Lowering blood pressure cuts risk of memory decline: U.S. study

UNTV News   •   July 26, 2018   •   2639

FILE PHOTO: A man has his blood pressure checked at the Remote Area Medical Clinic in Wise, Virginia, U.S., July 22, 2017. REUTERS/Joshua Roberts

CHICAGO (Reuters) – Aggressively lowering blood pressure significantly reduced the risk of mild cognitive impairment and dementia among hypertension patients in a large government-backed clinical trial, U.S. researchers said on Wednesday.

The results, presented at the Alzheimer’s Association International Conference in Chicago, offer some of the first tangible steps individuals can take to reduce their risk for dementia, experts said.

The results come from a landmark 2015 trial dubbed SPRINT involving of more than 9,300 hypertension patients which showed significant cardiovascular benefits in people whose systolic blood pressure – the top number in a blood pressure reading – was lowered aggressively to below 120, compared to a higher target of under 140.


The Sprint MIND study looked specifically at the implications of aggressive blood pressure lowering on symptoms of dementia from any cause, and mild cognitive impairment, or MCI, a precursor to dementia.

It found that people whose blood pressure was lowered to below 120 had a 19 percent lower rate of new cases of mild cognitive impairment and a 15 percent reduction in MCI and dementia combined.

The takeaway of the study, said Dr. Keith Fargo, director of scientific and outreach programs at the Alzheimer’s Association, is “see your doctor and know your numbers,” and if individuals have hypertension, get it treated.

“Not only do we already know that it reduces the risk for death due to stroke and heart attacks but we now know it supports healthy brain aging,” he said in an interview.

Although the study showed effects on MCI and combined dementia plus MCI, it did not show an overall reduction in dementia alone, at least not yet.

Fargo said it takes longer for people to develop dementia, but as the study continues, he expects more people treated to the higher target of 140 will develop dementia.

“Since it’s too early, too few people have developed dementia,” he said.

The study looked at all causes of dementia, including Alzheimer’s, the most common form marked by clumps of amyloid in the brain, and vascular dementia, which is caused by blocked blood flow to the brain.

Fargo said the result most likely affects the impact of blood pressure lowering on vascular dementia but noted that many people with Alzheimer’s also have some degree of vascular disease, and reducing the total dementia risk could delay the onset of memory problems.

Reporting by Julie Steenhuysen; Editing by Bill Trott

Childhood heart defects tied to early dementia

UNTV News   •   February 13, 2018

People gather outside an office of the Russian federal migration service, with children seen playing in the foreground, in Belgorod, June 9, 2014. REUTERS/Vladimir Kornev

(Reuters Health) — People who survive childhood heart defects may have an increased risk of developing dementia before age 65, a Danish study suggests.

“Previous studies showed that people born with heart defects . . . may be at higher risk of neurodevelopmental problems in childhood, such as epilepsy and autism, but this is, to our knowledge, the first study to examine the potential for dementia later in adult life,” said lead study author Carina Bagge of Aarhus University Hospital in Denmark.

Compared to people born with normal hearts, adult survivors of childhood heart defects were more than twice as likely to develop so-called early-onset dementia by age 65, the current study found. These survivors were also 30 percent more likely to develop dementia after 65.

The dementia risk increased with the severity of heart defects. Mild to moderate defects were associated with 50 percent greater likelihood of dementia, while the odds were doubled with severe defects.

“We believe this study extends the knowledge of long-term neurological impairment and brain health,” Bagge said by email. “It will become increasingly important to understand the risk and challenges throughout a lifespan in the growing and aging group of adults living with congenital heart disease.”

Congenital heart disease can include structural malformations like a hole in the heart, leaky valves and defective vessels. These are among the more common birth defects, occurring in up to 1 in 100 live births, researchers note in Circulation.

Some cases are mild with few if any symptoms or can be treated with medications to lower blood pressure or control the heart rate, while more severe cases may require surgery or a heart transplant.

For the current study, researchers examined data 10,632 cases of dementia diagnosed in Danish adults born with heart defects, mostly after 1960. They matched each of these patients with 10 people of the same sex born in the same year who didn’t have heart defects.

The most common type of heart defects were so-called atrial septal defects, a hole in the wall between the heart’s upper chambers, which accounted for 26 percent of the cases. Ventricular septal defects, or a hole in the wall between the lower chambers, accounted for 22 percent of cases.

Overall, 4 percent of the people in the study developed dementia by age 80.

By 80 years of age, 60 percent of the people with heart defects had died, compared with 35 percent of individuals born without these problems.

The study wasn’t a controlled experiment designed to prove whether or how a heart defect at birth might directly cause dementia or trigger its development sooner.

Also, the authors note, the results may not reflect what would happen with children born today who have a greater range of treatment options and better survival odds than babies with heart defects a generation ago.

Even so, the findings add to growing evidence that heart problems can also affect the brain, said Dr. Ralph Sacco, head of neurology at the Miller School of Medicine at the University of Miami, Florida, and a former president of the American Heart Association.

“Congenital heart disease that leads to decreased function of the heart could lead to decreased blood flow to the brain, strokes and other vascular disease that affects the brain,” Sacco, who wasn’t involved in the study, said by email.

Survivors can help minimize their risk of dementia by adopting a heart healthy lifestyle, Sacco noted.

This includes maintaining a healthy weight, exercising, avoiding cigarettes, and making sure to check and control blood pressure, cholesterol and blood sugar. It also involves following a diet rich in whole grains, fruits, vegetables, poultry and fish with limited soda, sugary treats and red meat.

“Congenital heart disease survivors need to be even more vigilant about maintaining ideal cardiovascular health,” Sacco said.

SOURCE: bit.ly/2Exh255 Circulation, online February 12, 2018.

New blood pressure range means half of Americans have hypertension

UNTV News   •   November 14, 2017

FILE PHOTO: A photo illustration shows a stethoscope and blood-pressure machine of a French general practitioner displayed in a doctor’s office in Bordeaux January 7, 2015. REUTERS/Regis Duvignau


(Reuters) – Tighter blood pressure guidelines from U.S. heart organizations mean millions more people need to make lifestyle changes, or start taking medication, in order to avoid cardiovascular problems.

Americans with blood pressure of 130/80 or higher should be treated, down from the previous trigger of 140/90, according to new guidelines announced on Monday by the American Heart Association and the American College of Cardiology.

At the new cutoff, around 46 percent, or more than 103 million, of American adults are considered to have high blood pressure, compared with an estimated 72 million under the previous guidelines in place since 2003.

High blood pressure accounts for the second-largest number of preventable heart disease and stroke deaths in the United States, second only to smoking.

The guidelines do not change the definition of normal blood pressure as 120/80 or lower.

Potentially deadly high blood pressure can be brought under control with a wide array of medications, many sold as relatively inexpensive generics. The drug classes include angiotensin receptor blockers, such as Novartis AG’s Diovan, calcium channel blockers, like Pfizer Incs’s Norvasc, ACE inhibitors, including Pfizer’s Altace, and diuretics, such as Merck & Co Inc’s Hyzaar.

But the drugs have side effects and the new guidelines emphasize lifestyle changes including weight loss, diet and exercise as the first tool for combating hypertension.

“I think this will encourage both patients to adhere to recommendations but also clinicians to be more vigorous in their attempts to prescribe lifestyle changes,” said Dr. Pamela Morris, chair of the ACC’s committee on prevention of cardiovascular disease.

Lifestyle modifications are the cornerstone for treatment, but the guidelines also stress that patients assessed to be at high risk of cardiovascular problems will be started on medication.

A large, government-sponsored study of hypertension patients aged 50 and older showed in 2015 that death from heart-related causes fell 43 percent and heart failure rates dropped 38 percent when their systolic blood pressure was lowered below 120 versus those taken to a target of under 140.

But patients in the 120 systolic blood pressure group had a higher rate of kidney injury or failure, as well as fainting.

Concerns about those side effects, as well as the fact that the close monitoring seen in a clinical trial is hard to replicate, led the AHA, ACC and other groups to select the 130 systolic blood pressure target.

The new guidelines also emphasize the importance of accurate blood pressure measurements, using an average of different readings at different times.

Adults with blood pressure of 130/80 “already have double the risk of heart attack compared to someone in the normal range,” said Dr. Paul Whelton, professor at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans and lead author of the new guidelines. “It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

Reporting by Deena Beasley; Editing by James Dalgleish

Pregnant women need routine blood pressure checks

UNTV News   •   April 26, 2017

A child touches her pregnant mother’s stomach at the last stages of her pregnancy in Bordeaux April 28, 2010. REUTERS/REGIS DUVIGNAU

(Reuters Health) – Pregnant women should get their blood pressure checked at each prenatal visit to screen for preeclampsia, a potentially fatal complication that can damage the kidneys, liver, eyes and brain, new U.S. guidelines say.

While many doctors already monitor blood pressure throughout pregnancy, the U.S. Preventive Services Task Force (USPSTF) updated its guidelines for the first time since 1996 to stress that screening at every visit can help doctors catch and treat preeclampsia before it escalates from a mild problem to a life-threatening one.

“Preeclampsia is one of the most serious health problems affecting pregnant women,” task force member Dr. Maureen Phipps, a women’s health researcher at Brown University in Providence, Rhode Island, said by email.

“Because this condition is common and critical, the Task Force offers two separate recommendations to help women lower the risk associated with preeclampsia – screening for preeclampsia is recommended for all pregnant women, and women at high risk of developing the condition can take low-dose aspirin to help prevent it,” Phipps added by email.

The screening recommendations, published on Tuesday in JAMA, apply to women without a history of preeclampsia or high blood pressure. Separate guidelines advise low-dose aspirin after the first 12 weeks of pregnancy for women with a history of elevated blood pressure. (bit.ly/2oIwP5B)

Preeclampsia can progress quickly, and typically develops after 20 weeks of pregnancy. Blood pressure screening earlier in pregnancy can show normal results for women who go on to develop preeclampsia.

In addition to elevated blood pressure, women with preeclampsia may also have excess amounts of protein in their urine, as well as swelling in the feet, legs and hands.

Women may suffer from stroke, seizures, organ failure and in rare cases, death. For babies, complications include slower growth inside the uterus, low birth weight and death.

Risks for preeclampsia include a history of obesity, diabetes, kidney disease, lupus or rheumatoid arthritis, as well as a mother or sister who has experienced the condition.

Because the risks of preeclampsia increase with age, women may be able to lower their chances of developing this complication by having babies sooner, said Dr. Dana Gossett, an obstetrics and gynecology researcher at the University of California, San Francisco, and co-author of an accompanying editorial in JAMA.

“Beyond that, it is also important to ensure that all health problems are well managed prior to pregnancy,” Gossett said by email. “High blood pressure should be under good control, other diseases like kidney disease or lupus should be well controlled, and women should try to be close to their ideal body weight prior to conception.”

Checking blood pressure at every prenatal visit can help prevent complications for mothers and babies alike, said Dr. Martha Gulati, chief of cardiology at the University of Arizona College of Medicine in Phoenix and author of a separate editorial in JAMA Cardiology.

“This is something that should be provided to every woman as part of preventive care,” Gulati said by email. “We will save lives and prevent complications and death in pregnant women with this simple, cost-effective” test that doesn’t take much time.

SOURCE: bit.ly/2oGYMKe and bit.ly/2peNbnM JAMA, online April 25, 2017; and bit.ly/2q1qDH4 JAMA Cardiology, online April 25, 2017.


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