AHA News: Despite Recent Setbacks, Americans’ Blood Pressure Has Dropped Dramatically Since 1960 | Health News

(HealthDay)

MONDAY, Oct. 5, 2020 (American Heart Association News) — Blood pressure among adults decreased significantly during a 45-year period, according to new research that may offer encouragement for the millions who continue to struggle to control their blood pressure.

The study, published Oct. 5 in the American Heart Association journal Circulation , sought to pinpoint the magnitude of blood pressure improvement in the United States between 1960 and 2005.

Researchers looked at rates of control for systolic blood pressure, the top number in a reading that indicates how much pressure blood exerts against artery walls when the heart beats. The study looked at data from 9,459 adults ages 45 and older, most of whom lived in the so-called “stroke belt” region of the Southeast.

It found major decreases in median blood pressure levels across the board, with larger decreases for Black participants compared to white participants. Among Black people aged 45 to 54, blood pressure dropped 38 mmHg, while their white counterparts saw an 18 mmHg drop. Dramatic shifts were larger at older ages for both groups, with a 45 mmHg drop for those 75 and older.

In addition, the severe blood pressure levels of greater than 200 mmHg reported in 1960 were practically eliminated during the study period. For example, among 65- to 74-year-olds with the highest blood pressure, the levels dropped 63 mmHg for white people and 77 mmHg for Black people – most likely because of aggressive high blood pressure control strategies, said study author Dr. Daniel Lackland.

He called the results “a great public health success story.”

“This shows we’ve made great improvements in reducing blood pressures for everybody, at all levels,” said Lackland, a professor of epidemiology and neurology at the Medical University of South Carolina in Charleston.

But in recent years, some of those improvements seem to have weakened.

New preliminary research presented in September at the AHA’s virtual Hypertension Scientific Sessions showed the percentage of U.S. adults with controlled blood pressure dropped 11% between 2013 and 2018, from 54.5% to 43.4%. All age groups saw an increase in systolic blood pressure of 3-4 mmHg.

Those data, however, used the old definition of high blood pressure: 140/90. High blood pressure is now defined as a reading of 130 or higher systolic, or 80 or higher diastolic (the bottom number). Nearly half of U.S. adults – an estimated 116 million – have high blood pressure, according to AHA statistics.

Lackland said the lessons learned from 1960 to 2005 offer a roadmap for reversing recent setbacks through a combination of drug therapy and lifestyle changes that include getting more exercise and eating a healthy diet low in salt and high in fruits and vegetables.

“We’ve proven we can lower blood pressure if patients comply. We just need to put our foot back on the pedal and regain our focus. We can’t be complacent,” he said.

Dr. Sandra Taler, a nephrologist and hypertension specialist at the Mayo Clinic in Rochester, Minn., said the findings are an

Users of blood pressure medicine have a lower risk of dying from influenza and pneumonia

Drugs to lower blood pressure of the type ACE inhibitors or angiotensin II receptor blockers reduce the mortality rate of influenza and pneumonia.

This is the main conclusion of a new reassuring study published in the Journal of the American Heart Association, which Christian Fynbo Christiansen and a number of Danish colleagues are behind. He is consultant, clinical associate professor and PhD at the Department of Clinical Epidemiology, which is part of the Department of Clinical Medicine at Aarhus University and Aarhus University Hospital in Denmark.

In the study, the researchers have compared mortality rates among 500,000 Danish patients who were admitted to hospitals in Denmark with influenza and pneumonia during the period 2005 to 2018. This has been done by correlating information from the National Patient Register (activity at Danish hospitals) with statistics from the Danish Register of Medicinal Products (the consumption of medicine in Denmark).

“A little over 100,000 of the admitted patients took ACE inhibitors or angiotensin II receptor blockers, and the study shows that fewer of them were put on a ventilator and that they had lower mortality rates than the hospitalised patients who took another type of drugs against elevated blood pressure, calcium blockers,” says Christian Fynbo Christiansen.

The study arrives mid in a discussion of treatment which peaked while the corona pandemic was at its height. Some medical doctors and researchers pointed out that ACE inhibitors may actually have the completely opposite effect – that is increasing the risk of dying from COVID-19 as the virus SARS-CoV-2 which causes COVID-19 enters the lungs through the same ACE receptors as the ACE inhibitors.

The hypothesis was that when the ACE inhibitor reduces the level of ACE, the body compensates for this by activating a much greater number of ACE receptors on the surface of the cells, which the SARS-CoV-2 virus then utilises as some kind of access key. The greater the number of access keys available on the surface of the cells, the more easily the virus gains access to the cells.

The theory about increased mortality has been nurtured by the fact that a strikingly large proportion of the patients who were seriously ill due to COVID-19 had elevated blood pressure, which is extensively treated with ACE inhibitors – of the 600,000 Danes who have elevated blood pressure, approximately one-third ( 200,000) of them take ACE inhibitors.

“We haven’t examined whether what applies to patients with influenza and pneumonia can be transferred directly to patients with COVID-19, but there is some evidence to suggest that ACE inhibitors have a protective effect against lung damage which we don’t see in patients who take other types of medicine to lower blood pressure. The first studies find no correlation between ACE inhibitors/angiotensin II receptor blockers and COVID-19. However, further studies are needed using the good Danish registers,” says Christian Fynbo Christiansen.

In Denmark, the discussion for and against the use of ACE inhibitors on corona patients has taken place (in Danish) in e.g. the Journal of

Intensive Blood Pressure Lowering Potentially Harmful in ICH

Intensive systolic blood pressure (SBP) lowering in patients with intracerebral hemorrhage (ICH) and excessively high initial SBP does not improve outcomes and is linked to safety concerns, new research shows.

Investigators found that ICH patients whose initial SBP was 220 mmHg and who underwent intensive BP lowering had twice the relative risk for neurologic deterioration at 24 hours without any reduction in hematoma expansion or 3-month risk for death and disability compared to their counterparts who underwent standard SBP lowering.

“The significantly higher rate of neurological deterioration associated with intensive treatment in patients with initial systolic blood pressure of 220 mm Hg or more warrants caution against broad recommendations for intensive systolic blood pressure reduction in patients with intracerebral hemorrhage,” the investigators, led by Iryna Lobanova, MD, Zeenat Qureshi Stroke Institute, University of Missouri, in Columbia, write.

The study was published online September 8 in JAMA Neurology.

Efficacy Unknown

American Heart Association and American Stroke Association guidelines recommend lowering SBP to 140 mmHg for ICH patients whose SBP is between 150 mmHg and 220 mmHg. However, guideline authors note that the safety and efficacy of intensive SBP lowering for patients with SBP >220 mmHg “appears to be unknown.”

To evaluate the safety and efficacy of intensive SBP reduction for ICH patients with excessively high initial SBP, the investigators analyzed data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage–II (ATACH-II) trial, which compared intensive and standard SBP reduction for patients with spontaneous supratentorial ICH.

Eligible participants had SBP >180 mmHg on two measurements. The first measurement that was recorded in the emergency department was considered the initial SBP.

Consistent with practice guidelines, treatment to lower SBP before randomization was permitted. The SBP measurement recorded immediately before randomization was the prerandomization SBP.

The treatment goal was to reduce SBP to a target range of 140 mmHg to 179 mmHg in the standard reduction group and 110 mmHg to 139 mmHg in the intensive reduction group over 24 hours.

The primary outcome was the proportion of patients who died or experienced severe disability at 90 days, defined as a Modified Rankin Scale score of 4 to 6.

Secondary outcomes included neurologic deterioration, as determined by the Glasgow Coma Scale or the NIH Stroke Scale, as well as hematoma expansion and hypotension.

Neurologic Deterioration

The study included 999 participants. Of these, 228 had an initial SBP of ≥220 mmHg. The mean age was significantly less in the excessively high SBP group than in the lower SBP group, at 59.0 and 62.8 years, respectively.

The mean minimum SBP at 6 to 7 hours and at 23 to 24 hours after randomization was significantly higher among the high SBP group than the lower SBP group.

Of the 228 patients whose initial SBP was ≥220 mmHg, 110 were randomly assigned to intensive SBP reduction, and 118 were assigned to standard SBP reduction. These two treatment groups did not differ significantly with respect to age or sex distribution.

Results showed that among participants with excessively high SBP, the

Way to Go! New Hyde Park students hold virtual blood drive

Two students from New Hyde Park Memorial High School have been combating the shortage of blood because of the coronavirus outbreak.

Aarti Devjani and Preesha Mody, both seniors, coordinated a seven-week virtual blood drive through the New York Blood Center in which individuals could schedule appointments to give blood through the center’s website. The drive allowed participants to stay safe and socially distance while helping their community, the students said.

As of late September, about 35 people had donated blood to the students’ drive, which ends Oct. 15. The duo has also raised more than $3,600 for the center through a GoFundMe page.

“This idea started in the middle of quarantine when we realized no one’s going anywhere,” Mody said. “Then my dad actually sent me this article about how there’s a shortage of blood, so we though ‘let’s do something about it.'”

The students then spread the word through social media — including Facebook, Instagram and Snapchat — and hung flyers in “every grocery store that would let us,” Mody said.

Devjani and Mody are members of their school’s National Junior Honor Society, Science Honor Society and Science Olympiad Club. Devjani has also volunteered at NYU Winthrop Hospital in Mineola, and Mody has volunteered at Stamford Hospital in Connecticut.

— MICHAEL R. EBERT

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Cape Cod Hospitals In Need Of Blood Donations

FALMOUTH, MA — Over the past few months, blood center inventories have fallen to their lowest levels since before the coronavirus pandemic. Cape Cod Healthcare officials said nationwide, blood centers have experienced a significant drop in donations which is limiting the ability for the overall blood supply to be adequately replenished.

Locally, health officials said the Cape Cod Healthcare blood program is experiencing the same challenge as the organization transitions back to a new normal.

Hospital officials said they need at least one week’s worth of blood on hand at all times, since each unit collected or purchased only lasts 42 days.

If you’d like to help replenish the supply, please consider taking part in one of the following blood drives:

  • October 1: 11 a.m. – 5 p.m., Bass River Rod & Gun Club, 621 Route 6A, Yarmouthport

  • October 5: 11 a.m. – 5 p.m., Grace Chapel Assembly of God, 25 Lieutenant Island Rd, Wellfleet

  • October 9: 11 a.m. – 5 p.m., Sandwich Masonic Lodge, 175 Main Street, Sandwich

  • October 13: 12 noon – 6 p.m., Chatham Works, 323 Orleans Rd, N. Chatham

  • October 14: 10 a.m. – 4 p.m., Barnstable Police Community Blood Drive at the Cape Codder Resort and Spa, 1225 Iyannough Rd, Hyannis

  • October 15: 11 a.m. – 5 p.m., John Wesley United Methodist Church, 270 Gifford Street, Falmouth

  • October 19: 11 a.m. – 5 p.m., Christ the King Church, 3 Jobs Fishing Rd, Mashpee

  • October 20: 9 a.m. – 3p.m., Harwich Community Center, 100 Oak Street, Harwich

  • October 26: 11 a.m. – 5 p.m., Orleans Police Station, 99 Eldredge Parkway, Orleans

  • October 27: 11 a.m. – 5 p.m., John Wesley United Methodist Church, 270 Gifford Street, Falmouth

  • October 28: 11 a.m. – 5 p.m., Eastham Library, 190 Samoset Rd, Eastham

  • October 30: 10 a.m. – 4 p.m., Cape Cod 5 Community Blood Drive at the Cape Codder Resort and Spa, 1225 Iyannough Rd, Hyannis

This article originally appeared on the Falmouth Patch

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Unstable Blood Sugar After Gastric Bypass

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