Tag: hypertension

Categories : Cardiovascular DiseaseTags :

Some Meds May be Raising Blood Pressure Unnecessarily

On By ModernMedia
Photo by Myriam Zilles at Unsplash

New research has found that nearly a fifth of adults with high blood pressure are taking a drug that may be raising their blood pressure further.

The findings presented at the American College of Cardiology’s 70th Annual Scientific Session. The results highlight the need for patients to regularly review all of the medications they take with their care team, including over-the counter drugs, to ensure none might interfere with blood pressure lowering efforts.

The research found that three most common culprits were antidepressants; nonsteroidal anti-inflammatory drugs (NSAIDs) that include ibuprofen and naproxen; and oral steroids used to treat conditions such as gout, lupus, rheumatoid arthritis or after an organ transplant. These drugs were reported by 9%, 7% and 2% of participants, respectively. Other drugs associated with blood pressure elevation included antipsychotics, certain oral contraceptives and popular decongestants.

Researchers said these findings raise concerns, especially as nearly half of Americans diagnosed with high blood pressure do not have it sufficiently controlled. Dr. Vitarello explained the goal blood pressure for hypertension patients is a reading of less than 130 mmHg over 80 mmHg, based on the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

“These are medications that we commonly take—both over-the-counter and prescribed medications—that may have the unintended side effect of raising blood pressure and could have adverse effects on our heart health,” said John Vitarello, MD, an internal medicine resident at Beth Israel Deaconess Medical Center in Boston and the study’s lead author. “We know that high blood pressure leads to cardiovascular disease, stroke and death and even small increases in blood pressure can have meaningful impacts on cardiovascular disease. Based on our findings, we need to be more aware of polypharmacy (the use of multiple medications by a single patient) in older adults who also have the highest burden of high blood pressure.”

The study examined data from 27 599 participants in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018. About half of the participants (49%) had hypertension (average age 55 years, 48% female), defined in the study as a blood pressure reading of ≥ 130 mmHg (systolic) or ≥80 mmHg (diastolic) or ever having been told they have high blood pressure. Researchers identified medications associated with blood pressure elevation based on those listed in the ACC/AHA guideline and examined use of these medications by hypertensive adults

Among hypertensive participants, 19% reported using one or more blood pressure raising medications and 4% reported using multiple. Nearly one-quarter (24%) of women with high blood pressure reported using a blood pressure raising medication compared with 14% of men. Older adults were more likely to be using blood pressure raising medications than younger adults (19% of participants over age 65 vs. 18% of participants under age 65).

Vitarello said the findings suggest that there may be opportunities to treat hypertension by switching out the drugs raising blood pressure rather than adding more anti-hypertensives. Some drugs may have the same benefit but impact on blood pressure less. Still, some patients may not have another medication option, so monitoring and talking to their care team is advised over stopping medications.

The researchers also estimated that if half of hypertensive US adults taking blood pressure raising drugs were to discontinue one of them, 560 000 to 2.2 million patients could be able to reach blood pressure goals without additional drugs. But Vitarello cautioned that this is only a preliminary analysis, and individual responses to stopping blood pressure drugs are variable, so the real-world benefit and tradeoffs of stopping these medications need to be further studied.

The study is limited in that it relies on participants’ self-report of having high blood pressure and an accurate accounting of all the medications they take. The study was funded by the National Institute on Aging and an ACC Fellows Career Development Award.

Source: American College of Cardiology

Categories : Ageing Cardiovascular DiseaseTags :

Cannabis can Lower Hypertension in Older Adults

On By ModernMedia

Adding to a growing body of evidence as to its health benefits, medical cannabis may lower blood pressure in older adults, according to research from Ben-Gurion University of the Negev (BGU) and its affiliated Soroka University Medical Center.

This is the first such study to investigate cannabis’  effect on blood pressure, heart rate and metabolic parameters in hypertensive adults 60 and older.

“Older adults are the fastest growing group of medical cannabis users, yet evidence on cardiovascular safety for this population is scarce. This study is part of our ongoing effort to provide clinical research on the actual physiological effects of cannabis over time,” said Dr Ran Abuhasira, BGU Faculty of Health Sciences and BGU-Soroka Cannabis Clinical Research Institute

Before and three months after beginning medical cannabis therapy, patients in the study were evaluated using 24-hour ambulatory blood pressure monitoring, ECG, blood tests, and body measurements. Patients ingested cannabis either orally in the form of oil extracts or by smoking.

The findings included a significant drop in 24-hour systolic and diastolic blood pressure values, with the lowest point occurring three hours after ingesting cannabis. Both daytime and nighttime reductions in blood pressure were observed, with more greater changes at night. Higher nighttime than daytime blood pressure may also raise the risk of Alzheimer’s disease, so lowering it at night may offer that benefit.

The pain relief from taking cannabis, often a reason for prescriptions, may also have resulted in a reduction of blood pressure, the BGU researchers postulated.

“Cannabis research is in its early stages and BGU is at the forefront of evaluating clinical use based on scientific studies,” said Doug Seserman, chief executive officer of American Associates, BGU. “This new study is one of several that has been published recently by BGU on the medicinal benefits of cannabis.”

Source: News-Medical.Net

Journal information: Abuhasira, R., et al. (2021) Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study. European Journal of Internal Medicine.doi.org/10.1016/j.ejim.2021.01.005.

Categories : UncategorizedTags :

Hypertension at Night Raises Cardiovascular Disease Risk

On By ModernMedia

An eight year long study conducted in Japan added to the evidence that hypertension during the night raises cardiovascular disease risk, especially compared to the daytime. 

Hypertension levels are usually assessed during the day, and do not give an accurate snapshot of a person’s circadian rhythm.  According to lead author of the study, Kazuomi Kario, MD, PhD, hypertension at night, especially when blood pressure is lower during the day, raises cardiovascular disease risk and is increasingly being recognised as a risk factor. Kario said, “This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure and different nighttime blood pressure phenotypes than have been reported previously.”

The Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study enrolled 6359 patients and measured daytime and nighttime levels using an at-home, wearable, ambulatory monitor. They were told to conduct their daily routine as normal, and to rest or sleep during the night. The results showed that elevated blood pressure during the night compared to the day was a significant indicator of raised cardiovascular disease risk. Patients who were hypertensive and then had a large dip in systolic pressure had a greater risk for stroke.

“Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events,” said Dr Kario. “The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period.”

Source: Medical Xpress

Categories : UncategorizedTags :

Algorithm-driven Treatment Lowers LDL-c, Blood Pressure

On By ModernMedia

Clinicians working at Brigham and Women’s Hospital in the US treated patients with the aid of digital tools and an algorithm which calculated the titration of medication for pharmacists.

Over 5000 patients were enrolled into the study, entering either the cholesterol control program, the hypertension program, or both. Of those in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes without ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-c) >190 mg/dL. 

Study lead author Benjamin Scirica, MD, MPH, a cardiologist at Brigham and Women’s Hospital and associate professor of medicine at the Harvard School of Medicine, said, “To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care.”

Patients with high LDL-c and/or hypertension were identified using electronic patient records, and received a digital blood pressure cuff for at-home monitoring. With the aid of the algorithm, pharmacists and support staff initiated and titrated medication.

For patients who completed the titration phase of the program, a 52mg/dL (42%) decrease in LDL-c was observed, while for all patients, LDL-c levels dropped by 24mg/dL (18%) and 14mmHg systolic and 6mmHg diastolic blood pressure drops were recorded. Patients in high-risk categories saw significant drops in LDL-c.

The research showed that efficient, effective care was possible, while simultaneously reducing the need for physical consultations. Such enabling technology allows access to care delivery to be significantly expanded.

Source: Science Daily

Categories : Cardiovascular DiseaseTags :

A Bad Rap? Statins Have “Nocebo” Effect

On By ModernMedia

According to an article by the BBC, new research funded by the Imperial Heart Foundation indicates that a significant portion of statins’ adverse side effects are attributable to the “nocebo” effect. 

Statins are one of the most prescribed tablets in the UK, used to lower low-density lipoprotein (LDL) cholesterol and triglycerides levels, and raise high-density lipoprotein (HDL) cholesterol. The effects help prevent heart attacks and stroke, but nearly a fifth of patients stop taking them due to side effects such as joint pain, muscle ache, fatigue and nausea. In 60 patients were recruited, who had all stopped taking statins due to their adverse effects. On a scale of 0 to 100, those taking placebo tablets reported a similarly high score (15.4) to those taking statins (16.3), compared to a group receiving no tablets (8).  The effect was so strong that many patients discontinued the dummy pills. 

The nocebo effect is the inverse of the placebo effect, where patients experience adverse effects even when they are taking a placebo. This is thought to explain why there is such a high prevalence of penicillin allergies when testing proves otherwise. 

Once the patients were talked through the nocebo effect, most were able to resume statins. It is not known as to why statins have such a powerful nocebo effect, although some attribute this to media creating a “self-fulfilling destiny”.

“If you stopped a man in the street and asked how do you feel about an aspirin or a statin a day, I think people would be much more positive about the aspirin,” said one of the researchers, Dr James Howard.