New Blood Pressure Guidelines Dangerous ?

     New Blood Pressure Guidelines Dangerous?

Research says the treatment threshold is too high for those over 60 years of age

Scientists continue to debate when doctors should prescribe blood pressure medication for older Americans, with a new study saying delayed treatment puts people at greater risk of stroke.

For people 60 and older, a U.S. panel in 2014 recommended raising the blood pressure rate at which doctors prescribe treatment from 140 to 150 systolic blood pressure. Systolic blood pressure is the top number in a blood pressure reading.


But the new study finds that people with systolic blood pressure of 140 to 149 have a 70 percent increased risk of stroke compared to people with lower blood pressure.

"Our study shows the borderline group is probably as risky as having a blood pressure greater than 150, at least for stroke risk," said senior author Dr. Ralph Sacco, chair of neurology at the University of Miami Miller School of Medicine. "This was a controversial move, and I think our study suggests we shouldn't switch it to 150. We should stick to 140."

The new findings, published online Feb. 1 in the journal Hypertension, are unlikely to quell arguments over proper blood pressure management, however.

For instance, the new study does not address the risk of side effects associated with blood pressure medications, or how medication would alter a person's overall stroke risk, said Dr. Paul James, head of family medicine at the University of Iowa Carver College of Medicine.

"It's a matter of balancing the risk of treatment with the benefits of treatment," said James. "That's not a simple thing, and it's not really something that one study like this study could answer."

About one in three adults in the United States has high blood pressure (or "hypertension"), according to the U.S. National Heart, Lung, and Blood Institute.

The institute formed the Eighth Joint National Committee, or JNC8, in 2008 to update high blood pressure treatment guidelines issued in 2003. Its final recommendation, issued in 2014, said that adults aged 60 or older should only take blood pressure medication if their blood pressure exceeds 150/90, a higher bar of treatment than the previous guideline of 140/90.

Arguments immediately sprang up around the JNC8 revised guidelines, with the American Heart Association expressing concern over potential delays in treatment of high blood pressure.

"These were extremely controversial, and the American Heart Association was adamant and vocal in our disagreement with that," said Dr. Mary Ann Bauman, a heart association spokeswoman. Bauman is the medical director of women's health and community relations at Integris Health in Oklahoma City.

Sacco and his colleagues launched their new study in response to the JNC8 recommendations. "We were concerned about the recommendations' potential effect on stroke prevention," he said.

The research team gathered data on 1,750 participants aged 60 and older in the Northern Manhattan Study, a study of stroke risk in a multi-ethnic community. None had diabetes or chronic kidney disease -- two risk factors for stroke.

During about 13 years of follow-up, 182 people suffered a stroke, the investigators reported.


The researchers concluded that having a systolic blood pressure of 140 to 149 elevated stroke risk as much as having systolic blood pressure greater than 150. Increased stroke risk was most notable among Hispanics and blacks, the findings showed.

"Our findings support adherence to current American Heart Association treatment guidelines," Sacco said. It recommends starting medication at 140 systolic or higher.

James responded that the new study does not provide solid evidence that would refute the JNC8 recommendation, which called for doctors to treat borderline blood pressure (140-149 systolic) through lifestyle factors such as diet and exercise.

He added that the new study is based on observational data, and can only draw associations about stroke risk. The JNC8 recommendations were based on clinical trials that proved that stricter guidelines and tighter blood pressure control provided no additional benefit to patients, James said.

"But the evidence told us going below 150 did not seem to translate into improved health or improved mortality," James said.

Bauman countered that the clinical trials the JNC8 relied upon didn't give a full picture of the long-term risks of high blood pressure.

"The complications of hypertension are long, long range, and I don't think the clinical trials they relied on went long enough," Bauman said.
Bauman and Sacco also pointed out that a new clinical trial called SPRINT, which came out after the JNC8 guidelines, has shown that driving blood pressure down to as low as 120 systolic can reduce by one-quarter the rate of death, heart attack, heart failure and stroke.

Paul agreed that the SPRINT trial "rises to that degree of evidence" that the JNC8 sought, and should be included in any future review of blood pressure guidelines.

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Common Habits Damaging Heart

6 Common Habits That Are Damaging Your Heart

Work long hours at a desk job? Forget to floss at night? These and other common habits can be hard on your heart. Stay safe by making these heart-healthy changes.

you know that eating a healthy diet and exercising regularly are important habits for a healthy heart. But did you know that you could still be undermining all your efforts with some surprisingly common bad habits?

“A number of activities that people don’t think twice about can have a negative impact on heart health,” says Kevin R. Campbell, MD, a cardiac electrophysiologist at North Carolina Heart and Vascular, UNC Health Care in Raleigh. Check out this list of heart-damaging habits to see if it's time to make changes to your routine:

1. Sitting All Day

Compared to people with an active lifestyle, those who don’t move enough and tend to sit for five hours or more each day have double the risk for heart failure, according to a study published in January 2014 in the American Heart Association (AHA) journal Circulation: Heart Failure.  

If your job requires sitting at a desk all day, get up and take a five-minute walk every hour. This small tweak in your routine can keep your arteries flexible and blood flowing properly, protecting against the negative effects of being sedentary, according to an Indiana University study published in August 2014 in Medicine & Science in Sports & Exercise. 

2. Overindulging in Alcohol

Drinking too much alcohol can lead to high blood pressure, stroke, and obesity — all of which increase your risk for heart disease. The AHA reports that excessive drinking — more than two drinks a day for men and one drink for women — can interrupt your normal heart rhythm and cause heart failure. It’s okay to enjoy the occasional cocktail or glass of wine, but you can protect your heart by sticking to the AHA guidelines. 

3. Stressing Too Much

Stress spurs the body to release adrenaline, which temporarily affects how your body functions — your heart rate increases, and your blood pressure may rise. Over time, too much stress can damage blood vessels in the heart and increase your risk for heart attack and stroke, Dr. Campbell says.

To minimize the harmful effects of stress, the AHA recommends the following:

Find a release. Share your feelings by talking with a trusted friend or family member. 

Exercise. Relieve mental tension by engaging in physical activity. Aim for about 30 minutes of moderate-intensity exercise on most days of the week. 

Plan your day. Prioritize tasks and plan ahead to help prevent rushing to get everything done.  

 4. Not Flossing

Your dentist is right: Flossing is important — but not just for your teeth. A study published in May 2014 in the Journal of Periodontal Research found that people with coronary heart disease who flossed experienced fewer cardiovascular problems. What's the connection? Certain studies, including one published in July 2013 in International Scholarly Research Notices, show that bacteria associated with gum disease promote inflammation in the body, and inflammation has been associated with increased risk for heart disease, Campbell explains.  

A variety of flossing tools are available to make the task a little easier in hard-to-reach areas, from flossing picks to threaders that guide the floss. 

 5. Overdoing It on Salt

Excessive sodium can lead to high blood pressure, a risk factor for heart disease, Campbell says. Avoiding the saltshaker isn’t too difficult, but what about hidden sodium? The National Heart, Lung, and Blood Institute (NHLBI) reports that processed foods — including canned vegetables and soups, lunch meats, frozen dinners, chips, and other salty snacks — account for most of the salt Americans consume. Be sure to read nutrition labels and compare products, choosing the one with the lowest percent daily value for sodium. A rule of thumb to follow: The AHA recommends that most people consume less than 1,500 mg of sodium per day.

6. Not Getting Enough Sleep

Your heart works hard all day, and if you don’t get enough sleep, your cardiovascular system doesn’t get the rest it needs. Your heart rate and blood pressure dip during the first phase of sleep (the non-REM phase), then rise and fall in response to your dreams during the second phase (REM sleep). These changes throughout the night seem to promote cardiovascular health, according to the NHLBI. 

Chronic sleep deprivation can also lead to high resting cortisol and adrenaline levels, similar to levels that you experience in a stressful situation, Campbell explains. He recommends that adults get 7 to 8 hours of sleep each night. Teens and young adults should aim for 9 to 10 hours, he says.

 Make Your Heart-Healthy Changes Stick

“Lifestyle changes are a process and do not occur quickly,” says Frank J. Sileo, PhD, a psychologist at The Center for Psychological Enhancement in Ridgewood, N.J. In fact, according to a study that appeared in the British Journal of General Practice in 2012, it takes about 66 days for a practiced behavior to become a habit. So practice patience and follow these steps to make your heart-healthy changes stick:

Write out a list of the changes you want to make. Putting goals down on paper makes them tangible and creates a guide you can follow, Dr. Sileo says. Just be sure you’re as realistic and specific as possible. 

Break down your goals into manageable milestones. Don’t try to make all the changes at once. “Most people run into difficulties and failure when they try to change too much too fast,” he says. Make sure each milestone feels attainable. 

Gradually add new changes. When a change starts to become second nature, add another goal. Keep doing this until you reach the end of your list. 

If you experience a setback, don’t give up. Remember that as changes turn into habits, you’ll be on your way to the ultimate goal: maintaining a healthier heart.

More Information : http://www.everydayhealth.com