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Wednesday, November 15, 2017

How Do I Lower My Blood Pressure?

As I wrote in my last blog post, the AHA/ACC earlier this week released new guidelines for the management of hypertension (HTN or blood pressure). The biggest change to these guidelines is the new definition of high blood pressure...

  • Now anyone with a blood pressure > 130/80 is classified as having Stage 1 HTN
  • Anyone with a blood pressure > 140/90 is classified as having Stage 2 HTN
The treatment recommendations have also been changed...
  • Stage 1 HTN with increased cardiac risk should be treated medically to BP < 130/80 + adopt aggressive life style modifications known to lower BP
  • Stage 1 HTN with no increased cardiac risk should adopt aggressive life style modifications known to lower BP
  • Stage 2 HTN should be treated medically + adopt aggressive life style modifications known to lower BP
So, what are some of the known life sytle modifications we can adopt that are known to lower BP
  • Eat a low salt diet or specifically follow the DASH Diet 
  • Lose weight 
  • Exercise (30-45min at least 3-5x week)
  • Decrease alcohol intake (no more than 2 glasses/day for men and 1 glass/day for women)
  • Avoid supplements known to raise BP (ephedra, St John's wort)
  • Avoid medications known to raise BP (amphetamines, decongestants, non-steroidal anti-inflammatory drugs/NSAIDs (ibuprofen/Advil and Celebrex), and prednisone
As with any of my recommendations, I suggest you discuss you BP/diet/medications with your physician

Tuesday, November 14, 2017

BREAKING NEWS: Definition of High Blood Pressure Drops

Just yesterday, the American Heart Association and the American College of Cardiology announced new guideline for hypertension. Below is an excellent summary of this new report. Please discuss the following with your doctor. 

By Dennis Thompson

HealthDay Reporter

MONDAY, Nov. 13, 2017 (HealthDay News) -- Nearly half of all adult Americans will be considered to have high blood pressure under new guidelines issued Monday by the nation's top heart health organizations.

The new guidelines lower the diagnostic threshold for stage 1 high blood pressure to 130/80, down from the previous level of 140/90, according to a joint statement from the American Heart Association and the American College of Cardiology.

Further, the guidelines also call for more aggressive treatment of high blood pressure, asking doctors and patients to set 130/80 as the new goal of therapy.

High blood pressure can lead to heart attacks, strokes and heart failure.

But the guidelines also press for more judicious treatment of high blood pressure -- sometimes called hypertension -- and an emphasis on lifestyle risk factors. Prescriptions for blood pressure drugs are not expected to leap under the guidelines, experts said.

The two heart organizations announced the new guidelines Monday at the American Heart Association's annual meeting, in Anaheim, Calif. The guidelines were last revised in 2003.

This change means that 103 million Americans will be considered to have high blood pressure, or about 46 percent of the adult population, said Dr. Paul Whelton. He is chair of the 2017 Hypertension Practice Guidelines and a professor of Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans.

That's a 14 percent increase from the previous guidelines, under which 72.2 million Americans (32 percent of adults) were considered to have high blood pressure.

The latest medical evidence has proven that people with blood pressure in the 130-139 range carry a doubled risk of heart attack, stroke, heart failure and kidney failure, compared to those with lower blood pressure, said Dr. Joaquin Cigarroa, a member of the clinical guidelines task force.

Previously, those people were considered to have prehypertension, but not actual high blood pressure.

"By incorporating the latest science, we recognize the risk is doubled," said Cigarroa, chief of cardiology and clinical chief of the Knight Cardiovascular Institute at Oregon Health & Science University, in Portland. "This now allows 14 percent of our population to understand that's a call to action. We have to empower them with the tools to make a difference."

The impact of the new guidelines is expected to be greatest among younger people. High blood pressure is expected to triple among men under age 45 and double among women under 45, according to the guidelines report.

However, only about 30 percent of people with stage 1 high blood pressure under the guidelines will require drug therapy, Whelton said.

That's because everyone with stage 1 high blood pressure will be evaluated for heart disease. Only those with heart disease or at high risk for developing it during the next decade will be prescribed drugs, the guidelines state.

"We're more specific about who should get treatment," Whelton said. "It's a nice combination of understanding accurately average blood pressure and also understanding underlying risk. We didn't have that in previous guidelines."

The rest of those at risk under the new guidelines will be urged to reduce their blood pressure through lifestyle changes -- losing weight, eating healthful foods, cutting down on salt, increasing potassium-rich foods, exercising regularly and moderating their drinking, said Dr. Bob Carey. He is vice chair of the 2017 Hypertension Practice Guidelines and dean emeritus of the University of Virginia School of Medicine.

The experts estimate "a projected increase in patients with stage 1 hypertension requiring drug therapy of 1.9 percent," Carey said. "This amounts to 4.2 million people, based on the U.S. population."

The new guidelines also stress the importance of using proper technique to measure blood pressure, with a person's level based on an average of two to three readings on at least two different occasions.

Home blood pressure monitoring also will be emphasized to avoid "white-coat hypertension" -- the tendency for some people to have higher blood pressure in a medical setting than they do in everyday life, the report said.

The U.S. government in 2013 asked the AHA and ACC to draft new guidelines for blood pressure management, said ACC President Dr. Mary Walsh. She is medical director of Heart Failure and Cardiac Transplantation at St. Vincent Heart Center of Indiana.

The new guidelines are the product of a 21-member committee, following a three-year review of medical evidence that included more than 900 studies, Whelton said. The studies were reviewed by 52 experts who submitted close to 1,000 questions, and approved by 11 partnering medical organizations.

The new guidelines "take advantage of evidence almost up to the minute, so they are very current," Whelton said.

Blood pressure categories in the new guidelines are:

Normal: Less than 120 systolic pressure (the top number).
Prehypertension: 120 to 129.
Stage 1: Systolic between 130 and139.
Stage 2: Systolic of 140 or higher.
Systolic pressure is the amount of pressure in your arteries during contraction of the heart muscle.

WebMD News from HealthDay


Copyright © 2013-2017 HealthDay. All rights reserved.


Monday, November 13, 2017

Do Statins Raise Odds for Type 2 Diabetes? Maybe, but heart benefits likely outweigh any potential risk from the drugs, experts say

The following is an article recently published on WebMD. Many patients have mentioned to me the reports about statins increasing the risk of developing Type 2 Diabetes. I definitely agree with Drs Crandall and Donovan (see statements in orange below). The benefits of statins in terms of prevention of cardiovascular events outweigh the slight increase risk in HgbA1C/DM.

By Serena Gordon
HealthDay Reporter
TUESDAY, Oct. 24, 2017 (HealthDay News) -- Cholesterol-lowering medications known as statins may lower your risk of heart disease, but also might boost the odds you'll develop type 2 diabetes, new research suggests.
"In a group of people at high risk of type 2 diabetesstatins do seem to increase the risk of developing diabetes by about 30 percent," said the study's lead author, Dr. Jill Crandall. She's a professor of medicine and director of the diabetes clinical trials unit at Albert Einstein College of Medicine in New York City.
But, she added, that doesn't mean anyone should give up on statins.
"The benefits of statins in terms of cardiovascular risk are so strong and so well established that our recommendation isn't that people should stop taking statins, but people should be monitored for the development of diabetes while on a statin," she explained.
At least one other diabetes expert agreed that statins are still beneficial for those at risk of heart trouble.
Dr. Daniel Donovan Jr. is professor of medicine and director of clinical research at the Icahn School of Medicine at Mount Sinai Diabetes, Obesity and Metabolism Institute in New York City.
"We still need to give statins when LDL (bad) cholesterol isn't under control. A statin intervention can lower the risk of a cardiovascular event by 40 percent, and it's possible the diabetes may have been destined to happen," he said.
The new study is an analysis of data collected from another ongoing study. More than 3,200 adults were recruited from 27 diabetes centers across the United States for the study.
The research goal was to prevent the progression of type 2 diabetes in people with a high risk of the disease, Crandall said. All of the study participants were overweight or obese. They also all showed signs that they weren't metabolizing sugar properly at the start of the study, but not poorly enough to be diagnosed with type 2 diabetes.
Study volunteers were randomly chosen to get treatment with lifestyle changes that would lead to modest weight loss, the drug metformin or a placebo pill.
At the end of the intervention, they were asked to participate in the 10-year follow-up program. They had their blood sugar levels measured twice a year, and their statin use was tracked, too.
At the start of the follow-up period, 4 percent of participants were taking statins. At the end, about one-third were.
Simvastatin (Zocor) and atorvastatin (Lipitor) were the most commonly used statins.
The study was an observational study, so it couldn't show a cause and effect relationship.
However, Crandall said the researchers measured levels of insulin secretion and insulin resistance. Insulin is a hormone that helps the body usher the sugar from foods into the body's cells to be used as fuel.
Crandall said insulin secretion goes down when people take statins. Less insulin would lead to higher blood sugar levels. She said there was no indication that statins affected insulin resistance.
Donovan added that the study provides important information. "But I don't think the message is stop statins," he said. "Most people are probably developing heart disease before diabetes, and it's important to treat the risk factors you can."
Though they weren't included in this study, people who already have type 2 diabetes should be closely monitored for increases in blood sugar when they start taking a statin, Crandall said. "The evidence so far is rather limited, but there have certainly been anecdotal reports of blood sugar being higher when someone starts statins," she said.
She also suggested that blood sugar levels likely aren't as much of a concern for those without diabetes or risk factors for diabetes when starting a statin. Besides excess weight, those risks include older age, high blood pressure and a family history of diabetes.
Crandall added that there are many people 50 and over with prediabetes who don't know it, so it could be an issue for them.
Findings from the study were published online Oct. 23 in BMJ Open Diabetes Research & Care.

WebMD News from HealthDay


WebMD: Does Sex Really Trigger Cardiac Arrest?

Does Sex Really Trigger Cardiac Arrest?

By Dennis Thompson
HealthDay Reporter
SUNDAY, Nov. 12, 2017 (HealthDay News) -- It's a common Hollywood trope -- an older guy is having enthusiastic sex with a gal half his age when he suddenly flops over dead.
But in real life, sexual activity very rarely causes cardiac arrest, a new study reassuringly reports.
Sex was linked to only 34 out of more than 4,500 cardiac arrests that occurred in the Portland, Ore., metropolitan area between 2002 and 2015. That's a rate of just 0.7 percent, the researchers noted.
Of those cases, 18 occurred during sex and 15 immediately after sex. Time couldn't be determined for the last case.
"I'm a little surprised at the really tiny number," said study senior researcher Dr. Sumeet Chugh, medical director of the Heart Rhythm Center at Cedars-Sinai Medical Center in Los Angeles. "But mostly I feel it's reassuring data."
The news is most welcome for patients with heart problems who aren't sure if sex could be dangerous, Chugh said.
"Previously we would say the risk is probably low, but we don't know how low," Chugh noted. "Now we have data and we can say to them the risk is very low."
The new findings are part of a 16-year study of heart risk factors involving about a million people living in and around Portland.
"Sexual activity is just one variable in the whole big picture" of cardiac risks, but one that hasn't been studied in depth, Chugh added.
Men are more likely than women to have their heart stop as a result of sex. Just two of the 34 cardiac arrest patients were female, the findings showed.
But overall, sex was linked to only 1 percent of all cardiac arrests that occurred in men.
Other heart experts said they weren't surprised by the results.
Sex just isn't as strenuous as people believe. The aerobic activity associated with sex is equivalent to climbing two flights of stairs, explained Dr. Nieca Goldberg. She is director of the NYU Center for Women's Health and an AHA spokeswoman.
Dr. Martha Gulati, chief of cardiology for the University of Arizona College of Medicine, said, "Although a lot of us think sex requires an intense level of activity, even in the most extreme situations it's not as intense as people imagine it."


NYTimes: The Growing Toll of Our Ever-Expanding Waistlines

The Growing Toll of Our Ever-Expanding Waistlines

Paul Rogers 
I hope you’re not chomping on a bagel or, worse, a doughnut while you read about what is probably the most serious public health irony of the last half century in this country: As one major killer — smoking — declined, another rose precipitously to take its place: obesity.
Many cancer deaths were averted after millions quit lighting up, but they are now rising because even greater numbers are unable to keep their waistlines in check.
Today, obesity and smoking remain the two leading causes of preventable deaths in this country.
Reviewing more than 1,000 studies, the International Agency for Research on Cancer and the Centers for Disease Control and Prevention linked the risk of developing 13 kinds of cancer to overweight and obesity, especially cancers that are now being diagnosed in increasing numbers among younger people.
Included are cancers of the esophagus, liver, gallbladder, colon and rectum, upper stomach, pancreas, uterus, ovary, kidney and thyroid; breast cancer in postmenopausal women; meningioma and multiple myeloma. Only for colorectal cancers has the overall incidence declined, primarily the result of increased screening and removal of precancerous polyps.
In most cases, the studies revealed, cancer risk rose in direct proportion to the degree of excess weight. In other words, the heavier you are, the more likely you will be to develop one of these often fatal cancers.
From 2005 to 2014, the C.D.C. reported in October, there was a 1.4 percent annualincrease in cancers related to overweight and obesity among people aged 20 to 49, and a 0.4 percent rise in these cancers among people 50 to 64.
“Nearly half of all cancers in people younger than 65 were associated with overweight and obesity,” C.D.C. experts reported in JAMA. And they predicted that given the current “high prevalence of overweight and obesity among adults, children and adolescents,” going forward there will be additional increases in weight-related cancers and cancer deaths among Americans.
The experts called upon clinicians who treat children and adults to do their due diligence and spend more time assessing body mass index (B.M.I.) and counseling patients about how to avoid or reduce excess weight. The payoff in terms of health, life and dollar savings would likely far outweigh the costs of society-wide professional and public health measures to curb America’s expanding waistlines.
Of course, it is not just cases and deaths from cancer that such an effort could prevent. Overweight, and especially obesity, are major risk factors for Type 2 diabetes, heart disease and stroke, high blood pressure, osteoarthritis, gout, gallbladder disease, and respiratory disorders like sleep apnea and asthma.
However, even when the costs of weight assessments and counseling are fully covered by insurance, it seems they are rarely done. In November 2011, the Obama administration offered free weight-loss counseling to obese seniors on Medicare, with no co-payment or deductible for those with Medicare Part B insurance. The benefit, which is still available, applied to the approximately 30 percent of Medicare beneficiaries with a B.M.I. of 30 or more.
Yet in the first three years, only about 120,000 seniors, representing less than 1 percent of those on Medicare, took advantage of this benefit, a result weight-loss specialists have called “very disappointing” and “a huge lost opportunity.”
The free coverage includes weekly counseling for the first month, a session every other week for months two through six, then monthly sessions for another six months for those who lose at least 6.6 pounds by the sixth month. Participants who fail to hit the six-month target can get a second chance six months later, with no limit to how many times they can take advantage of this benefit if their B.M.I. is still 30 or higher.
To be sure, many of those with serious weight problems have probably tried and failed to lose weight and keep it off, leading them to think there’s little hope that yet another effort will bring success. But it is worth noting that for most people who managed to quit smoking, it typically took anywhere from eight to 30 attempts.
The fault with weight-loss failures may lie almost as much with health care practitioners as with their patients. Many primary care doctors have little to no training in how to counsel patients who need to lose weight. Some have told me that they are afraid patients won’t come back if they focus on a need to lose weight. And patients are often turned off by what they perceive to be their health care providers’ negative attitudes toward people with weight problems.
An online survey by researchers at Yale University’s Rudd Center for Food Policy and Obesity revealed that people considered terms like “obese,” “fat” and “morbidly obese” to be stigmatizing and blaming language used by doctors. Nearly one participant in five said they would avoid future medical appointments, and 21 percent said they would seek a new doctor, if they felt stigmatized about their weight.
The Medicare opportunity notwithstanding, there is a growing need to tackle weight issues much earlier in life. Researchers at the Harvard School of Public Health reported in JAMA in July that 23 percent of women and 13 percent of men gained 44 pounds or more between the ages of 18 and 55. And Dr. William H. Dietz of the C.D.C., who noted in an accompanying editorial that “obesity-related cancers in both men and women were associated with moderate weight gain during adulthood,” added that “efforts to prevent and control obesity in young adults should be accorded a high priority.”
Dr. Dietz also pointed to a doubling in the prevalence of obesity between the childhood ages of 6 to 11, now at 17 percent, and young adulthood ages of 20 to 29, now at 34 percent.
Why are so many young Americans seriously overweight? The prevalence of high-calorie snacks and fast foods and cutbacks in physical activity both within and outside of school are not the only reasons. The problem can start as soon as babies are weaned and able to eat solid foods. Too often parents and caretakers, in the interest of keeping youngsters subdued, ply them with snacks all day long, creating in some a lifelong oral drive linking comfort and food.
And, for too many, I’m afraid, an increased risk of developing and dying from cancer.