Checking blood pressure at home pays off

Posted July 03, 2013, 2:57 pm

Do-it-yourselfers, take heart. Here’s something else to do at home that can have a substantial benefit on your health: measure your blood pressure. It’s easy, inexpensive, and helps control blood pressure better than visits to the doctor.

The latest evidence for the benefits of home blood pressure monitoring comes from researchers in Minnesota. They studied 450 people with hypertension, more commonly known as high blood pressure. All had blood pressures higher than deemed healthy—above 140/90, or above 130/80mmHg if they had diabetes or kidney disease.

About half of the volunteers were given home blood pressure monitors capable of electronically sending readings to a secure website. After being shown how to use their monitors, the volunteers were asked to send six readings each week. That information was assessed by pharmacists, who could adjust medications if needed and offer advice on lifestyle changes that could improve blood pressure. The other volunteers received usual care from their primary care providers.

At every step of the way, people in the home monitoring group had more success getting their blood pressure under control than people who had received only usual care. At the end of the trial, 72% of those doing home monitoring had their blood pressure under control, compared to 57% of the usual care group. The benefits persisted six months after the program had ended.

The results, published today in JAMA, are similar to the findings of previous studies on home blood pressure monitoring. But, according to the researchers, this is the first time people with both uncontrolled blood pressure and other conditions (such as diabetes) have been studied in such a program, and the first time results were measured after the formal monitoring program had ended.

“More frequent blood pressure monitoring allows more opportunities to detect blood pressure that is higher than the desired range. That may trigger more intensive treatment of elevated blood pressure,” says cardiologist Dr. Deepak Bhatt, a professor at Harvard Medical School. In other words, if you stay on top of it, you’ll do a better job of treating it.

An editorial accompanying the report said that the study “demonstrates how to improve blood pressure control by making hypertension management more like modern banking: accessible, easy, and convenient.”

The Centers for Disease Control and Prevention reports that 1 in 3 adults in the United States has high blood pressure, and half of them don’t have it under control. High blood pressure increases the risk for heart disease and stroke, the leading causes of death in the United States.

Even though the American Heart Association and other organizations have called for greater use of home blood pressure monitoring, it isn’t yet widespread. One reason is that insurance coverage for such programs still lags. Another is that full-fledged efforts like the one in Minnesota could cost $1,350 per person.

But you don’t need a special program. You can buy a good home blood pressure monitor at a pharmacy or online merchant for anywhere from $50 to $100. (Ask if your insurance company will cover the cost.) A few things to look for:

an automatic monitor that doesn’t require a stethoscope (it’s easier to use)a monitor that takes the blood pressure reading using a cuff that fits around the upper arm;a read-out large enough for you to see the numbers;a seal from an organization such as the British Hypertension Society, International Protocol for the Validation of Automated BP Measuring Devices, or Association for the Advancement of Medical Instrumentation (AAMI).

Ask your doctor, nurse, or pharmacist for help calibrating your monitor and learning how to use it.

How often should you check? At first, take your blood pressure twice a day for a week. The best times are early in the morning (before you have taken any blood pressure medications) and again in the evening. After you’ve done this for a week, once or twice a month—or whatever your doctor recommends—is fine.

“It can be a very effective way to see if blood pressure medications are doing the trick. It can also be useful to monitor for the side effect of blood pressure that is too low. Just remember that home monitoring should not be used as a substitute for regular physician check-ups, especially for patients with poorly controlled blood pressure,” says Dr. Bhatt.

Check out the video below to see the right, and wrong, ways to check blood pressure at home. And you can see more tips here.

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Pharmacist-Guided Home Blood Pressure Monitoring May Help Patients

Study found combination led to better control of hypertension

By Serena Gordon

HealthDay Reporter

TUESDAY, July 2 (HealthDay News) -- Using home blood pressure monitoring and partnering with a pharmacist for lifestyle advice and medication changes led to better control of hypertension, a new study shows.

After six months of the intervention, nearly 72 percent of the study volunteers had their high blood pressure under control compared to 45 percent in the group that received usual care. Also, the effects of the intervention persisted even after the intervention ended. Six months later, about 72 percent of the intervention group had their high blood pressure under control compared to 57 percent in the usual care group.

"The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together -- home monitoring and pharmacist managements -- and this is one system that we've shown works very well for blood pressure control," said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.

The findings appear in the July 3 issue of the Journal of the American Medical Association.

High blood pressure affects about 30 percent of U.S. adults, according to background information in the study. Treating and controlling high blood pressure can help prevent cardiovascular events, such as heart attacks. However, only about half of the adults in the United States with high blood pressure have it under control.

Home blood pressure monitoring has shown some success in helping people lower their blood pressure, so the researchers took that a step further and used telemonitoring devices that could send blood pressure readings to a pharmacist who could then adjust that person's blood pressure medication accordingly.

The study included 450 people receiving care at one of eight different clinics. All of the people recruited for the study had high blood pressure that wasn't well controlled.

The patients were randomized to receive either usual care (222 people) or the study intervention, which included blood pressure telemonitoring with pharmacist management.

In the study intervention group, each person received a home blood pressure monitor capable of sending readings to a secure website that a pharmacist monitored. At the start of the study, patients met with the pharmacist for an hour and were taught how to use the machines. They were also given lifestyle advice on lowering their blood pressure.

People in the study intervention group were asked to send at least six blood pressure readings from different times of the day to the pharmacist each week. During the first six months of the study, patients and pharmacists talked by phone every two weeks, until blood pressure was under control for at least six weeks, and then they talked monthly. During months seven to 12 of the study, the calls were reduced to every two months. During the calls, pharmacists reviewed lifestyle changes and emphasized adherence to medications.

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Cellphone Calls During Blood Pressure Readings May Skew Results

Interruption can cause spike in systolic pressure, study found

By Alan Mozes

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- New Italian research offers some cautionary advice for patients with high blood pressure: The next time you take a blood pressure reading, turn off your cellphone.

The reason: Answering a cellphone call during a reading may cause a temporary but significant spike in blood pressure, rendering the results inaccurate and misleading.

"The cellular phone has burst into our everyday life, and is often an indispensable communication tool for business and social relations," said study author Dr. Giuseppe Crippa, head of the hypertension unit at Guglielmo da Saliceto Hospital in Piacenza, Italy. "[Now] we know that the radio-frequency field generated by mobile phones does not affect blood pressure, and should not increase blood pressure in subjects suffering from hypertension.

"But what is the effect of the noise generated by the phone ringing and of the intrusion into our life of an unscheduled phone conversation?" Crippa asked. "In our study, we have shown that blood pressure, particularly systolic blood pressure, increases quickly and significantly in this situation."

The study authors said one in three Americans (and 1 billion people worldwide) currently struggles with high blood pressure.

Those grappling with keeping their high blood pressure under control often are instructed to either come in for routine readings taken by a health care professional, or to use one of many at-home monitoring kits that give patients the option of taking their own readings on a regular basis.

To explore the question of how cellphones might affect such readings, the authors focused on 49 Italian women with an average age of 53, all of whom were taking medication to control high blood pressure.

After discussing their general cellphone usage habits, all underwent two sets of multiple blood pressure readings, each set registering six readings at one-minute intervals. All the readings took place in a physician's office, where patients were left alone (in what the researchers described as a "comfortable" setting) after the first reading.

During one of the two readings, an investigator disabled caller ID and anonymously called each patient's cellphone three times, with a patient's response to at least one of the calls being deemed sufficient for testing purposes.

The result: By comparing readings taken with and without incoming calls, the team found that patients' systolic numbers (the top figure in a blood pressure reading, indicating blood pressure as the heart contracts) went up "significantly" whenever the patients answered their phones.

Patients who had indicated relatively heavy routine cellphone usage (30 or more calls per day), however, experienced a less steep rise in their systolic numbers during incoming calls. Since heavy users tended to be younger, the team theorized that a greater cellphone comfort level among younger patients may protect them from the cellphone dynamic.

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Cellphone Calls During Blood Pressure Readings May Skew Results

By Alan Mozes
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- New Italian research offers some cautionary advice for patients with high blood pressure: The next time you take a blood pressure reading, turn off your cellphone.

The reason: Answering a cellphone call during a reading may cause a temporary but significant spike in blood pressure, rendering the results inaccurate and misleading.

"The cellular phone has burst into our everyday life, and is often an indispensable communication tool for business and social relations," said study author Dr. Giuseppe Crippa, head of the hypertension unit at Guglielmo da Saliceto Hospital in Piacenza, Italy. "[Now] we know that the radio-frequency field generated by mobile phones does not affect blood pressure, and should not increase blood pressure in subjects suffering from hypertension.

"But what is the effect of the noise generated by the phone ringing and of the intrusion into our life of an unscheduled phone conversation?" Crippa asked. "In our study, we have shown that blood pressure, particularly systolic blood pressure, increases quickly and significantly in this situation."

The study authors said one in three Americans (and 1 billion people worldwide) currently struggles with high blood pressure.

Those grappling with keeping their high blood pressure under control often are instructed to either come in for routine readings taken by a health care professional, or to use one of many at-home monitoring kits that give patients the option of taking their own readings on a regular basis.

To explore the question of how cellphones might affect such readings, the authors focused on 49 Italian women with an average age of 53, all of whom were taking medication to control high blood pressure.

After discussing their general cellphone usage habits, all underwent two sets of multiple blood pressure readings, each set registering six readings at one-minute intervals. All the readings took place in a physician's office, where patients were left alone (in what the researchers described as a "comfortable" setting) after the first reading.

During one of the two readings, an investigator disabled caller ID and anonymously called each patient's cellphone three times, with a patient's response to at least one of the calls being deemed sufficient for testing purposes.

The result: By comparing readings taken with and without incoming calls, the team found that patients' systolic numbers (the top figure in a blood pressure reading, indicating blood pressure as the heart contracts) went up "significantly" whenever the patients answered their phones.

Patients who had indicated relatively heavy routine cellphone usage (30 or more calls per day), however, experienced a less steep rise in their systolic numbers during incoming calls. Since heavy users tended to be younger, the team theorized that a greater cellphone comfort level among younger patients may protect them from the cellphone dynamic.

Incoming calls had no impact on patients' diastolic numbers (the bottom figure in a reading, indicating blood pressure while the heart is at rest), nor did patients' overall heart rates shift when the cellphone rang.

The team concluded that patients should be advised to turn off their cellphones whenever and wherever they have a blood pressure reading, to ensure accuracy.

"It is noteworthy that the great majority of the patients recruited for this survey were not used to turning off the mobile phone, even during a medical examination, and easily answered the calls even when an automated device was measuring blood pressure," Crippa said.

"Therefore, we believe that it is important to advise patients that the unnecessary and exaggerated use of cellphones can increase, at least temporarily, their blood pressure," he said.

Dr. Gary Schwartz, a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn., said the issue is not the disturbance of a cellphone call, but rather any disturbance in general.

"I wouldn't look at this study and say cellphones are bad for you," Schwartz said. "But American Heart Association standards call for the need to be quiet, whether you're getting your blood pressure measured at a doctor's office or at home.

"Just engaging in conversation, whether or not it's on the phone, can raise the numbers and give an inaccurate reading," he said. "It's the same principle behind why we don't measure a person's blood pressure while they're playing tennis. What we want is for patients to be quiet and at rest."

Crippa and his colleagues are scheduled to present their findings Wednesday at the American Society of Hypertension annual meeting in San Francisco. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Giuseppe Crippa, M.D., head, hypertension unit, Guglielmo da Saliceto Hospital, Piacenza, Italy; Gary Schwartz, M.D., professor, medicine, Mayo Clinic College of Medicine, Rochester, Minn.; May 15, 2013, presentation, American Society of Hypertension annual meeting, San Francisco

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Yoga May Help Ease High Blood Pressure, Study Finds

Numbers were lowered when people engaged in a few sessions per week

By Robert Preidt

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- People who follow the ancient practice of yoga may be getting an added health boost, with a new study suggesting it can fight high blood pressure -- also known as hypertension.

"This study confirms many people's feelings that exercise may be useful in the control of hypertension," said Dr. Howard Weintraub, a cardiologist and associate professor of medicine at NYU Langone Medical Center in New York City. Weintraub was not connected to the new study.

Based on the new findings, "yoga would be a useful adjunct in the lowering of blood pressure in certain populations," he said.

In the study, researchers led by Dr. Debbie Cohen of the University of Pennsylvania tracked 58 women and men, aged 38 to 62, for six months.

Although the study couldn't prove a cause-and-effect relationship, doing yoga two to three times a week was associated with an average drop in blood pressure readings from 133/80 to 130/77, the researchers said.

In comparison, the average decrease in blood pressure was smaller (134/83 to 132/82) among people who ate a special diet but did not do yoga.

In a bit of a surprise, doing yoga in tandem with a special diet did not outperform doing yoga alone -- blood pressure numbers fell only slightly (135/83 to 134/81) among people who ate a special diet and also did yoga, the researchers said.

The small decline in blood pressure among people who ate a special diet and did yoga may be because doing both required a greater amount of time, making it more difficult for participants to stick with their regimens, the authors said.

Weintraub said the study shows that "yoga can have a favorable effect" on hypertension. Although the amount of change was small, he said, "some large population studies have suggested that changes of this magnitude could have very significant long-term benefits."

The study did have some limitations, including its relatively short length and the fact that most participants were young and had milder forms of high blood pressure, Weintraub said.

Another expert agreed that the ancient Indian practice of yoga might ease hypertension.

"Yoga, along with deep breathing exercises, meditation and inner reflection, is a good adjunctive and integrative cardiovascular approach to better health, including lowering blood pressure, as this data suggests," said Dr. David Friedman, chief of Heart Failure Services at the North Shore-LIJ Plainview Hospital, in Plainview, N.Y.

"In addition to proper diet and aerobic physical fitness most days of the week, I recommend that my patients take time each day for the above measures of finding disciplined inner peace, for improved health and well-being," he said.

The findings were presented Wednesday at the annual scientific meeting of the American Society of Hypertension, in San Francisco. Findings presented at medical meetings typically are considered preliminary until published in a peer-reviewed journal.

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Can I lower my blood pressure without taking medication?

Posted June 28, 2013, 2:00 am

My blood pressure medication has side effects that are difficult to tolerate. What else can I do to lower my BP?

If you’re a regular reader of this column, you’ve heard me say more than once that diet and exercise sometimes can eliminate the need for medications for a variety of conditions. That’s true — and it surely is true for high blood pressure.

However, sometimes diet, exercise and stress management lower blood pressure only part of the way. Medications may still be necessary. Every medicine ever invented can cause side effects in some people. But the other side of that coin is that medicines often do not cause side effects. And just because one medicine causes side effects does not mean that another will.

Fortunately, there are many different medicines to treat high blood pressure. In my experience, you can usually find a blood pressure medication that is both effective and free of side effects. But even when that’s true, it’s still important to get back to basics: a healthy lifestyle.

A healthy lifestyle is the cornerstone for preventing and treating hypertension. It may allow you to lower your medication dose or stop taking medication altogether. At the very least, you’ll feel better:

First and foremost, if you smoke, quit. Your blood pressure will start to decrease within hours after your last cigarette. Your doctor can recommend resources to help you quit.Another important step is to reach and maintain a healthy body weight. Being overweight or obese itself raises your blood pressure.Even if you don’t need to lose weight, eating the right foods can make a difference. The key features of a blood-pressure-friendly diet include plenty of fruits, vegetables and whole grains; several servings daily of low-fat dairy products; some fish, poultry, dried beans, nuts and seeds; and minimal red meat, sweets and sugar-laden beverages. Also try to limit your sodium intake to less than 1.5 grams of sodium per day. You can find the sodium content of prepared foods on the Nutrition Facts label.Limiting alcohol can help. Have no more than two drinks per day if you’re male, or one drink per day if you’re female. That’s drinking in moderation. Drinking in moderation may even help lower blood pressure, while drinking more can definitely raise blood pressure.Regular exercise lowers high blood pressure. Aim for at least 30 minutes of moderate-intensity exercise on all or most days of the week. Examples include walking or riding a stationary bike. Regular exercise is a potent tonic for lowering your blood pressure — even if you don’t lose weight.Finally, relax. Ongoing stress raises your blood pressure. Learn relaxation techniques, such as meditation, progressive muscle relaxation, deep breathing or yoga. I have a patient who took up tai chi several years ago and does it daily. I can’t prove there’s a connection, but I can tell you that her blood pressure has never been so low, and she says she feels great. window.fbAsyncInit = function() { FB.init({appId: "199616670120169", status: true, cookie: true, xfbml: true});}; (function() { var e = document.createElement("script"); e.async = true; e.src = document.location.protocol + "//connect.facebook.net/en_US/all.js"; document.getElementById("fb-root").appendChild(e);}());

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Health Tip: Lower Your Blood Pressure

(HealthDay News) -- High blood pressure increases a person's risk for heart attack, stroke, kidney disease and congestive heart failure.

The U.S. Centers for Disease Control and Prevention offers this advice for people whose pressure is too high:

Cut back on salt in your diet, and increase consumption of fruits and vegetables.Get plenty of regular exercise.Lose weight if you're overweight or obese.Don't smoke, and limit alcohol intake.Take any prescribed blood pressure medication as directed. Talk to your doctor if you have side effects from any medication.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Study: Low Blood Pressure May Weaken Brains of Some Heart Patients

Pressure that's too low -- or too high -- might damage brain cells, new research suggests

By Steven Reinberg

HealthDay Reporter

MONDAY, June 10 (HealthDay News) -- People suffering from cardiovascular disease who have lower-than-normal blood pressure may face a higher risk of brain atrophy -- the death of brain cells or connections between brain cells, Dutch researchers report.

Such brain atrophy can lead to Alzheimer's disease or dementia in these patients. In contrast, similar patients with high blood pressure can slow brain atrophy by lowering their blood pressure, the researchers added.

Blood pressure is measured using two readings. The top number, called systolic pressure, gauges the pressure of blood moving through arteries. The bottom number, called diastolic pressure, measures the pressure in the arteries between heartbeats. Normal blood pressure for adults is less than 120/80, according to the U.S. National Heart, Lung, and Blood Institute.

For the study, 70 to 90 was considered normal diastolic blood pressure, while under 70 was considered low.

"Our data might suggest that patients with cardiovascular disease represent a subgroup within the general population in whom low diastolic blood pressure might be harmful," said researcher Dr. Majon Muller, an epidemiologist and geriatrician at VU University Medical Center in Amsterdam.

On the other hand, lowering blood pressure in people with high blood pressure might slow brain atrophy, she said.

"Our findings could imply that blood pressure lowering is beneficial in patients with higher blood pressure levels, but one should be cautious with further blood pressure lowering in patients who already have low diastolic blood pressure," Muller added.

The report was published in the June 10 online edition of JAMA Neurology.

A U.S. expert noted the complex effects of blood pressure levels on the brain.

"High blood pressure has been shown to increase the risk of vascular brain lesions and brain atrophy. Trials of blood pressure lowering in patients with hypertension have shown reduced risk of brain lesions," said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and a spokesman for the American Heart Association.

However, in patients with hypertension, the relationship between the levels of systolic and diastolic blood pressure and brain atrophy has been less clear, he said.

This new study suggests that low diastolic blood pressure levels were associated with brain atrophy regardless of blood pressure levels after patients developed dementia, Fonarow said.

"These findings suggest that while treatment and control of high blood pressure is very important for brain and cardiovascular health, caution is needed in patients who have low diastolic blood pressure levels," he said.

To see what changes blood pressure would make in the progression of brain atrophy, Muller's group studied 663 patients who suffered from heart disease, cardiovascular disease, peripheral artery disease or abdominal aortic aneurysm. The average age of participants was 57 and most were men.

People whose diastolic blood pressure was below 70 had more brain atrophy over time, the study found. For people with higher-than-normal blood pressure, brain atrophy decreased when their blood pressure did. When blood pressure rose, however, atrophy increased.

Another expert, Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City, said that the finding "is an important cautionary tale."

"This implies that one must adapt the approach to the individual patient. Correction of hypertension is helpful, but reducing blood pressure in patients with normal blood pressure is risky and complicated," Gandy said.

Although the study found an association between low diastolic blood pressure and the risk of developing brain atrophy for people with artery disease, it did not establish a cause-and-effect relationship.

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How do blood pressure drugs work and how can I find the one that’s right for me?

Posted June 10, 2013, 2:00 am

How do blood pressure drugs work? And how will my doctor know which one is right for me?

There are many different drugs for blood pressure and they work in different ways. Finding which one will work best for you may involve a process of trial-and-error. But in the end, you’ll be rewarded with a medication that offers the best blood pressure control with the fewest side effects.

If you have other health conditions — diabetes and heart disease often accompany hypertension, for instance — certain drugs can lower blood pressure while also helping to treat these conditions.

I’ll briefly summarize the different classes of blood pressure drugs and how they work. I won’t go into the potential side effects of these drugs here, but you should discuss them with your doctor. (I’ve put tables with examples of the different types of drugs at the end of this post.)

Diuretics, or “water pills,” help the kidneys eliminate sodium and water from the body. This decreases blood volume, so the heart has less to pump with each beat. Of all the blood pressure drugs used today, diuretics have been around the longest and their beneficial effects are solidly proven.ACE inhibitors decrease blood volume by preventing the kidneys from retaining sodium and water. They do this by deactivating angiotensin-converting enzyme (ACE). ACE is a natural chemical (an enzyme) that converts another natural chemical, angiotensin I, to the chemical called angiotensin II. Angiotensin I is inactive, but angiotensin II raises blood pressure. So reducing the amount of angiotensin II by reducing ACE, the enzyme that makes angiotensin II, helps lower blood pressure.Angiotensin-receptor blockers (ARBs) block the blood pressure-raising effects of angiotensin II. So, the ACE inhibitors reduce the amount of angiotensin II the body makes, and the ARBs reduce the blood pressure-raising effect of angiotensin II.Calcium-channel blockers slow the movement of calcium into the smooth-muscle cells that are in the heart and the walls of the blood vessels. This makes heart muscle pump less forcefully (but still forcefully enough), which reduces blood pressure. Calcium-channel blockers also relax the muscle in the blood vessel walls, which makes blood vessels open wider, lowering blood pressure.Anti-adrenergics limit the action of the hormones epinephrine and norepinephrine. This relaxes the blood vessels and reduces the speed and force of the heart’s contractions.Direct-acting vasodilators relax the arteries. They act quickly and are often used in emergencies.Direct renin inhibitors inhibit the activity of renin, the enzyme largely responsible for angiotensin II levels. Aliskiren (Tekturna) is a renin inhibitor.

There really is no “best” blood pressure medication. The goal is to find the right medication for you. Often, more than one type of medicine used in combination proves the best. That means finding the medicine or medicine combo that effectively lowers your blood pressure while not causing side effects — and not costing more than you can afford.

Weakness, confusion, potassium depletion, gout, fatigue, thirst, frequent urination, lightheadedness, muscle cramps, diarrhea or constipation, increased sensitivity to sunlight, allergic reaction in people allergic to sulfa drugs, impotence.Esidrix, HydroDiuril, MicrozideWeakness, confusion, potassium depletion, gout, fatigue, thirst, diarrhea or constipation, increased sensitivity to sunlight, allergic reaction in people allergic to sulfa drugs, impotence.Potassium-sparing diuretics/aldosterone-receptor blockers*Excessive potassium levels, especially in patients with kidney disease; breast enlargement and erectile dysfunction in men; menstrual irregularities in women.Headache, dizziness, diarrhea, fatigue, upset stomach, and breast enlargement or tenderness.*Note: Potassium-sparing diuretics also directly or indirectly block aldosterone, a hormone that raises blood pressure by causing the kidneys to conserve sodium and water. As a result, these four medications are sometimes also known as aldosterone-receptor blockers. Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium) also affect other hormones and thus carry some unwanted side effects, such as breast enlargement and impotence in men and menstrual irregularities in women.Beta blockers (cardioselective)acebutolol (Sectral)atenolol (Tenormin)betaxolol (Kerlone)bisoprolol (Zebeta)metoprolol (Lopressor)metoprolol extended release (Toprol-XL)nebivolol (Bystolic)penbutolol (Levatol)Wheezing, dizziness, depression, impotence, fatigue, insomnia, decreased HDL cholesterol levels, lower exercise tolerance. Can worsen peripheral vascular disease and heart failure. Abrupt withdrawal may trigger angina or a heart attack in patients with heart disease.nadolol (Corgard)pindolol (Visken)propranolol (Inderal, Inderal LA)sotalol (Betapace)timolol (Blocadren)doxazosin (Cardura)prazosin (Minipress)terazosin (Hytrin)A drop in blood pressure upon standing up, fainting, weakness, heart palpitations, headache, nasal congestion, dry mouth.carvedilol (Coreg)labetalol (Normodyne, Trandate)Wheezing, depression, insomnia, diarrhea, lightheadedness, dizziness, unusual tiredness or weakness, drying of the eyes, erectile dysfunction, headache, dry mouth, nasal congestion, decreased HDL cholesterol levels, lower exercise tolerance, a drop in blood pressure upon standing up, fainting, heart palpitations. Can worsen peripheral vascular disease and heart failure. Abrupt withdrawal may trigger angina or a heart attack in patients with heart disease.clonidine (Catapres, Catapres-TTS)methyldopa (Aldomet)A drop in blood pressure upon standing up, drowsiness, sedation, dry mouth, fatigue, erectile dysfunction, depression, dizziness. Catapres-TTS (a patch) may cause a rash.Peripheral nerve–acting agentsguanethidine (Ismelin)reserpine (Serpalan)A drop in blood pressure upon standing up, depression, nasal stuffiness, nightmares. Guanethidine may slow heart rate, and reserpine may cause indigestion. Headaches, palpitations, weakness, flushing, nausea. Minoxidil may cause hair growth, fluid retention, and increased blood sugar.Headache, dizziness, edema, and heartburn. Nifedipine can cause palpitations. Diltiazem and verapamil can cause constipation and a slowed heartbeat.Cough, rash, fluid retention, high potassium levels, and loss of taste. May cause low blood pressure and fainting. Can worsen kidney impairment if narrowed arteries feed both kidneys. May cause spontaneous abortion. window.fbAsyncInit = function() { FB.init({appId: "199616670120169", status: true, cookie: true, xfbml: true});}; (function() { var e = document.createElement("script"); e.async = true; e.src = document.location.protocol + "//connect.facebook.net/en_US/all.js"; document.getElementById("fb-root").appendChild(e);}());

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I have high systolic, but normal diastolic blood pressure. Do I need treatment?

Posted May 30, 2013, 2:00 am

I’m 71 years old. My systolic blood pressure is usually in the 150s to 160s, which is high. But my diastolic blood pressure is usually in the 70s, which is normal. Do I need treatment?

A blood pressure measurement includes two numbers: systolic pressure (the upper number) and diastolic pressure (the lower number). These numbers are measured in millimeters of mercury, or mmHg.

Your systolic pressure is high: 140 mmHg or over is high. And your lower number is normal: normal diastolic pressure is below 80 mmHg. When your systolic blood pressure is high and your diastolic blood pressure is low, it’s called isolated systolic hypertension (ISH). People with ISH do benefit from treatment, as it lowers the risk of heart disease and stroke.

Are you currently being treated for high blood pressure (hypertension)? If not, your doctor might start with lifestyle changes. Regular exercise, weight loss and cutting down on salt in your diet might fix the problem without medication.

If lifestyle changes aren’t enough, you’ll likely need medication. Because of your age, your doctor will probably aim to first gently lower your systolic pressure to below 150 mmHg. If you don’t have any bothersome symptoms, such as lightheadedness, your doctor will push to get your systolic pressure below 140 mmHg. Such treatment is also likely to lower your diastolic pressure, but the focus should be on your systolic pressure.

I was taught three things in medical school: (1) all that really mattered was the diastolic pressure; (2) older people had naturally higher pressures, so they didn’t need treatment; and (3) when you treated older patients, it caused symptoms such as lightheadedness.

Research since I was a medical student has shown conclusively that (1) and (2) are wrong. In fact, they were backward. Systolic pressure matters more than diastolic pressure, and older people clearly benefit from treatment. People like you with just a high systolic pressure are at higher risk for having a heart attack, heart failure or a stroke if you don’t get treatment. That’s as true for a 71-year-old person like you as for a 50-year-old person — even more true, since you’re at higher risk for heart disease and stroke at age 71 than at age 50.

It is true that a minority of older patients develop symptoms if blood pressure is lowered too suddenly. But that’s why your doctor is likely to go slow. I learned that lesson many years ago when I started taking care of a woman in her late 70s who had ISH.

She was not very receptive when I recommended treatment. She finally agreed, and I prescribed a standard dose of a blood pressure medicine. It made her quite dizzy, so she stopped taking it. It was six months before I could convince her to start again — on a lower dose. It worked like a charm.

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Experts Question Use of Ankle Blood Pressure to Gauge Heart Risks

Title: Experts Question Use of Ankle Blood Pressure to Gauge Heart Risks
Category: Health News
Created: 3/18/2013 6:35:00 PM
Last Editorial Review: 3/19/2013 12:00:00 AM

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People With High Blood Pressure May Crave Salt

It's important to resist these cravings, study author says

By Maureen Salamon

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- High-salt diets have long been linked to high blood pressure, but new research finds that those with the condition may have a far greater preference for salty foods than those with normal blood pressure.

In a small study of older adults, researchers from the University of Sao Paulo in Brazil found that participants with high blood pressure, or hypertension, favored bread dusted with the highest concentration of salt more than twice as much as those with normal blood pressure. Adding other seasonings to the salted bread, however, diminished the preference for salt across both groups.

The question remains: Are people with high blood pressure naturally drawn to salty foods, making them more prone to the condition?

"This is difficult to answer, but I believe that the genetic factor to salt appetite can be the beginning of the process," said study author Patricia Villela, a nutritionist and doctoral student at the university. "I was surprised by the fact that added seasonings may have changed the preference of the elderly, decreasing [their] appetite for salt."

The study was scheduled to be presented Wednesday at the annual meeting of the American Society of Hypertension, in San Francisco. Research presented at scientific conferences has typically not been peer-reviewed or published, and results are considered preliminary.

About 67 million American adults -- roughly one in three -- have high blood pressure, according to the U.S. Centers for Disease Control and Prevention, as do nearly 1 billion people worldwide. The condition puts people at risk for heart disease, kidney damage, strokes and vision loss, among other health problems.

Villela and her team analyzed 44 seniors with an average age of 73, including 16 with normal blood pressure readings. All were initially given three pieces of French bread with varying amounts of salt on each. In that test, 68 percent of participants with high blood pressure preferred the bread with the highest concentration of salt, compared with 31 percent of those with normal blood pressure.

Fifteen days later, participants underwent a similar test, but this time other seasonings had been added to the salted bread. In that case, only 14 percent of patients with hypertension and none with normal blood pressure favored the bread with the highest salt content.

Dr. Domenic Sica, president-elect of the American Society of Hypertension, said the findings may have been influenced by the limited number of patients involved.

"The concept of taste retraining in hypertensive patients, either young or old, is at the foundation of this [research] and is studied in a creative manner," said Sica, a professor of internal medicine and nephrology at Virginia Commonwealth University, in Richmond. "How rapidly salt preference fell in this study is surprising, and may relate to the small number of subjects studied and a possible training effect."

Some previous studies have pointed to a genetic predisposition to craving salty foods, Villela said, and although there is no way of knowing who may have this predisposition, patients should know it is important to avoid salt despite the cravings.

"[In future research], it would be important to demonstrate that changes in habits can be maintained in the long term and the effect of these changes is reducing cardiovascular risk," she said.

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Yoga May Help Ease High Blood Pressure, Study Finds

Numbers were lowered when people engaged in a few sessions per week

By Robert Preidt

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- People who follow the ancient practice of yoga may be getting an added health boost, with a new study suggesting it can fight high blood pressure -- also known as hypertension.

"This study confirms many people's feelings that exercise may be useful in the control of hypertension," said Dr. Howard Weintraub, a cardiologist and associate professor of medicine at NYU Langone Medical Center in New York City. Weintraub was not connected to the new study.

Based on the new findings, "yoga would be a useful adjunct in the lowering of blood pressure in certain populations," he said.

In the study, researchers led by Dr. Debbie Cohen of the University of Pennsylvania tracked 58 women and men, aged 38 to 62, for six months.

Although the study couldn't prove a cause-and-effect relationship, doing yoga two to three times a week was associated with an average drop in blood pressure readings from 133/80 to 130/77, the researchers said.

In comparison, the average decrease in blood pressure was smaller (134/83 to 132/82) among people who ate a special diet but did not do yoga.

In a bit of a surprise, doing yoga in tandem with a special diet did not outperform doing yoga alone -- blood pressure numbers fell only slightly (135/83 to 134/81) among people who ate a special diet and also did yoga, the researchers said.

The small decline in blood pressure among people who ate a special diet and did yoga may be because doing both required a greater amount of time, making it more difficult for participants to stick with their regimens, the authors said.

Weintraub said the study shows that "yoga can have a favorable effect" on hypertension. Although the amount of change was small, he said, "some large population studies have suggested that changes of this magnitude could have very significant long-term benefits."

The study did have some limitations, including its relatively short length and the fact that most participants were young and had milder forms of high blood pressure, Weintraub said.

Another expert agreed that the ancient Indian practice of yoga might ease hypertension.

"Yoga, along with deep breathing exercises, meditation and inner reflection, is a good adjunctive and integrative cardiovascular approach to better health, including lowering blood pressure, as this data suggests," said Dr. David Friedman, chief of Heart Failure Services at the North Shore-LIJ Plainview Hospital, in Plainview, N.Y.

"In addition to proper diet and aerobic physical fitness most days of the week, I recommend that my patients take time each day for the above measures of finding disciplined inner peace, for improved health and well-being," he said.

The findings were presented Wednesday at the annual scientific meeting of the American Society of Hypertension, in San Francisco. Findings presented at medical meetings typically are considered preliminary until published in a peer-reviewed journal.

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High Blood Pressure May Add to Alzheimer's Risk, Study Finds

Title: High Blood Pressure May Add to Alzheimer's Risk, Study Finds
Category: Health News
Created: 3/18/2013 4:36:00 PM
Last Editorial Review: 3/19/2013 12:00:00 AM

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High Blood Pressure May Add to Alzheimer's Risk, Study Finds

People with a genetic mutation plus hypertension have more brain plaque, researchers find

By Steven Reinberg

HealthDay Reporter

MONDAY, March 18 (HealthDay News) -- High blood pressure in people with a genetic risk for Alzheimer's disease may spur development of brain plaque, a hallmark of the age-related brain disorder, a new study suggests.

The findings suggest yet another reason for keeping blood pressure, also known as hypertension, under control, the researchers said.

"Maintaining good vascular health by avoiding or controlling diseases like hypertension has important benefits beyond keeping your heart healthy. It may promote good brain health as we age," said lead researcher Karen Rodrigue, an assistant professor of behavioral and brain sciences at the University of Texas at Dallas.

This is especially so for people who are genetically at risk for Alzheimer's disease, the study suggested. "Keeping good vascular health may limit or delay the brain changes associated with Alzheimer's disease and other aging-related neurological deterioration," Rodrigue said.

No cure exist for Alzheimer's, and experts anticipate that by 2050 the number of Americans with the brain disease will approach 14 million if no progress is made.

The study of nearly 120 adults found that people with this genetic risk factor for Alzheimer's disease -- called an apolipoprotein E 4 allele -- plus untreated high blood pressure have more beta-amyloid plaques compared to those with just one or neither of these risk factors.

One expert said the findings have important implications.

"This is good news," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City.

"This means that yet another simple intervention -- here, blood pressure control, but think also of physical exercise -- can have an important impact on dementia risk and rate of progression," Gandy said. "We must not overlook these simple effective interventions while developing new therapies."

For the study, which was published online March 18 in the journal JAMA Neurology, the researchers looked at 118 people with normal brain function who were between 47 and 89 years old. They divided the patients into those with high blood pressure and those without high blood pressure, and those with and without the genetic risk factor for Alzheimer's. The participants also were given brain scans to look for plaques.

The researchers found people with both high blood pressure and the genetic risk factor had significantly more brain plaque than those with only one or no risk factors.

Moreover, those with the highest blood pressure and the gene mutation tended to have the most plaque, they found. The study did not, however, prove a cause-and-effect relationship between high blood pressure, this genetic mutation and increased brain plaque.

High blood pressure is highly responsive to lifestyle changes and medical treatment, and it may provide a future target for delaying or preventing Alzheimer's disease, the researchers noted.

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Cellphone Calls During Blood Pressure Readings May Skew Results

Interruption can cause spike in systolic pressure, study found

By Alan Mozes

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- New Italian research offers some cautionary advice for patients with high blood pressure: The next time you take a blood pressure reading, turn off your cellphone.

The reason: Answering a cellphone call during a reading may cause a temporary but significant spike in blood pressure, rendering the results inaccurate and misleading.

"The cellular phone has burst into our everyday life, and is often an indispensable communication tool for business and social relations," said study author Dr. Giuseppe Crippa, head of the hypertension unit at Guglielmo da Saliceto Hospital in Piacenza, Italy. "[Now] we know that the radio-frequency field generated by mobile phones does not affect blood pressure, and should not increase blood pressure in subjects suffering from hypertension.

"But what is the effect of the noise generated by the phone ringing and of the intrusion into our life of an unscheduled phone conversation?" Crippa asked. "In our study, we have shown that blood pressure, particularly systolic blood pressure, increases quickly and significantly in this situation."

The study authors said one in three Americans (and 1 billion people worldwide) currently struggles with high blood pressure.

Those grappling with keeping their high blood pressure under control often are instructed to either come in for routine readings taken by a health care professional, or to use one of many at-home monitoring kits that give patients the option of taking their own readings on a regular basis.

To explore the question of how cellphones might affect such readings, the authors focused on 49 Italian women with an average age of 53, all of whom were taking medication to control high blood pressure.

After discussing their general cellphone usage habits, all underwent two sets of multiple blood pressure readings, each set registering six readings at one-minute intervals. All the readings took place in a physician's office, where patients were left alone (in what the researchers described as a "comfortable" setting) after the first reading.

During one of the two readings, an investigator disabled caller ID and anonymously called each patient's cellphone three times, with a patient's response to at least one of the calls being deemed sufficient for testing purposes.

The result: By comparing readings taken with and without incoming calls, the team found that patients' systolic numbers (the top figure in a blood pressure reading, indicating blood pressure as the heart contracts) went up "significantly" whenever the patients answered their phones.

Patients who had indicated relatively heavy routine cellphone usage (30 or more calls per day), however, experienced a less steep rise in their systolic numbers during incoming calls. Since heavy users tended to be younger, the team theorized that a greater cellphone comfort level among younger patients may protect them from the cellphone dynamic.

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Vitamin D Supplements Tied to Lower Blood Pressure in Blacks

Study found modest, but significant, drops depending on dosage

By Steven Reinberg

HealthDay Reporter

FRIDAY, March 15 (HealthDay News) -- Black Americans who take vitamin D supplements may significantly lower their blood pressure, a new study suggests.

"Compared with other races, blacks in the United States are more likely to have vitamin D deficiency and more likely to have high blood pressure," said lead researcher Dr. John Forman, an assistant professor of medicine at the renal division of Brigham and Women's Hospital in Boston.

But among the black study participants, three months of supplemental vitamin D was associated with a drop in systolic blood pressure (the top number in a blood pressure reading) of up to 4 mm Hg, the researchers found.

"If our findings are confirmed by other studies, then vitamin D supplementation may be a useful means of helping black individuals lower their blood pressure," Forman said.

Dr. Michael Holick, a professor of medicine, physiology and biophysics at Boston University School of Medicine, said that vitamin D may lower blood pressure by causing blood vessels to relax, allowing for more and easier blood flow.

In addition, because many black Americans are deficient in vitamin D, taking a supplement may benefit their health even more, said Holick, who was not involved with the study.

"We are now beginning to believe that a lot of the health disparities between blacks and whites are due to vitamin D deficiency, including the risk for type 2 diabetes, heart disease, cancers and even infectious disease," he said.

Diet and sunlight are two natural sources of vitamin D in humans. However, having dark-colored skin cuts down on the amount of vitamin D the skin makes, according to the U.S. National Institutes of Health.

For the study, published online March 13 and in the April print issue of the journal Hypertension, Forman's team randomly assigned 250 black participants to one of three doses of vitamin D supplements or an inactive placebo.

After three months, the researchers found that those taking 1,000 international units (IU) of vitamin D a day saw their systolic blood pressure drop by 0.7 mm Hg. For those taking 2,000 IU, the drop was 3.4 mm Hg, and for those taking 4,000 IU, systolic pressure dropped by 4 mm Hg.

In contrast, those receiving the placebo saw their systolic blood pressure rise by 1.7 mm Hg, the researchers noted.

Forman said the gains from supplemental vitamin D were significant, but modest. In addition, there were no changes in diastolic blood pressure among those in any group.

Systolic blood pressure is pressure in the arteries when the heart beats. Diastolic blood pressure, the bottom number, is pressure in the arteries between heart beats, the study authors pointed out.

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High Blood Pressure in Pregnancy May Predict Later Ills, Study Says

Title: High Blood Pressure in Pregnancy May Predict Later Ills, Study Says
Category: Health News
Created: 2/11/2013 4:35:00 PM
Last Editorial Review: 2/12/2013 12:00:00 AM

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High Blood Pressure in Kids May Be Less Common Than Thought

TUESDAY, Jan. 29 (HealthDay News) -- The number of U.S. kids with full-blown high blood pressure could be lower than previously thought, if new research findings are on the mark.

In a study of nearly 200,000 children aged 3 to 17 years, researchers found that only 0.3 percent met the standard for high blood pressure -- elevated readings at three consecutive doctor visits.

That stands in contrast to past studies, which have suggested that anywhere from 0.8 to 4.5 percent of American kids have high blood pressure.

But experts say the "correct" rate among U.S. kids is still unknown. And even if blood pressure is lower than earlier estimates, children should still have their blood pressure measured at routine checkups, said Dr. Stephen Daniels, an expert in pediatric high blood pressure who was not involved in the new study.

The American Academy of Pediatrics and the U.S. National Heart, Lung, and Blood Institute both recommend that kids have yearly screenings for high blood pressure, starting at age 3.

"I don't think that should change," said Daniels, the chief pediatrician at Children's Hospital Colorado and head of pediatrics at the University of Colorado School of Medicine in Aurora. "I wouldn't want parents to get the message that their child doesn't need to have their blood pressure measured."

As for why the new figure is lower than past estimates, it's probably due to how the study was done, according to lead researcher Dr. Joan Lo, a research scientist with Kaiser Permanente Northern California in Oakland.

The children in her study were from three different U.S. states, and all were visiting the doctor for routine "well-child" visits. Past studies have mainly been done in schools, in a single city or region. And some of those studies were run in urban areas, with a high proportion of black and obese kids -- both of whom are at increased risk of elevated blood pressure, Daniels noted.

Still, the true rate of high blood pressure among U.S. children remains unclear, according to Daniels.

"This new study is narrow in its own way," he said, noting that the kids involved had health insurance and got routine check-ups. The group was racially diverse, but Daniels said they may have been better off -- financially and health-wise -- than a random sample of U.S. kids would be.

The findings, which appear in the February issue of the journal Pediatrics, are based on 199,513 children and teens enrolled in three large health plans.

Almost 11,000 of those kids had an elevated blood pressure reading at their first doctor visit during the study period. But after repeat tests at their next two visits, less than 4 percent of them were ultimately diagnosed with high blood pressure.

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Blood Pressure Drug May Lower Alzheimer's Risk

Jan. 7, 2013 -- Can commonly prescribed blood pressure pills help reduce the risk of developing dementia?

Maybe, according to a new study of 774 elderly Japanese-American men.

While it’s well known that high blood pressure in midlife raises a person’s risk for developing thinking and memory problems as they age, and that certain types of blood pressure medications may help lower this risk, little was known about how a class of drugs called beta-blockers stacked up, until now.

According to the new findings, men who took beta-blockers were less likely to have changes in their brains that can be signs of Alzheimer’s disease and other types of dementia, compared to men who took other types of blood-pressure-lowering drugs.

The findings will be presented at the American Academy of Neurology’s 65th Annual Meeting in San Diego.

All of the men took part in the Honolulu-Asia Aging Study. Of the 774 men, 610 had high blood pressure or were being treated for high blood pressure. Among about 350 who had been treated, 15% received a beta-blocker, 18% received a beta-blocker plus one or more other medications, and the rest received other blood pressure drugs.

All types of blood pressure medications seemed to have a positive effect on the risk of dementia, the study shows.

Researchers led by Lon White, MD, of the Pacific Health Research and Education Institute in Honolulu, Hawaii, performed autopsies on the brains of these men. They looked for brain lesions indicating Alzheimer’s disease and microinfarcts, scars left behind most likely from unrecognized mini-strokes. 

Men who had received beta-blockers alone showed fewer brain abnormalities than those who had not been treated for high blood pressure or who had received other blood pressure drugs. Study participants who had taken beta-blockers alone or in combination with another blood pressure medication showed less shrinkage in their brains.

Richard Isaacson, MD, says the new study findings add more grist to the mill when it comes to preventing Alzheimer’s disease. Isaacson is an associate professor of clinical neurology and the director of the Alzheimer's division at the University of Miami Miller School of Medicine.

“Treating blood pressure, in general, is quite likely to reduce the risk of cognitive decline and Alzheimer’s disease, and specific treatments may be preferential,” he says.

Exactly how high blood pressure increases the chances of dementia, and how treating it reduces this risk, is not fully understood, Isaacson says. It may reduce the risk of mini-strokes that can lead to dementia or help brains maintain their volume. “We know that treating high blood pressure reduces your risk for stroke and heart attack, and now the icing on the cake may be that it can also delay the onset of Alzheimer’s disease and other forms of cognitive decline.”

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