Tag: high blood pressure

Categories : Cardiovascular DiseaseTags :

Blood Pressure Meds May Lower Heart Risk Even For the Healthy

On By ModernMedia
Red blood cells. CC0 Commons


Blood pressure-lowering medication can prevent serious cardiovascular conditions such as strokes, heart failure and heart attacks even in adults with normal blood pressure, according to new research published in The Lancet.

Importantly, the study found the beneficial effects of treatment were similar regardless of the starting blood pressure level, in both people who had previously had a heart attack or stroke and in those who had never had heart disease.

The authors say that the findings have immediate and important implications for global clinical guidelines that typically limit blood pressure-lowering treatment to individuals with high blood pressure (typically above 140/90 mmHg).

“Our findings are of great importance to the debate concerning blood pressure treatment,” said lead author Professor Kazem Rahimi at the University of Oxford. “This new and best available evidence tells us that decisions to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s blood pressure level. Instead, medication should be viewed as an effective tool for preventing cardiovascular disease in people at increased risk of developing heart disease or stroke. Clinical guidelines should be changed to reflect these findings.”

He cautioned, “We’re not saying that everyone must begin treatment. The decision will depend on an individual’s risk factors for developing cardiovascular disease, the potential for side effects and patient choice.”

In many Western countries as well as developing economies like South Africa, heart disease and stroke, linked to high blood pressure, are among the leading causes of death. Blood pressure medication is widely acknowledged as protecting people with a history of heart attack or stroke from having a recurrence, but there is debate about their use in people with normal or mildly elevated blood pressure.

To date, conflicting findings have come from studies examining whether blood pressure-lowering medication is equally beneficial in people with and without a history of cardiovascular disease, and at lower blood pressures warranting treatment (typically considered 140/90 mmHg or higher). This has led to contradictory treatment recommendations around the world.

For the current analysis, the Blood Pressure Lowering Treatment Triallists’ Collaboration pooled data from 344 716 adults in 48 randomised trials to investigate the effects of blood pressure-lowering medications.

Participants were classified as those with a prior diagnosis of cardiovascular disease (157 728 participants – secondary prevention group) and those without (186,988 – primary prevention group, without cardiovascular disease).

Each group was then divided into seven subgroups based on levels of systolic blood pressure at the start of the study. About 20% (31 239) of participants with prior cardiovascular disease and 8% (14 928) of those who had never had cardiovascular disease had normal or high-normal systolic blood pressure at the start of the trials (systolic blood pressure less than 130 mmHg).

Over an average of four years follow-up, 4324 participants experienced at least one major cardiovascular event (ie. heart attack, stroke, heart failure, or death from cardiovascular disease).

With every 5mmHg reduction in systolic blood pressure, the risk of developing major cardiovascular disease decreased by approximately 10% (18 287 vs 24 037 major cardiovascular disease in the intervention and comparator groups, respectively), stroke by 13% (6005 vs 7767), heart failure by 13% (3249 vs 4584), ischaemic heart disease by 8% (8307 vs 11 145), and  cardiovascular disease mortality by 5% (4 825 vs 6 110).

The beneficial effects of the treatment did not differ based on a history of having had cardiovascular disease or the level of blood pressure at study entry.

“It is important that people are considered for blood pressure-lowering treatment based on their cardiovascular risk, rather than focusing on blood pressure itself as a qualifying factor for or target of treatment,” said co-author Zeinab Bidel from the University of Oxford. “We must provide well-rounded guidelines to lower risks for cardiovascular disease that include exercise, nutrition, smoking cessation, and – where appropriate – medication.”

The study has some limitations, such as only investigating the impact of baseline blood pressure and prior cardiovascular disease on treatment effects, so the findings cannot be generalised to other patient characteristics that have not been included in the analysis.

Additionally, effects on diseases other than major cardiovascular disease, including potential treatment side effects, were not specifically examined.

Source: News-Medical.Net

Journal information: The Blood Pressure Lowering Treatment Trialists’ Collaboration., (2021) Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. The Lancet. doi.org/10.1016/S0140-6736(21)00590-0.

Categories : Cardiovascular DiseaseTags :

Study Upends Preconceptions of Blood Pressure Management

On By ModernMedia

New research could change how doctors treat some patients with hypertension, as they find that low diastolic blood pressure can be benign in blood pressure management.

The study by researchers at NUI Galway, Johns Hopkins University and Harvard Medical School found no evidence that diastolic blood pressure can be harmful to patients when reduced to levels that were previously considered to be too low. High blood pressure, or hypertension, affects a quarter of men and a fifth of women. Blood pressure medications reduce both systolic and diastolic values.

Lead researcher Bill McEvoy, Professor of Preventive Cardiology at NUI Galway and a Consultant Cardiologist at University Hospital Galway, said the findings have the potential to immediately influence the clinical care of patients. The study was published in the prestigious journal Circulation.

“We now have detailed research based on genetics that provides doctors with much-needed clarity on how to treat patients who have a pattern of high systolic values – the top reading for blood pressure – but low values for the diastolic, or bottom, reading,” said Bill McEvoy, Professor of Preventive Cardiology at NUI Galway. “This type of blood pressure pattern is often seen in older adults. Old studies using less reliable research methods suggested that the risk for a heart attack began to increase when diastolic blood pressure was below 70 or above 90. Therefore, it was presumed there was a sweet-spot for the diastolic reading.”

Hypertension is a major contributor to mortality around the world, linked to heart attacks as well as brain, kidney and other diseases. It has also emerged as a risk factor for COVID severity and mortality.

Using new technologies that take into account genetic information that is unbiased, which was not the case with prior observational studies, Professor McEvoy and the international research team analysed genetic and survival data from more than 47 000 patients worldwide.

The researchers found that there is apparently no lower limit of normal for diastolic blood pressure and no evidence in this genetic analysis that diastolic blood pressure can be too low. They also found no genetic evidence of increased risk of heart disease when a patient’s diastolic blood pressure reading is as low as 50. The findings confirmed that values of the top, systolic, blood pressure reading above 120 increased the risk of heart disease and stroke. 

“Because doctors often focus on keeping the bottom blood pressure reading in the 70-90 range, they may have been undertreating some adults with persistently high systolic blood pressure,” Prof McEvoy explained. “The findings of this study free up doctors to treat the systolic value when it is elevated and to not worry about the diastolic blood pressure falling too low.

“My advice now to GPs is to treat their patients with high blood pressure to a systolic level of between 100-130mmHg, where possible and without side effects, and to not worry about the diastolic blood pressure value.” 

Source: News-Medical.Net

Journal information: Arvanitis, M., et al. (2021) Linear and Nonlinear Mendelian Randomization Analyses of the Association Between Diastolic Blood Pressure and Cardiovascular Events. Circulation. doi.org/10.1161/CIRCULATIONAHA.120.049819.

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Inflammatory Foods Raise Cardiovascular Risk

On By ModernMedia

A pair of studies have examined the effect that the dietary inflammatory index has on cardiovascular health, and found that inflammatory foods increase cardiovascular risk.

It is known that inflammatory biomarkers such as interleukins, chemokines and adhesion molecules are associated with atherosclerosis, and proinflammatory foods such as red meats are also associated with cardiovascular risk. The study examined 210 000 participants over 32 years, who filled out a dietary survey every four years, and controlled for variables such as overweight.

“Using an empirically-developed, food-based dietary index to evaluate levels of inflammation associated with dietary intake, we found that dietary patterns with higher inflammatory potential were associated with an increased rate of cardiovascular disease,” said Jun Li, MD, Ph.D., lead author of the study and research scientist in the department of nutrition at Harvard T.H. Chan School of Public Health. “Our study is among the first to link a food-based dietary inflammatory index with long-term risk of cardiovascular disease.”

The other study looked at the beneficial effects of walnuts, which have a strong anti-inflammatory effect. Participants who were assigned to eat 30-60gm of walnuts a day showed significantly reduced inflammation in 6 of 10 biomarkers used.

“The anti-inflammatory effect of long-term consumption of walnuts demonstrated in this study provides novel mechanistic insight for the benefit of walnut consumption on heart disease risk beyond that of cholesterol lowering,” said Montserrant Cofán, Ph.D., lead author of the study and a researcher at the August Pi i Sunyer Biomedical Research Institute in Barcelona, Spain.

Source: Medical Xpress

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Research Suggests Vitamin C Beneficial for Severe COVID

On By ModernMedia

According to Associate Professor Anitra Carr of Otago University in New Zealand, research provides evidence that large doses of Vitamin C is beneficial for severe COVID. A 2019 study previously showed that giving Vitamin C to patients with Acute Respiratory Distress reduced mortality rates.

“A recent study that came out of the US showed that patients with coronavirus in ICU with Covid-19 also had very low vitamin C levels,” Carr said. “That’s because the body chews through a lot more of it when you get an infection – and your requirements increase significantly. But the standard doses given in the intensive care unit aren’t enough to compensate, given a severe case of the disease comes with a huge inflammatory response and oxidative stress.”

 Carr said that delivering the drug intravenously was critical to supplying the high levels of Vitamin C needed. One study from Wuhan, China showed Vitamin C conferred a survival benefit to placebo, though Carr noted that many more studies are needed and will come throughout the next year.

However, besides its normal dietary role, there was little research to show that Vitamin C had much of a preventative role. Carr said, “Some research has shown that, if you’re under enhanced stress, your risk for infection increases, so in those people vitamin C may decrease the risk of getting it. But in the general everyday population, who aren’t under extreme physical stress, it may not decrease your chances of catching the disease.”

Source: NZ Herald