High Blood Pressure Treatment For The Over 80s Too Aggressive, Warns Expert

People over 80 years are being treated too aggressively for high blood pressure, warns an expert in an editorial in BMJ Clinical Evidence this week.

26 dec 2009--According to Dr James Wright, the latest evidence suggests that less aggressive drug therapy may be more effective at reducing mortality in this age group. Based on this evidence, he suggests clinicians change what they are presently doing and move towards a more conservative approach for people aged over 80.

Despite limited evidence about high blood pressure (hypertension) treatment in the over 80s, UK and US guidelines recommend that people over 80 should receive the same treatment as people of any other age. This means using combinations of drugs to reach a target blood pressure of 140/90 mmHg.

But could this be doing more harm than good, asks Wright?

He points to the results of a recently updated Cochrane review which suggest that our present approach may be "excessively aggressive."

This review includes data from two new trials which looked specifically at the effect of antihypertensive drugs in people over the age of 80. Interestingly, the only trial that found a significant reduction in mortality was the most conservative in terms of number of drugs and dose of drugs allowed. The treatment regime involved three easy steps, with a target blood pressure of 150/80 mmHg.

Using this approach would require little adjustment of drug doses and would markedly simplify and reduce the cost of managing these patients, says Wright.

However, he points out that only half of the people on this regimen would achieve a target blood pressure of 150/80 mmHg. This is below recommendations set out for UK GPs in the Quality and Outcomes Framework (QOF), which suggest that 70% of all patients should meet treatment targets.

Trials are now needed to compare this conservative approach with the more aggressive treatment strategies in common use today, he writes. In the meantime, clinicians should change what they are presently doing and move towards a more conservative approach for people aged over 80.

Source
British Medical Journal

Loneliness Linked To High Blood Pressure In Aging Adults

08 oct 2009--Loneliness is a major risk factor in increasing blood pressure in older Americans, and could increase the risk of death from stroke and heart disease, new research at the University of Chicago shows.

Scholars found that lonely people have blood pressure readings that are as much as 30 points higher than in non-lonely people, even when other factors such as depressive symptoms or perceived stress are taken into account, said Louise Hawkley, Senior Research Scientist with the Center for Cognitive and Social Neuroscience at the University of Chicago, and John Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology. This is equivalent to the difference between a normal blood pressure of 120 and a level of 150 which signifies Stage 1 hypertension. Blood pressure differences between lonely and non-lonely people were smallest at age 50 and greatest among the oldest adults tested, those at retirement age.

Hawkley and Cacioppo are authors of the paper, "Loneliness is a Unique Predictor of Age-Related Differences in Systolic Blood Pressure," published in the journal Psychology and Aging. Other co-authors were Christopher Masi, Assistant Professor of Medicine at the University of Chicago, and Jarett Berry of the Department of Preventive Medicine, Northwestern.

The increase in blood pressure associated with loneliness is about the same magnitude as reductions attained through weight loss and regular physical activity in people suffering from hypertension. "By these standards, improvements in a sense of social connectedness may have clinical benefits comparable to lifestyle modifications," the authors wrote.

The team based their research on a study of 229 people aged 50 to 68. The randomly chosen group includes whites, African Americans and Latinos who are part of a long-term study on aging. Members of the group were asked a series of questions to determine if they perceived themselves as lonely.

They were asked to rate their connections with others through a series of topics, such as "I have a lot in common with the people around me," "My social relationships are supeficial," and "I can find companionship when I want it."

The research team also examined data on weight, alcohol consumption, smoking, blood pressure medications, and demographic characteristics and found that people who rated high on being lonely had a significantly higher blood pressure than non-lonely people with similar profiles on the other measures.

The research also showed that the normal increases in blood pressure associated with aging are augmented by loneliness.

The paper builds on Cacioppo's earlier research that demonstrated that the loneliness is related to increased peripheral vascular resistance among young people. Although both lonely and non-lonely people in that study experienced stress, subjects in both studies reacted to stress differently.

"Lonely people differ from non-lonely individuals in their tendency to perceive stressful circumstances as threatening rather than challenging, and to passively cope with stress by failing to solicit instrumental and emotional support and by withdrawing from stress rather than by actively coping and attempting to problem solve," Cacioppo said.

The study on young people showed that stress caused an increase in resistance to blood flow brought on by their response to stress. Greater resistance to blood flow in lonley people compared to non-lonely idnvidiauls could increase blood pressure over the lifetime of lonely people, Cacioppo said.

Longitudinal studies are underway to look at how loneliness, now associated with an increase in blood pressure, may play a causal role in the increase, he said.

"I'm surprised by the magnitude of the relationship between loneliness and hypertension in this well-controlled cross-sectional study," said Richard Suzman, Ph.D., director of the Behavioral and Social Research Program at the National Institute on Aging (NIA), a funder of the research "Older people's relationships are often disrupted by death, illness and geographic mobility. One of NIA's goals is to help determine what can be done to improve the quality of relationships and social connectedness as a way to ease loneliness and reduce blood pressure."

Common virus may cause high blood pressure: study

CHICAGO, 17 may 2009- A common virus may be a major cause of high blood pressure, researchers said on Thursday in a finding that may bring new approach to treating a condition that affects an estimated 1 billion people worldwide.

Based on a series of studies in mice, they said cytomegalovirus or CMV -- a herpes virus that affects some 60 to 99 percent of adults globally -- appears to increase inflammation in blood vessels, causing high blood pressure.

And when combined with a fatty diet, CMV may also cause hardening of the arteries, a major risk factor for heart attacks, strokes, and kidney disease, they said.

"I think it could be very important," said Dr. Clyde Crumpacker of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, who worked on the study in the Public Library of Science Journal PLoS Pathogens.

"It may suggest a whole new way of looking at high blood pressure and vascular disease," Crumpacker said in a telephone interview.

He said the research offers the first direct proof that the virus causes persistent infection in blood vessels. Doctors typically use generic drugs such as beta blockers and ACE inhibitors to control blood pressure, a condition that affects one in every three adults in the United States.

Crumpacker said the study suggests vaccines and antiviral drugs may offer a new approach at treating hypertension.

Currently, there is no vaccine, but several companies, including Sanofi-Aventis, Novartis , GlaxoSmithKline PLC and Vical, are working on them.

And Swiss drugmaker Roche Holding AG makes an antiviral drug called Valcyte to prevent CMV infections in transplant recipients.

CMV AND DIET

By age 40, most adults will have been exposed to CMV, although many never experience any symptoms. But the virus can cause harm in people with compromised immune systems, such as transplant recipients, and it is a major cause of birth defects in babies whose mothers were infected during pregnancy.

In one experiment, Crumpacker and colleagues examined four groups of lab mice. Two were fed a standard diet and two were fed a high fat diet. After for weeks, half of the mice from the standard and fatty diet groups were exposed to the virus.

Six weeks later, mice in both infected groups had elevated blood pressure, but 30 percent of infected mice on high cholesterol diet also showed signs of atherosclerosis.

"This strongly suggests that the CMV infection and the high cholesterol diet might be working together," Crumpacker said.

In another study of kidney cells in infected mice, the team found high levels of the enzyme renin, which is known to cause high blood pressure. They found the same high rates of the enzyme in human blood vessel cells infected with CMV.

And they found that CMV infection increased markers for inflammation in blood vessels.

More research is needed looking at the role of viruses in causing heart disease, but Crumpacker said the findings suggest new treatment possibilities.

"Some cases of hypertension might be treated or prevented by antiviral therapy or a vaccine against CMV," he said.

Rapid growth in heart meds seen in younger patients

By Bill Berkrot 40 minutes ago
Growth in prescription drug use among younger adults for heart disease-related conditions, such has high cholesterol and high blood pressure, is outpacing that among older adults, according to a study by Medco Health Solutions Inc.
While heart disease is usually associated with an older population, people are beginning to take medicines that could help prevent heart problems at a much younger age, according to data collected by Medco, a pharmacy benefit manager.
High cholesterol and high blood pressure are among the leading risk factors for heart disease, heart attack and stroke.
"We were pretty surprised by the rapid increase in a short time frame in this age group," Dr. Robert Epstein, Medco's chief medical officer, said in an interview. "Certainly it's a sign of the epidemic of overweight and obesity in this country, which are underlying factors."
Between 2001 and 2006, the number of 20-to-44-year-olds taking prescription medicines to treat high cholesterol increased 68 percent. The estimated number of patients on lipid-lowering drugs in that age group nationwide rose to 4.2 million in 2006 from 2.5 million in 2001, said Medco, which has a large mail-order pharmacy operation.
The use of anti-hypertensives jumped 21 percent among the age group, with those on medication to control high blood pressure rising to 8.5 million from 7 million in the six-year period, according to Medco's analysis of the data.
Those numbers should put a smile on the faces of drug company executives, as these medications, once started, are usually taken for life. An earlier start translates into many more years of sales.
"In general, people are less bothered by taking prescription drugs than they used to be," Epstein said.
The increase in the number of 20-to-44-year-olds on lipid-lowering medications was 37 percent higher than it was for those ages 45 to 64, and 31 percent higher than among patients 65 and older.
Growth in those on blood pressure medicines among the younger age group was 52 percent greater than among 45-to-64-year-olds and more than double the growth seen among senior citizens.
"It's another signal that we have an issue in this country that we have to get our arms around sooner rather than later because we are destining these young people to lifelong therapy," Epstein said, stressing the importance of diet and exercise lifestyle adjustments.
But the findings also are a sign that people are addressing medical problems sooner and possibly heading off suffering and much higher health care costs down the road.
"The good news part of the story is that prevention is really important," Epstein said. "It's not bad that people get these problems controlled at a younger age because it will reduce the lifelong complications."
In addition, he noted: "A lot of these therapies are going or have gone generic, so the actual costs are not going to be as high as they had been five or 10 years ago."
Medco got its data from a representative sample database of 2.5 million of the 60 million people for whom it serves as a benefits manager.

Hot flashes linked to high blood pressure

NEW YORK (Reuters Health) - While past research has shown a link between menopause and high blood pressure, a new study suggests there is a relationship between hot flashes and high blood pressure, independent of menopausal status.
In the study, reported in the journal Menopause, ambulatory blood pressure monitors worn for 24 hours recorded awake and sleep blood pressure of 154 women, ranging in age from 18 to 65 years (with an average age of 46), no previous cardiovascular disease and either mildly elevated or normal blood pressure.
One third of the women reported having hot flashes within the past 2 weeks, note Dr. Linda Gerber of Weill Medical College of Cornell University, New York, and colleagues.
The average values for systolic blood pressure (the top number of the blood pressure reading), while awake and asleep were significantly higher in the women who had experienced hot flashes compared with women who did not.
In women with hot flashes, average systolic awake and sleep blood pressure was 141 and 129 mm Hg, respectively - this compared with 132 and 119 mm Hg, respectively, for women not reporting hot flashes.
Hot flashes continued to predict higher systolic awake and sleep systolic blood pressure after controlling for race, ethnicity, body mass index and "even after adjusting for whether they were premenopausal, menopausal, or postmenopausal," Gerber said in a statement.

Special chiropractic adjustment lowers blood pressure

A Chicago-area study of 50 individuals with a misaligned Atlas vertebra (located high in the neck) and high blood pressure showed that after a one-time specialized chiropractic adjustment, blood pressure decreased significantly. The decrease was equal to taking two blood-pressure drugs at once. The results are published in the online March 2 issue of the Journal of Human Hypertension.
According to lead author George Bakris, MD, director of the hypertension center at the University of Chicago Medical Center, unlike other vertebrae, which interlock one to the next, the Atlas (also known as C-1) relies solely upon soft tissue (muscles and ligaments) to maintain alignment; therefore is uniquely vulnerable to displacement. Displacement of C-1 can occur without pain and thus, often goes undetected and untreated.
A small cadre of chiropractic specialists have foregone typical "full-spine manipulations," limiting their practice to precise, delicate manual alignment of a single vertebra, C-1. These practitioners make up the National Upper Cervical Chiropractic Association (NUCCA).
http://www.eurekalert.org/pub_releases/2007-03/uocm-sca_1031407.php