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Uncontrolled Hypertension: The Old ‘Silent Killer’ is Alive and Well

The AHA! Team — Mon, 18 Nov 2024 06:53:13 +0000

Florida Atlantic University via EurekAlert! – In the United States and worldwide, cardiovascular disease is the leading avoidable cause of premature death and disability. Primarily heart attacks and stroke, cardiovascular disease accounts for more than 900,000 annual deaths nationally and about 10 million deaths globally. Uncontrolled hypertension or high blood pressure is a major risk factor for stroke and heart attacks. Prevention and management of cardiovascular disease involves therapeutic lifestyle changes such as diet and exercise and adjunctive drug therapies of proven benefit. In a commentary published in The American Journal of Medicine, researchers from Florida Atlantic University’s Schmidt College of Medicine and colleagues alert health care providers that the old “silent killer” is alive and well. “Health providers should be aware that uncontrolled hypertension is one of the most common, serious and increasing conditions in their patients,” said Stacy Rubin, M.D., senior author and an assistant professor of medicine, FAU Schmidt College of Medicine. “Health providers urgently need to control blood pressure and should be mindful that sudden cardiac death accounts for 50% of deaths from cardiovascular disease and is the first symptomatic event in about 25% of cases. Moreover, for 76% of stroke patients, the initial presenting symptom is the stroke itself.” The authors note that controlling hypertension is effective and, at least in theory, straightforward. Landmark U.S. study in the 1970s, about 50% of patients were aware of their high blood pressure Before the Hypertension Detection and Follow Up Program, a landmark study conducted in the 1970s in the U.S., only about 50% of patients were aware of their high blood pressure. Of those, only 50% were actively treated. Of that group, only 50% received effective treatment. Therefore, only one-eighth of all patients were effectively treated. Today, these figures show that 54% are aware of their high blood pressure, 40% are actively treated and 21% are actively controlled. Guidelines have been developed in many countries worldwide and all tend to emphasize the need for strict control. According to the latest guidelines from the American Heart Association and the American College of Cardiology, healthy individuals should have a systolic blood pressure of 130 millimeters of mercury (mmHg) or less, and a diastolic blood pressure of 80 mmHg or less. “With these latest definitions, hypertension affects about 45% of the U.S. adult population,” said Panagiota “Yiota” Kitsantas, Ph.D., co-author and professor and chair of the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. “Another clinical challenge is metabolic syndrome, which includes central adiposity, high triglycerides, low high-density lipoprotein cholesterol, elevated fasting blood glucose and hypertension.” Metabolic syndrome is a chief risk factor for heart attacks and stroke in the U.S. The authors caution that metabolic syndrome is a chief risk factor for heart attacks and stroke in the U.S., which is the heaviest society in the world. “For patients with metabolic syndrome, we believe that angiotensin converting enzyme or ACE inhibitors or their more potent next generation drugs, the receptor blockers, are the first drug of choice,” said Charles H. Hennekens, M.D., Dr.PH., co-author, and corresponding author, the first Sir Richard Doll Professor of Medicine, senior academic advisor, and a professor of preventive medicine in the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. “These drugs have beneficial effects on heart attacks, stroke, and kidney disease, another major consequence of untreated hypertension.” Making positive lifestyle changes like losing weight, being more physically active, and cutting down on salt intake has been shown to be beneficial for managing blood pressure. For those whose blood pressure is above 130/80, a combination of these lifestyle changes along with medications can safely and effectively lower blood pressure. Medications are typically started for individuals whose pressure remains above 140/90 despite these lifestyle changes. The authors suggest that both health providers and patients should be aware of the variability of blood pressure from day-to-day and from morning to night. As such, effective treatment is complicated by the health provider’s need to produce an algorithm to each of their patients. In addition, the patient must take an active role in monitoring their blood pressure. For this reason, the American Heart Association and the American College of Cardiology recommend the Omron blood monitor, which is used to measure blood pressure levels at home. Health providers should counsel their patients to check their blood pressure each morning and night “Health providers should counsel their patients to check their blood pressure each morning and night and whether to administer a particular drug or its dose, which should be adjusted accordingly based on the average of three readings taken about five minutes apart,” said Hennekens. “While uncontrolled hypertension remains alive and well in the U.S. and worldwide, strict attention to these issues by health providers has the potential to ‘kill the old silent killer.’” Co-authors are Barry R. Davis, M.D., Ph.D., professor emeritus of biostatistics and data science, University of Texas – Houston School of Public Health; Jared Greenwald, a high school and pre-medical student; John Dunn and Alexandra Matarazzo, both second-year medical students at FAU; and Katerina Benson, a second-year pre-medical student at FAU. Hennekens served as principal investigator (PI) of the Coordinating Center for the landmark National Heart Lung and Blood Institute (NHLBI) funded Trials of Hypertension Prevention multicenter randomized trials for both phases I and II. Davis served as PI of the Coordinating Center for the landmark NHLBI funded Anti-Hypertensive and Lipid Lowering to Prevent Heart Attack multicenter randomized trials. – FAU – Journal The American Journal of Medicine DOI 10.1016/j.amjmed.2024.07.005 To read the original article click here.

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Fitful Nightly Sleep Linked to Chronic Inflammation, Hardened Arteries

AHA Publisher — Wed, 10 Jun 2020 07:00:25 +0000

University of California – Berkeley via EurekAlert – Disrupted nightly sleep and clogged arteries tend to sneak up on us as we age. And while both disorders may seem unrelated, a new study from the University of California, Berkeley, helps explain why they are, in fact, pathologically intertwined. UC Berkeley sleep scientists have begun to reveal what it is about fragmented nightly sleep that leads to the fatty arterial plaque buildup known as atherosclerosis that can result in fatal heart disease. “We’ve discovered that fragmented sleep is associated with a unique pathway — chronic circulating inflammation throughout the blood stream — which, in turn, is linked to higher amounts of plaques in coronary arteries,” said study senior author Matthew Walker, a UC Berkeley professor of psychology and neuroscience. The findings, published June 4 in the journal PLOS Biology, adds poor sleep as a key risk factor for cardiovascular disease, which ranks as the top killer of Americans, with some 12,000 deaths each week — although COVID-19, which has killed, on average, 1,000 a day during the pandemic in the U.S., comes close. “To the best of our knowledge, these data are the first to associate sleep fragmentation, inflammation and atherosclerosis in humans,” said study lead author Raphael Vallat, a postdoctoral researcher in Walker’s Center for Human Sleep Science at UC Berkeley. Established risk factors for cardiovascular disease in humans include poor diet, lack of exercise, obesity, high blood pressure and smoking. Using statistical modeling, the researchers analyzed the diagnostic data of more than 1,600 middle-aged and older adults using a national dataset known as the Multi-Ethnic Study of Atherosclerosis. To isolate the effect of sleep quality on heart health, the study controlled for age, ethnicity, gender, body mass index, sleep disorders, blood pressure and high-risk behaviors such as smoking. The researchers then tracked the results of the study participants, analyzing their blood tests, their calcium scores that can gauge plaque buildup, as well as several different measures of sleep, including wristwatch-assessed sleep across a week and a night in a sleep laboratory that measured electrical brainwave signals. The final outcome clearly linked disrupted sleep patterns to higher concentrations of circulating inflammatory factors and, specifically, of white blood cells known as monocytes and neutrophils, which are key players in atherosclerosis. “In revealing this link with chronic inflammation, the findings suggest a missing middleman that is brokering the bad deal between fragmented sleep and the hardening of blood vessels,” Walker said. “Indeed, these associational results in humans mirror recent data in which experimentally manipulated sleep disruption in mice led to higher levels of circulating inflammation that caused atherosclerotic lesions in the rodents,” added Vallat. The findings linking poor sleep to atherosclerosis via chronic inflammation have major public health implications, researchers said. For example, atherosclerosis often begins in early adulthood. “Unfortunately, this process goes largely unnoticed until the plaque buildup, in middle or old age, suddenly blocks arterial blood flow to the heart, lungs, brain and/or other organs, hence its moniker, ‘silent killer,'” said Vallat. “The insidious nature of the disease requires that we pay attention to our sleep hygiene, even starting in early to midlife,” said study co-lead author Vyoma Shah, a doctoral student in Walker’s lab. To more accurately gauge one’s sleep quality, the researchers recommend the use of clinical grade sleep trackers, because the study found that people’s subjective assessments of their sleep were not reliable. “If you track your sleep patterns using objective measures, the same way you track your weight, blood pressure or cholesterol, you can make modifications to your sleep habits, which could make a tangible difference to later life health outcomes,” said Shah. With chronic inflammation shaping up to be a bridge connecting poor sleep to cardiovascular disease, it’s worth exploring its role in a plethora of other diseases where inflammation is known to be a possible factor, the researchers said. “This link between fragmented sleep and chronic inflammation may not be limited to heart disease, but could include mental health and neurological disorders, such as major depression and Alzheimer’s disease,” Walker said. “These are new avenues we must now explore.” To read the original article click here.

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