Posts Tagged ‘hypertension’

Don’t over-medicate high blood pressure

Wednesday, July 21st, 2010

There are still many practitioners treating patients for hypertension who believe that systolic blood pressure should be suppressed to less than 130 mm Hg with medication. Another study just published in JAMA (The Journal of the American Medical Association) adds more evidence that this is not helpful even for individuals with diabetes and coronary artery disease. The authors set out to:

“…determine the association of systolic BP control achieved and adverse cardiovascular outcomes in a cohort of patients with diabetes and CAD (coronary artery disease).”

They analyzed data for 6400 subjects from 862 sites in 14 countries for more than ten years.

“Patients received first-line treatment of either a calcium antagonist or β-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic, or both to achieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg. Patients were categorized as having tight control if they could maintain their systolic BP at less than 130 mm Hg; usual control if it ranged from 130 mm Hg to less than 140 mm Hg; and uncontrolled if it was 140 mm Hg or higher.”

The data they accumulated painted this picture:

“…little difference existed between those with usual control and those with tight control…The all-cause mortality rate was 11.0% in the tight-control group vs 10.2% in the usual-control group; however, when extended follow-up was included, risk of all-cause mortality was 22.8% in the tight control vs 21.8% in the usual control group.”

Note that the tight control group had a slightly higher risk of all-cause mortality over the longer time period. Besides the greater likelihood of adverse effects with higher doses of medication, lower blood pressure means diminished delivery of oxygen to tissues (the pressure acts to overcome the increased resistance of less a healthy circulatory system).

Their conclusion clearly states the lack of benefit with suppression to less than 130 mm Hg:

“Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control.”

See another recent study that proves the same point.

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Both are good for weight loss, which is better for high blood pressure: higher protein or higher fat?

Saturday, April 17th, 2010

European Journal of Clinical Nutrition 0310Most of you reading this are aware that a lower glycemic diet can promote weight and fat loss through its beneficial effect on insulin levels. But which is better for blood pressure control, a higher or lower protein to fat ratio? This study recently published in the European Journal of Clinical Nutrition was designed to answer that question.

“There is controversy over dietary protein’s effects on cardiovascular disease risk factors in diabetic subjects. It is unclear whether observed effects are due to increased protein or reduced carbohydrate content of the consumed diets. The aim of this study was to compare the effects of two diets differing in protein to fat ratios on cardiovascular disease risk factors.”

What did their data show? Interestingly,…

“Both diets were equally effective in promoting weight loss and fat loss and in improving fasting glycemic control, total cholesterol and low-density lipoprotein (LDL) cholesterol, but the…HP–LF [high protein-low fat] diet improved significantly both systolic and diastolic blood pressure when compared with the LP–HF [low protein-high fat] diet. No differences were observed in postprandial glucose and insulin responses.”

The authors conclude:

“A protein to fat ratio of 1.5 in diets significantly improves blood pressure and TG [triglyceride] concentrations in obese individuals with DM2 [type 2 diabetes].”

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More aggressive blood pressure control for diabetes is not better

Friday, April 2nd, 2010

New England JournalHigh blood pressure is common with type 2 diabetes because the excessive levels of insulin that lead up to the breakdown in blood sugar control promote hypertension. This study recently published in The New England Journal of Medicine has practical importance for many people who require treatment for high blood pressure. The authors first note:

“There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events.”

They constructed their study to discriminate outcomes between reducing blood pressure to less than 140 mm Hg and less than 120 mm Hg:

“A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years.”

I have told patients for years that it is not desirable to aggressively medicate blood pressure much below a systolic reading of 135-140 mm Hg because the increased pressure is a compensatory effort by the body to deliver oxygen to the tissues against increased resistance. There has to be a happy medium. What did the data from this investigation show?

“Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%).”

This compelled them to conclude that:

“In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

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Controlling inflammation and hypertension help prevent Alzheimer’s

Wednesday, November 25th, 2009

If you have a parent who has suffered from Alzheimer’s disease, this paper just published in the Archives on General Psychiatry identifies two vascular factors that you can use for screening and prevention: hypertension (high blood pressure) and pro-inflammatory cytokines (signaling molecules that promote inflammation). The authors conclude: “Hypertension and the expression of an innate pro-inflammatory cytokine profile in middle age are early risk factors of AD in old age. For the offspring of affected families, it provides clues for screening and preventive strategies…” Blood tests that measure cytokines are available at a discount due to our co-op association with Labcorp.

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Vitamin D & high blood pressure

Friday, October 30th, 2009

This a recent review of the evidence for and mechanisms of the role of Vitamin D in arterial hypertension in Nature Reviews Cardiology. Not surprisingly, the investigators found the antihypertensive effect of Vitamin D to be especially prominent when both deficiency and elevated blood pressure are present. “Thus, in view of the relatively safe and inexpensive way in which vitamin D can be supplemented, we believe that vitamin D supplementation should be prescribed to patients with hypertension and 25-hydroxyvitamin D levels below target values.”

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