future treatment will be more effective and, since fewer side effects will lead to better acceptance of therapy, many fewer heart attacks and strokes are likely."

The 'ACCELERATE' study of 1250 patients with hypertension shows that a new accelerated treatment programme lowers blood pressure faster, more effectively, and with fewer side effects than conventional treatment.

ACCELERATE shows that patients who start treatment with a single tablet containing a combination of drugs will have a 25% better response during the first six months of treatment than patients receiving conventional treatment, and -- remarkably -- are less likely to stop treatment because of side effects. Still more remarkably, the blood pressure in the conventional treatment arm never caught up with the new treatment arm, even when all the patients in the study were being treated with the same combination of drugs.

The authors suspected that conventional treatment allows the body to partially neutralise each drug, and ACCELERATE was designed to show that the new treatment programme prevents this neutralisation from happening.

ACCELERATE was designed by The British Hypertension Society, who entered a unique partnership with Novartis in order for the treatment programme to be simultaneously tested in ten countries on four continents.

Currently, patients with hypertension take many months to have their blood pressure lowered, following guidance to start with a low-dose of one tablet, and gradually increase the dose and number of drugs. This traditional 'start low, go-slow' policy is encouraged in order to avoid side effects, but has been shown to delay the protection from strokes which is the main reason for treating hypertension. In the longer-term, patients are also less likely to take their medication if multiple tablets are required.

Funded by the British Heart Foundation, the British Hypertension Society Research Network is now doing a similar study with different medicines to be sure these results are generalisable.

Reference: "Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial" will be published in the Lancet on 13 January.

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Watermelon lowers blood pressure, study finds

ScienceDaily (Oct. 14, 2010) — No matter how you slice it, watermelon has a lot going for it -- sweet, low calorie, high fiber, nutrient rich -- and now, there's more. Evidence from a pilot study led by food scientists at The Florida State University suggests that watermelon can be an effective natural weapon against prehypertension, a precursor to cardiovascular disease.

It is the first investigation of its kind in humans. FSU Assistant Professor Arturo Figueroa and Professor Bahram H. Arjmandi found that when six grams of the amino acid L-citrulline/L-arginine from watermelon extract was administered daily for six weeks, there was improved arterial function and consequently lowered aortic blood pressure in all nine of their prehypertensive subjects (four men and five postmenopausal women, ages 51-57).

"We are the first to document improved aortic hemodynamics in prehypertensive but otherwise healthy middle-aged men and women receiving therapeutic doses of watermelon," Figueroa said. "These findings suggest that this 'functional food' has a vasodilatory effect, and one that may prevent prehypertension from progressing to full-blown hypertension, a major risk factor for heart attacks and strokes.

"Given the encouraging evidence generated by this preliminary study, we hope to continue the research and include a much larger group of participants in the next round," he said.

Why watermelon?

"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 essential to the regulation of vascular tone and healthy blood pressure," Figueroa said.

Once in the body, the L-citrulline is converted into L-arginine. Simply consuming L-arginine as a dietary supplement isn't an option for many hypertensive adults, said Figueroa, because it can cause nausea, gastrointestinal tract discomfort, and diarrhea.

In contrast, watermelon is well tolerated. Participants in the Florida State pilot study reported no adverse effects. And, in addition to the vascular benefits of citrulline, watermelon provides abundant vitamin A, B6, C, fiber, potassium and lycopene, a powerful antioxidant. Watermelon may even help to reduce serum glucose levels, according to Arjmandi.

"Cardiovascular disease (CVD) continues to be the leading cause of death in the United States," Arjmandi said. "Generally, Americans have been more concerned about their blood cholesterol levels and dietary cholesterol intakes rather than their overall cardiovascular health risk factors leading to CVD, such as obesity and vascular dysfunction characterized by arterial stiffening and thickness -- issues that functional foods such as watermelon can help to mitigate.

"By functional foods," said Arjmandi, "we mean those foods scientifically shown to have health-promoting or disease-preventing properties, above and beyond the other intrinsically healthy nutrients they also supply."

Figueroa said oral L-citrulline supplementation might allow a reduced dosage of antihypertensive drugs necessary to control blood pressure.

"Even better, it may prevent the progression from prehypertension to hypertension in the first place," he said.

While watermelon or watermelon extract is the best natural source for L-citrulline, it is also available in the synthetic form in pills, which Figueroa used in a previous study of younger, male subjects. That investigation showed that four weeks of L-citrulline slowed or weakened the increase in aortic blood pressure in response to cold exposure. It was an important finding, said Figueroa, since there is a greater occurrence of myocardial infarction associated with hypertension during the cold winter months.

"Individuals with increased blood pressure and arterial stiffness -- especially those who are older and those with chronic diseases such as type 2 diabetes -- would benefit from L-citrulline in either the synthetic or natural (watermelon) form," Figueroa said. "The optimal dose appears to be four to six grams a day."

Approximately 60 percent of U.S. adults are prehypertensive or hypertensive. Prehypertension is characterized by systolic blood pressure readings of 120-139 millimeters of mercury (mm Hg) over diastolic pressure of 80-89 mm Hg. "Systolic" refers to the blood pressure when the heart is contracting. "Diastolic" reflects the blood pressure when the heart is in a period of relaxation and expansion.

Findings from Figueroa's latest pilot study at Florida State are described in the American Journal of Hypertension. A copy of the paper ("Effects of Watermelon Supplementation on Aortic Blood Pressure and Wave Reflection in Individuals With Prehypertension: A Pilot Study") can be accessed online.

The paper's lead author, Figueroa holds a medical degree, a doctoral degree in physiological sciences, and a master's degree in sports medicine. He has been a faculty member in the Florida State University Department of Nutrition, Food and Exercise Sciences since 2004. Figueroa's coauthor and colleague Arjmandi serves as chairman of the department, which is a part of Florida State's interdisciplinary College of Human Sciences. Arjmandi also is the author or coauthor of an extensive body of published research on the health benefits of prunes and other functional foods.

Coauthors of the Figueroa-Arjmandi paper in the American Journal of Hypertension are Marcos A. Sanchez-Gonzalez, a Florida State doctoral student in exercise physiology, and Penelope Perkins-Veazie, a horticulture professor at North Carolina State University.

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Journal Reference:

Arturo Figueroa, Marcos A. Sanchez-Gonzalez, Penelope M. Perkins-Veazie, Bahram H. Arjmandi. Effects of Watermelon Supplementation on Aortic Blood Pressure and Wave Reflection in Individuals With Prehypertension: A Pilot Study. American Journal of Hypertension, 2010; DOI: 10.1038/ajh.2010.142

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African-Americans with high blood pressure need treatment sooner, more aggressively, experts urge

ScienceDaily (Oct. 4, 2010) — According to a consensus statement by the International Society on Hypertension in Blacks (ISHIB), high blood pressure in African-Americans is such a serious health problem that treatment should start sooner and be more aggressive. The ISHIB statement is published in Hypertension: Journal of the American Heart Association.

Complications related to high blood pressure such as stroke, heart failure and kidney damage occur much more frequently in African-Americans compared with whites.

"Evidence from several recently completed studies converged to convince our committee that we were waiting a little bit too long to start treating hypertension in African-Americans," said John M. Flack, M.D., M.P.H., lead author and chairman of the Department of Internal Medicine at Wayne State University in Detroit.

The update to the ISHIB's 2003 consensus statement makes two major recommendations: First, the thresholds at which African-American patients begin treatment should be lowered. Second, doctors should move quickly from single-drug therapy to multi-drug therapy to keep a patient's blood pressure comfortably below the thresholds.

"We believe that these recommendations will lead to better blood pressure control, and a better outlook for African-Americans with high blood pressure," Flack said.

Blood pressure is reported as two numbers, measured in millimeters of mercury (mm Hg). The top number represents the pressure in the arteries when the heart beats and the lower number reflects the pressure when the heart relaxes between beats.

Blood pressure below 120/80 is considered normal for healthy U.S. adults. However, the ISHIB proposes that doctors recommend lifestyle changes to lower blood pressure in otherwise healthy African-Americans with blood pressure at or above 115/75. Those changes include reduced dietary sodium (salt) and increased potassium from eating more fruits and vegetables, as well as losing weight if necessary, getting regular aerobic exercise and drinking in moderation, Flack said.

"Epidemiological data shows that 115/75 is the critical blood pressure number for adults, and every time that figure goes up by 20/10 the risk of cardiovascular disease essentially doubles. We think it makes perfect sense to start lifestyle changes at that lower threshold," he said. "The natural history of blood pressure is that it continues to go up as a person ages. In fact, from the age of 50 and onward, Americans have a 90 percent chance of developing hypertension."

Doctors currently begin drug therapy to reduce blood pressure in patients without a history of cardiovascular disease, diabetes or high blood pressure-related organ-damage when blood pressure is at or above 140/90. This is referred to as primary prevention. The ISHIB recommends tightening the primary prevention threshold to 135/85 for African-Americans.

In addition, the ISHIB recommends starting treatment earlier for African-Americans who have cardiovascular disease, diabetes, kidney disease or damage to target organs (the heart, brain, kidneys). This treatment, known as secondary prevention, should start when blood pressure is at or above 130/80, according to the ISHIB statement.

The ISHIB also recommends that doctors move swiftly from single-drug therapy to multi-drug therapy if one agent doesn't lower the pressure.

"The majority of patients of any race, and certainly African-Americans, are going to need more than one drug to be consistently controlled below their goal," Flack said. "The debate in the medical community over which single drug is best overwhelms the most pressing question: Which drugs work best together?"

Based on a review of recently completed studies, the ISHIB document provides doctors with step-by-step guidance on the best second, third and fourth drugs to add based on individual patient characteristics. The ISHIB statement provides charts with alternate multi-drug combinations so physicians have several options for keeping patients' blood pressure under targets, Flack said.

Flack stressed that the ISHIB tried whenever possible to suggest cheaper generic drugs to keep cost from becoming a treatment barrier.

"These guidelines raise the question for addressing issues surrounding treatment strategies and goals for African-Americans with hypertension," said Sidney C. Smith Jr., M.D., an American Heart Association spokesman and professor of medicine at the University of North Carolina School of Medicine in Chapel Hill, N.C. "Studies continue to accumulate that address ethnic, age and gender differences, as well as optimal therapies."

A major comprehensive statement regarding hypertension is expected to be published by the National Institutes of Health (NIH) by late 2011, Smith said.

The American Heart Association participates as a member organization in the NIH Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines.

Co-authors of the ISHIB statement are: Domenic A. Sica, M.D.; George Bakris, M.D.; Angela L. Brown, M.D.; Keith C. Ferdinand, M.D.; Richard H. Grimm, Jr., M.D., Ph.D.; W. Dallas Hall, M.D.; Wendell E. Jones, M.D.; David S. Kountz, M.D.; Janice P. Lea, M.D.; Samar Nasser, P.A.-C., M.P.H.; Shawna D. Nesbitt, M.D.; Elijah Saunders, M.D.; Margaret Scisney-Matlock, R.N., Ph.D. and Kenneth A. Jamerson, M.D. Individual author disclosures are on the manuscript.

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Medication adherence improves blood pressure control in chronic kidney disease

ScienceDaily (Nov. 3, 2010) — Researchers at the University of Cincinnati (UC) and the Cincinnati Veterans Affairs (VA) Medical Center have found that about one-third of chronic kidney disease patients who are prescribed therapies for high blood pressure do not often adhere to treatments.

This report was published in the Nov. 2 online edition of the American Journal of Nephrology.

The study, led by researchers at UC and the Cincinnati VA, showed that treatment of hypertension in patients with chronic kidney disease continues to be a challenge in their care and that by simply improving medication adherence, outcomes would improve greatly.

Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body. Ongoing hypertension is often associated with kidney disease.

"Hypertension, or high blood pressure, is probably the most important modifiable risk factor in chronic kidney disease -- a precursor to end-stage renal disease that is associated with increased risk of morbidity and mortality," says Charuhas Thakar, MD, associate professor in the division of nephrology and hypertension at UC and chief of the renal section at the Cincinnati VA. "In chronic conditions, such as hypertension, whether or not a patient takes the correct dosage and amount of their hypertension medication is critical in reaching treatment goals.

"Patterns of medication adherence for these agents and their impact on blood pressure in practice settings were not previously well studied. We wanted to find out if medication adherence could make a difference on outcomes in kidney disease patients."

Using two years worth of data from patients seeking ambulatory care at the VA, researchers examined 7,227 chronic kidney disease patients who received at least one blood pressure medication prescription. Outpatient blood pressure measurements were averaged as high (more than 130/80 mm of Hg) versus normal, based on the national guidelines for hypertension management in kidney disease.

Medication adherence was calculated using medication possession ratio, meaning the actual treatment days divided by the total possible treatment days.

"Good versus poor medication adherence groups were compared for differences in demographic, co-morbid and laboratory variables," says Kristen Schmitt, chief of pharmacy at the Cincinnati VA and the lead author of the study. "Results showed that while 67 percent of patients took their medication properly, a total of 33 percent of patients had poor medication adherence. More importantly, those with poor adherence were 23 percent more likely to have sub-optimal blood pressure control during the entire two-year study period."

"With this data, we hope to develop a multidisciplinary approach to help kidney disease patients adhere to their prescribed blood pressure medications. This will not only improve their clinical outcomes but will also help in reducing costs of care," she continues.

"Although the results represent a large sample of patients, they are derived from a single center," adds Thakar. "Further investigations are needed to accurately assess the impact of medication adherence on cardiovascular and renal outcomes in practice."

This study was funded by a Federal Services Research Grant from the American Society of Health System Pharmacists (ASHP) Foundation.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cincinnati Academic Health Center.

Journal Reference:

Kristen E. Schmitt, Christine F. Edie, Paul Laflam, Loretta A. Simbartl, Charuhas V. Thakar. Adherence to Antihypertensive Agents and Blood Pressure Control in Chronic Kidney Disease. American Journal of Nephrology, 2010; 32 (6): 541 DOI: 10.1159/000321688

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Preventing High Blood Pressure

If you are concerned about your blood pressure getting overly high, you will probably go to your GP to seek advice. Your GP will invariably like you to attempt some lifestyle changes or / and take medication if this does not have an effect. Making lifestyle changes is the first strategy, but it does not always do the trick. It usually does, but just not always.

However, it is vital to strive to reduce your blood pressure, also called hypertension, before you go on medication. Lots of people are of the opinion that once your body relies on medication to reduce its hypertension, you will never be able to get yourself off the tablets. This is what my GP told me. Therefore, if it goes against your personal beliefs to take tablets, now is the time to do something about it.

The first thing to do is stop smoking and if you frequently drink too much alcohol, to cut back on that too, as both actions will have the impact of elevating your blood pressure. Adopting these measures will also have knock-on effects for the rest of your body. You will become fitter in general by not smoking at all and not drinking too much.

The next thing to do is to increase your level of daily activity. Do you take any exercise at all? If not, you will be surprised at how much two thirty-minute sessions of light exercise will help. Walk for thirty minutes in the morning and evening or substitute one walk for thirty minutes gardening or swimming.

Diet is another manner of beating off the hypertension tablets. Salt, or sodium as it is often referred to, is a major cause of hypertension, usually because it encourages water retention. So, cutting back on salt or following a sodium depleted diet can have a major impact on your blood pressure.

Try substituting something else for salt: more pepper, a mixture of some other herbs or simply leave it out altogether. After a few weeks you will not notice, except that everyone else's cooking will taste very heavily over-salted! I did this fairly successfully.

Add more fresh fruit and vegetables to your diet, because that will also reduce your hypertension. Eating less fat and red meat will also help. Stress is a major factor in hypertension, strive to relax a bit more and possibly take up meditation or yoga.

If you are on medication, it is possible that the drugs are increasing your blood pressure. If you think that this might be the case, take your drugs to the physician and ask his opinion. You may be able to substitute some of them. Some of the drugs that can have an undesirable effect are: oral contraceptives, steroids, anti-depressants and cold / flu medicines.

You will notice that lots of these techniques for decreasing your (possible) hypertension are related, so if you are an over-weight, inactive smoker who likes a drink, you can do a lot by remedying that and your pressure will fall and you will be healthier in other ways as well.

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Hypertension Patients Should Pay Attention to Daily Diets

Modern medical research has found out that, during the spring, people are vulnerable to many diseases, such as the fluctuation of blood pressure, headache, dizziness, insomnia and other symptoms. As a result, in addition to taking moderate exercise and medicine, people with hypertension should also pay great attention to daily diet.

First of all, eat more fresh vegetables and fruits.
According to the report, eating more fresh fruits and vegetables can significantly decrease the risk of stroke. Citrus, fruit juice, carrot, celery, cucumber, cabbage and other green leafy vegetables all have a protective effect on cardiovascular, so they can always eat these foods.

Secondly, control the intake of salt.
Too much salt will aggravate the disease. Generally speaking, the patients with hypertension should control the daily intake of salt between 4 to 6 grams. But they should pay attention to increase the intake of potassium at the same time. This is because potassium can protect the cardiac cells. Foods such as amaranth, spinach, tomato, bitter gourd, yam all contain a large number of potassium.

Thirdly, control the intake of cholesterol and fatty acids.
Eat less greasy foods, especially animal fats, and limit the intake of all animal organs (such as heart, liver, kidney), fatty meat, butter, egg yolk and other foods which are rich in cholesterol and fatty acids. They can appropriately take in some plant oil such as peanut oil and corn oil. At the same time, in order to avoid increasing the burden on the kidney, do not take in too much protein.

Fourthly, keep away from smoking and alcohol.
The nicotine in cigarette may stimulate the heart, accelerate the heart rate, thus leading to high blood pressure. What's more, nicotine can also promote the deposition of cholesterol on the vascular wall, which may increase the chance of coronary heart disease and stroke. Drinking a small amount of alcohol can increase the level of high-density lipoprotein in blood, so it can prevent atherosclerosis. While excessive drinking high-degree alcohol not only may accelerate the risk of atherosclerosis, but also has a resistant effect on the antihypertensive medicine.

Fifthly, choose a reasonable and healthy diet.
There are many kinds of foods which have the effect of bringing down the blood pressure, such as chrysanthemum, seaweed, celery, black fungus, and so on. These foods contain plenty of protein, cellulose, glucose, fructose, etc, so they can be taken as the medical food for hypertension and diabetics.

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Hypertension - Can Kill

There are two forms of hypertension, the Primary form, also known as Essential Hypertension, and the Malignant form. Essential hypertension is the type that can be inherited; however there can be other factors involved, such as environmental, vascular, nutritional, and the stresses of daily living. When left untreated essential hypertension can develop into the malignant form. The malignant form of hypertension is due to malfunctioning or diseased kidneys; however there can be other causes.

It is estimated that there can be more than 50 million people suffering from hypertension in the United States. The aging of the population can guarantee that these numbers will be rising steadily. Nearly 25% of whites and 50% of blacks over age 65 have high blood pressure. Many of these people are not aware that they have high blood pressure. If left untreated, these are the people that are seriously at risk for heart attack or stroke.

Normal range for blood pressure is 120mm Hg systolic and 80mm Hg diastolic. There is an allowable 10mm Hg plus (+) or minus (-) from these numbers. Over the age of 60 a systolic somewhat higher is acceptable. A systolic over 140mm Hg is considered a stage 1 high blood pressure.

Having a sustained high blood pressure can lead to heart attack or stroke. The importance of knowing your blood pressure is paramount. Many people have no idea what their pressure is. It is recommended that an individual check their blood pressure on a weekly basis. Many Drug Stores have blood pressure machines so that anyone can check their blood pressure for free. There are also very sophisticated blood pressure monitors that can be purchased so that the individual can keep track of their own pressure at home.

The easiest of such units is the wrist monitor, with which you can check your pressure in about a minute. With this monitor you can check your pressure, once or more daily if need be. It is also very helpful to keep a log of your daily pressure, taking it in the morning and then again in the evening. If you find a sustained elevation of blood pressure above the normal after 2-3 readings on 3 separate days, you should see your doctor for an evaluation. Showing him/her your log will prove very helpful.

Knowing what your blood pressure is will motivate you in making the necessary changes to correct whatever the causes are. Read more about changes that are absolutely needed in the health hints below.

Health Hints: Correcting high blood pressure must start with correcting your lifestyle. First look to your nutrition. What you eat plays a very significant part in controlling blood pressure. Reducing your salt intake is of prime importance. Try to limit salt to 2-3 grams per day. Do not use the saltshaker and be sure to read the labels on the foods you eat. Frozen meals generally contain more salt than is allowed in your daily requirement. Canned vegetables are also generally high in salt content. Limit your intake of red meats to once weekly. A portion should consist of 3 ounces or about the size of the palm of your hand.

Limit the use of dairy products and cut them out as much as possible. Increase your intake of fruits and vegetables. Try to have at least five or more servings per day. Instead of eating 3 large meals per day, you may find it more satisfying in eating 5 smaller meals during the day. Next, you must look to your weight. Anyone 10 to 20 lbs or more over- weight must make every effort to lose that weight. Losing this weight can significantly impact your blood pressure, and very possibly return it to a normal level.

Anyone who drinks alcohol must reduce his or her alcohol intake. Men should have no more than two drinks per day. Women should have no more than one drink per day. If you smoke, you must stop by any means possible. There are nutritional supplements that may prove helpful as well. Garlic has been shown to be helpful in reducing blood pressure. Calcium and magnesium supplementation can be of value. Flaxseed oil and Coenzyme Q10 are other supplements that can be of great value. Flax Seed used two to three times daily can be added to cereal, shakes, etc. Flax seed contains alpha-linolenic acid, which is an essential fatty acid that is necessary for blood pressure regulation. Flax seed also contains lignans, which are compounds with antioxidant-like properties. PLEASE NOTE: you should discuss with your healthcare provider before using any of the above supplements, or making changes in your diet.

Next and most important, is starting an exercise program. That too should be discussed with your healthcare provider. Being a "couch potato" is the most detrimental thing that impacts all facets of your life. Find an exercise program that suits your lifestyle, one that you can dedicate yourself too. Being happy and at ease with the program is extremely important, because the average individual who starts an exercise program will give up sometime within 3 months. If you can remain with the program for over 3 months, chances are, you will stick with the program. This can change your entire lifestyle, keeping you vigorous and vital throughout your senior years.

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High Blood Pressure Remedies - What You Can Do Without Using Drugs

According to the American Heart Association there are high blood pressure remedies that don't call for drugs that most of the 50 million Americans who have this condition can benefit from. In fact the AMA says that medication is only useful when diet, exercise and changes in lifestyle fail to work. So what are these drug free remedies and why aren't more people using them?

To answer the last part of the question first, our American medical professionals turn to pharmaceuticals first as a matter of routine. That's the way they are trained and that's the most efficient use of the 15 minutes that they typically can allow for each doctor's visit. This is not to say that they don't care, it's just the way our health care system has evolved.

The net result is that treatment for high blood pressure usually involves testing different types of drugs and different doses until a combination is reached that effectively manages blood pressure. The problem of course is the discomfort and unnecessary over dosing that can result from this practice of mixing and matching. People trust their doctors so they accept this practice.

But how much do you know about blood pressure remedies that don't require drugs?

There are no definitive causes for hypertension but there are almost always the same lifestyles that lead up to it. Common characteristics in people with elevated pressure include obesity typically caused by a sedentary lifestyle and a diet high in fats and low in nutrition. Stress is the second common characteristic and with over half of Americans suffering from some form of sleep deprivation that's understandable.

The three things that are common to bringing on HBP, lack of exercise, poor diet and stress are the three things that can just as easily reverse and even cure the condition.

But this is where it can get really complicated and requires more effort than some people are willing to exert.

Exercise

This is an easy one. Exercise is the fastest way to lower blood pressure period. Forty minutes of light aerobic exercises like walking or riding a bike will lower pressure immediately after the exercise ends and keeps it down for approximately 24 hours.

Exercise strengthens the heart muscle making it a more efficient pump, trains the blood vessels to expand during the systolic beat, burns off excess adrenalin and other stress related chemicals and of course over time burns off extra pounds reducing the risk of obesity.

Diet

Thanks to the food processing and packaging industry, and restaurants that are more interested in making a buck than nutrition, eating a healthy diet has become almost impossible. Additives like sodium and high fructose corn syrup (HFCS) are found in all types of processed and packaged foods even the so called reduced fat and low fat varieties.

The only way you can insure you get the nutrition you need is to eat fresh food. The vitamins, minerals and antioxidants that are needed to counter hypertension are most abundant in fresh fruits, vegetables and certain fish. Eating right requires extensive planning. See the AMA's DASH diet for a list of foods that are truly heart healthy.

Stress

In today's uncertain economic environment there's enough stress to go around for everyone and it affects more than just our blood pressure. Stress can be managed in part by diet or rather by avoiding certain foods and drinks in our diet, As mentioned above, exercise burns off the affects of stress and you may want to consider exercising in the evening after a day of building up stress rather than in the morning.

In order for these blood pressure remedies to work you have to have a plan and you have to stick to it. The good news is even if you do just a little bit to improve your lifestyle and diet it will have an incremental impact on your pressure. If you use a home blood pressure monitor (which you absolutely should) you'll be able to get instant feedback on how your efforts are doing.

Home remedies for hypertension do work...it simply takes a commitment to stick to the plan.?

What are you doing to treat your high blood pressure? How is it working for you? Wouldn't it be great to wake up one morning and have the whole problem in your past?

Well it doesn't happen overnight and it doesn't happen at all until you take charge of your health. If you want help with that then you need a plan that charts out exactly what you need to do. Do yourself and your family and at least take a look at this incredibly helpful tool now. Click here.

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Choosing the Right Blood Pressure Measuring Tool

If you want to check your blood pressure at home, you will need a blood pressure monitor. These monitors are not of necessity very expensive and are within the budget of most households. There are in essence two kinds of home monitor: aneroid and digital.

The aneroid monitor has a dial-type gauge and you read off your blood pressure figures from that. It also has a cuff, which you wrap around your arm and which you inflate with a rubber bulb. The digital monitors also use a cuff, but it can be manually or automatically blown up. The results are read from a small screen. The choice is yours, but most people prefer the automatic digital device.

An aneroid home monitor is portable and necessitates neither batteries nor electricity so is somewhat cheaper than the digital version. It also has a stethoscope built into the cuff for simple monitoring. A problem could arise in raucous surroundings or if the user is hard of hearing. Someone with arthritic hands or fingers may have problems squeezing the bulb as well.

Digital monitors are dearer, yet they are more popular too despite that, because they can be completely automatic. The screen is also easier to read and some units come with a small printer to produce a physical record of your readings. Other digital home monitors have a memory.

The one I use has three memories of thirty slots each so that you can compare records for a month. Having three memories means that you can monitor and record readings for three separate people or three distinct time slots for one person over the period of a month. If you go for three time slots they could be morning, noon and night, as blood pressures vary during the day.

Whichever sort of monitor you opt for, make certain that the cuff is the correct size for you. Be especially careful if you have very substantial or very thin arms. Check the age range for the device as well. Mine says for use only on individuals more than 18 years, but does not say why.

If electricity or batteries is ever likely to be a a problem, then the automatic digital home monitor may not be for you, although you might be able to fix it up to photovoltaic cells and exploit the sun's rays.

Neither of these devices are difficult to use, when you know how, so make certain that the instruction book does not seem as if it was translated by machine. It is of course very important to know how to take accurate readings and how to interpret them. In order to check the accuracy of your machine it is worth taking it with on your next visit to your medical doctor.

You can check your readings against those of his sphygmomanometer, which is considered the gold standard of blood monitoring devices. Your GP will also be able to tell you what your systolic and diastolic pressures ought to be.

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