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Category: blood pressure

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The bottom line: for better health be physically active at least is 2.5 hours of week. Note that HbA1c is a measure of glycated hemoglobin which identifies average plasma glucose concentration (and lower is better). From Medscape:

Exercise Tied to Cardiometabolic Markers in Clinic Patients 

Healthy, middle-aged outpatients who were physically active for at least 2.5 hours a week had better blood pressure and blood glucose levels than their sedentary peers in a large cross-sectional study in California. The differences were especially notable in women, in this study published online December 18, 2014 in Preventing Chronic Disease.

Men and women who were consistently physically active—defined as performing moderate to vigorous activity such as brisk walking for at least 150 minutes a week, as self-reported at all three outpatient visits in a 33-month period—had lower diastolic blood pressure, glucose, and HbA1c levels than patients not reporting exercise at that level.

Moreover, on a population level, the observed associations "were comparable to those needed to reduce the risk of coronary heart disease, stroke, and diabetes," they continue. "If healthcare providers would routinely assess the physical activity of their patients and refer those who are physically inactive to effective physical-activity programs, it may reduce the burden of future chronic diseases."

They analyzed electronic records from over 622,000 adults covered by Kaiser Permanente Southern California healthcare insurance who made at least three clinic visits between April 2010 and December 2012 and were not being treated for diabetes or hypertension.

The consistently active women had systolic and diastolic blood pressures that were 4.60-mm-Hg lower and 3.28-mm-Hg lower, respectively, than inactive women. Perhaps surprisingly, somewhat active women had slightly better blood-pressure values than the more active group.

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Further reasons to try to consume foods and beverages from glass containers and avoid cans and plastic bottles. Note that the BPA caused changes within 2 hours, and that BPA-free alternatives may be no better than BPA. Some researchers are speculating whether the high incidence of hypertension is linked to the prevalence of BPA in our environment. From Medical Xpress:

Cans lined with Bisphenol A may increase blood pressure

Drinking or eating from cans or bottles lined with Bisphenol A (BPA) could raise your blood pressure, according to new research reported in the American Heart Association's journal Hypertension. BPA, a chemical used as an epoxy lining for cans and plastic bottles, is everywhere, and its consumption has been associated with high blood pressure and heart rate variability. Previous studies have shown that BPA can leach into foods and drinks.

"A 5 mm Hg increase in systolic blood pressure by drinking two canned beverages may cause clinically significant problems, particularly in patients with heart disease or hypertension," said Yun-Chul Hong, M.D., Ph.D., study author... "A 20 mm Hg increase in systolic blood pressure doubles the risk of cardiovascular disease."

In this study, researchers conducted a randomized crossover trial recruiting 60 adults, mostly Korean women, over the age of 60 from a local community center. Each trial member visited the study site three times and was randomly provided with soy milk in either glass bottles or cans. Later urine was collected and tested for BPA concentration, blood pressure and heart rate variability two hours after consumption of each beverage.

Urinary BPA concentration increased by up to 1,600 percent after consuming canned beverages compared to after consuming the glass-bottled beverages.. Soy milk was the ideal beverage for the test because it has no known ingredient that elevates blood pressure, researchers said.

UPDATE: The NY Times has a nice write-up of this research with further details:

BPA in Cans and Plastic Bottles Linked to Quick Rise in Blood Pressure

A single instance of increased blood pressure may not be particularly harmful. But the findings suggest that for people who drink from multiple cans or plastic bottles every day, the repeated exposure over time could contribute to hypertension, said Dr. Karin B. Michels, an expert on BPA who was not involved in the new research.

BPA has been used since the 1960s to make countless everyday products like plastic bottles, food containers, contact lenses, and even sippy cups and baby bottles. The chemical can leach into food, and studies show that the vast majority of Americans who are tested have BPA in their urine.

The chemical is an endocrine disrupter that can mimic estrogen. In 2012, the Food and Drug Administration said BPA could no longer be used in baby bottles and children’s drinking cups. Canadian regulators formally declared BPA a toxic substance in 2010 and banned it from all children’s products.

Because of growing consumer concerns, some bottles and packaged food products now carry “BPA free” claims on their labels. However, these products often contain chemically similar alternatives – like bisphenol S. One study in the journal Environmental Health Perspectives found that plastic products advertised as BPA-free still leached chemicals with estrogenic activity – and some of these chemicals were even more potent than BPA.

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Think lifestyle changes, not medications. From Medical Daily:

Mild Hypertension Should Be Treated With Advice On Lifestyle Changes, Not Medication

In 2013, Dr. Iona Heath, a retired general practitioner published an article in the Journal of  the American Medical Association, in which she spoke about the side effects of overtreatment and overdiagnosis of mild hypertension. Now, in a new study, researchers revisit this idea, saying that unnecessary treatment of mild hypertension in low-risk patients is harming them and putting a burden on health care resources. They also argue that there's a need to reexamine criteria for diagnosing hypertension and treating blood pressure. 

About 40 percent of the world’s population, including 67 million American adults, have hypertension. Over half are classified as having mild hypertension. 

More than half of people with mild hypertension are treated with drugs, but there has been no evidence to suggest that blood pressure-lowering drugs prevent heart attacks. Instead of prescribing drugs to control mild hypertension, the authors urge clinicians to recommend healthier lifestyles to patients, which include exercising, quitting smoking, and decreased alcohol consumption. They also urge clinics to improve the accuracy of blood pressure-measuring instruments and to inform patients about measuring blood pressure at home. 

From Medical Xpress:

Experts raise concern over unnecessary treatment of mild hypertension in low risk people

Lowering the drug threshold for high blood pressure has exposed millions of low-risk people around the world to drug treatment of uncertain benefit at huge cost to health systems, warn US experts in BMJ today. Dr Stephen Martin and colleagues argue that this strategy is failing patients and wasting healthcare resources.

Over half of people with mild hypertension are treated with medication. Yet treating low risk mildly hypertensive patients with drugs has not been proven to reduce cardiovascular disease or death. The authors argue that overemphasis on drug treatment "risks adverse effects, such as increased risk of falls, and misses opportunities to modify individual lifestyle choices and tackle lifestyle factors at a public health level."

And for those over 65 the levels can be even higher. From Science News:

'Mild' control of systolic blood pressure in older adults is adequate: 150 is good enough

A broad review of the use of medications to reduce blood pressure has confirmed that "mild" control of systolic pressure is adequate for adults age 65 or older -- in the elderly, there's no clear benefit to more aggressive use of medications to achieve a lower pressure. Historically, most medical practitioners tried to achieve control of systolic pressure -- the higher of the two blood pressure readings -- to 140 or less. Recently changed guidelines now suggest that for adults over 60, keeping the systolic pressure at 150 or less is adequate, and this extensive analysis confirms that.

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From Science Daily:

High protein diets lead to lower blood pressure, study finds

Adults who consume a high-protein diet may be at a lower risk for developing high blood pressure, concludes a study that found participants consuming the highest amount of protein -- an average of 100 g protein/day -- had a 40 percent lower risk of having high blood pressure compared to the lowest intake level.

One of three U.S. adults has hypertension and 78.6 million are clinically obese, a risk factor for the development of hypertension. Because of the strain that it puts on blood vessel walls, HBP is one of the most common risk factors of stroke and an accelerator of multiple forms of heart disease, especially when paired with excess body weight.

The researchers analyzed protein intakes of healthy participants from the Framingham Offspring Study and followed them for development of high blood pressure over an 11-year period. They found that adults who consumed more protein, whether from animal or plant sources, had statistically significantly lower systolic blood pressure and diastolic blood pressure levels after four years of follow-up. In general, these beneficial effects were evident for both overweight (BMI ≥25 kg/m2) and normal weight (BMI <25 kg/m2) individuals. They also found that consuming more dietary protein also was associated with lower long-term risks for HBP. When the diet also was characterized by higher intakes of fiber, higher protein intakes led to 40-60 percent reductions in risk of HBP.

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Two studies about blood pressure and how it can be easily changed without medications. From Science Daily:

Small weight gain can raise blood pressure in healthy adults

Gaining a few pounds can increase blood pressure in healthy adults, researchers report. Increased fat inside the abdomen led to even larger increases in blood pressure, their study results showed. Many people understand the health dangers of large amounts of extra body weight, but researchers in this study wanted to see the impact of a small weight gain of about five to 11 pounds.

At the beginning of the eight-week study, a 24-hour monitor tested the blood pressure of 16 normal weight people. Their results were compared to 10 normal weight, healthy people who maintained the same weight over the eight weeks. Researchers found: -Those who gained weight had a systolic blood pressure (top number) increase from an average 114 mm Hg to an average 118 mm Hg. -Those who gained more weight inside their abdomen had a greater blood pressure increase. -A five to 11 pound weight gain didn't change cholesterol, insulin or blood sugar levels. The study was conducted in healthy people ages 18-48. 

From Science Daily:

Restricting calories may improve sleep apnea, blood pressure in obese people

Restricting calories may improve sleep apnea and reduce blood pressure in obese adults. Those who restricted their calories had higher levels of oxygen in their blood and a greater reduction in body weight, a study has demonstrated.

 "Losing weight was most likely the key to all the benefits observed in the calorie-restricted group. A greater reduction in systolic blood pressure can be explained, at least partially, by the reduction in body weight that was associated with reduction in obstructive sleep apnea severity and sympathetic nervous system activity." Systolic blood pressure is the top number in a blood pressure reading, which measures the force of the blood in the arteries when the heart is contracted.

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The great effects (especially for hemorrhagic stroke) were found in people eating just 1 1/2 portions of fresh fruit daily. The amazing part is that 6.3% admitted to never consuming fruit. From Science Daily:

Fruit consumption cuts cardiovascular disease risk by up to 40 percent

Daily fruit consumption cuts the risk of cardiovascular disease (CVD) by up to 40 percent, according to research. The findings from the seven-year follow-up study of nearly a half million people in the China Kadoorie Biobank found that the more fruit people ate, the more their risk of CVD declined.

Dr Du said: "CVD, including ischaemic heart disease (IHD) and stroke, is the leading cause of death worldwide. Improving diet and lifestyle is critical for CVD risk reduction in the general population but the large majority of this evidence has come from western countries and hardly any from China."

The current study included 451 681 participants with no history of CVD and not on anti-hypertensive treatment at baseline from the China Kadoorie Biobank(1) conducted in 10 different areas of China, 5 rural and 5 urban. Habitual consumption of fruit was recorded at baseline according to five categories: never, monthly, 1-3 days per week, 4-6 days per week, daily.

Over the seven year follow up period there were 19 300 cases of IHD and 19 689 strokes (14 688 ischaemic and 3562 haemorrhagic). Some 18% of participants consumed fruit daily and 6.3% never consumed fruit. The average amount of fruit eaten by the daily consumers was 1.5 portions (~150g).

The researchers found that compared to people who never ate fruit, those who ate fruit daily cut their CVD risks by 25-40% (around 15% for IHD, around 25% for ischaemic stroke and 40% for haemorrhagic stroke). There was a dose response relationship between the frequency of fruit consumption and the risk of CVD.

Dr Du said: "Our data clearly shows that eating fresh fruit can reduce the risk of cardiovascular disease, including ischaemic heart disease and stroke (particularly haemorrhagic stroke). And not only that, the more fruit you eat the more your CVD risk goes down. It does suggest that eating more fruit is beneficial compared to less or no fruit."

The researchers also found that people who consumed fruit more often had significantly lower blood pressure (BP). Eating fruit daily was associated with 3.4/4.1 mmHg lower systolic/diastolic BP compared to those who never ate fruit. 

In a separate analysis, the researchers examined the association of fruit consumption with total mortality and CV mortality in more than 61,000 patients from the China Kadoorie Biobank who had CVD or hypertension at baseline. They found that compared to those who never ate fruit, daily consumers of fruit cut their overall risk of death by 32%. They also reduced their risks of dying from IHD by 27% and from stroke by around 40%.

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Even though it looks to be a modest effect, it is still good news. But they should have added kefir to the list of probiotic containing foods. From Science Daily:

Eating probiotics regularly may improve your blood pressure

Eating probiotics regularly may modestly improve your blood pressure, according to new research in the American Heart Association journal  Hypertension. Probiotics are live microorganisms (naturally occurring bacteria in the gut) thought to have beneficial effects; common sources are yogurt or dietary supplements.

"The small collection of studies we looked at suggest regular consumption of probiotics can be part of a healthy lifestyle to help reduce high blood pressure, as well as maintain healthy blood pressure levels," said Jing Sun, Ph.D., lead author and senior lecturer at the Griffith Health Institute and School of Medicine, Griffith University, Gold Coast, Queensland, Australia. "This includes probiotics in yogurt, fermented and sour milk and cheese, and probiotic supplements."

Analyzing results of nine high-quality studies examining blood pressure and probiotic consumption in 543 adults with normal and elevated blood pressure, researchers found:

  • Probiotic consumption lowered systolic blood pressure (the top number) by an average 3.56 millimeters of mercury (mm Hg) and diastolic blood pressure (the lower number) by an average 2.38 mm Hg, compared to adults who didn't consume probiotics.
  • The positive effects from probiotics on diastolic blood pressure were greatest in people whose blood pressure was equal to or greater than 130/85, which is considered elevated.
  • Probiotics with multiple bacteria lowered blood pressure more than those with a single bacteria.

We believe probiotics might help lower blood pressure by having other positive effects on health, including improving total cholesterol and low-density lipoprotein, or LDL, cholesterol; reducing blood glucose and insulin resistance; and by helping to regulate the hormone system that regulates blood pressure and fluid balance," Sun said.

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Moderate levels of exercise seems to have tremendous benefits for everyone, but there are downsides to being an extreme exerciser.  From Science Daily:

Elderly men with high blood pressure lower death risk with moderate fitness

Elderly men with high blood pressure can lower their risk of death with even moderate levels of fitness. "This level of fitness is achievable by most elderly individuals engaging in a brisk walk of 20 to 40 minutes, most days of the week," said Charles Faselis, M.D., lead author of the study.

For the study, researchers assessed the fitness status of 2,153 men, aged 70 years and older with high blood pressure by a standard treadmill exercise test. Researchers applied the international units used to measure fitness, called metabolic equivalents (METs), to determine the men's peak fitness levels. After an average follow-up of nine years, researchers found that the risk of death was 11 percent lower for every one-MET increase in exercise capacity.

"For every 100 people who died in the least-fit category, 82 died in the low-fit, 64 in the moderate-fit and 52 in the high-fit categories," Kokkinos said. "The death rate is cut in half for those in the highest fitness category."

Too much exercise also has negatives for men. From Medical Xpress:

Too much prolonged high-intensity exercise risks heart health

Overdosing on high intensity exercise may actually increase the risk of death from a heart attack or stroke in those with existing heart disease, suggests German research published online in the journal Heart.

Similarly, a second Swedish study in the journal suggests that young men undertaking endurance exercise for more than five hours a week may increase their risk of developing an irregular heart rhythm in later life.

Both sets of findings indicate a J-shaped curve for the health benefits of exercise... And they describe "a similar U-shaped or reverse J-shaped pattern for the dose-response effect of exercise: maximum cardiovascular benefits are obtained if performed at moderate doses, while these benefits are lost with (very high) intensity and prolonged efforts."

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A small study, but interesting to see if it holds up. Note that watermelon extract is not actual watermelon. From Science Daily:

Chowing down on watermelon could lower blood pressure, study suggests

A new study by Florida State University Associate Professor Arturo Figueroa, published in the American Journal of Hypertension, found that watermelon could significantly reduce blood pressure in overweight individuals both at rest and while under stress.

The study started with a simple concept. More people die of heart attacks in cold weather because the stress of the cold temperatures causes blood pressure to increase and the heart has to work harder to pump blood into the aorta. That often leads to less blood flow to the heart.

Thus, people with obesity and high blood pressure face a higher risk for stroke or heart attack when exposed to the cold either during the winter or in rooms with low temperatures.

So, what might help their hearts? It turned out that watermelon may be part of the answer.

Figueroa's 12-week study focused on 13 middle-aged, obese men and women who also suffered from high blood pressure. To simulate cold weather conditions, one hand of the subject was dipped into 39 degree water (or 4 degrees Celsius) while Figueroa's team took their blood pressure and other vital measurements.

Meanwhile, the group was divided into two. For the first six weeks, one group was given four grams of the amino acid L-citrulline and two grams of L-arginine per day, both from watermelon extract. The other group was given a placebo for 6 weeks. Then, they switched for the second six weeks. Participants also had to refrain from taking any medication for blood pressure or making any significant changes in their lifestyle, particularly related to diet and exercise, during the study.

The results showed that consuming watermelon had a positive impact on aortic blood pressure and other vascular parameters. Notably, study participants showed improvements in blood pressure and cardiac stress while both at rest and while they were exposed to the cold water.

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Vegetarian diet lowers blood pressure without medications. From Medscape:

Vegetarian Diet Cuts Blood Pressure in Meta-Analysis

Eating a vegetarian diet is associated with reductions in blood pressure (BP) on par with adopting the DASH (low-sodium) diet, and roughly half that of starting pharmaceutical treatment, a new meta-analysis suggests .

"These findings establish the value of nonpharmacologic means for reducing BP," lead author on the study, Dr Yoko Yokoyama (National Cerebral and  Cardiovascular Center, Osaka, Japan). "Unlike drugs, there is no cost to a diet adjustment of this type, and all the 'side effects' of a plant-based diet are desirable: weight loss, lower cholesterol, and better blood sugar control, among others. I would encourage physicians to prescribe plant-based diets as a matter of routine and to rely on medications only when diet changes do not do the job."

Yokoyama et al's meta-analysis is published February 24, 2014 in JAMA Internal Medicine. The study is the latest to examine the health impact of a vegetarian-style eating pattern on cardiovascular disease risk factors.

The authors reviewed over 250 studies addressing vegetarian diets, ultimately including seven clinical trials (six of which were randomized) and 32 observational studies that included blood-pressure findings. Diets ranged from vegan to lacto-ovo vegetarian, with one study including fish, but no meat).

The authors found that reductions in both systolic and diastolic blood pressure were significantly greater for the vegetarian diets than for the comparator (omnivorous) diets, both in the pooled clinical trials and in the pooled observational studies, although drops were greater in the observational studies.

"This issue was examined by nearly 40 independent studies, some of which had hundreds or even thousands of participants, and the findings are strikingly consistent," Yokoyama said. "A vegetarian diet is clearly associated with lower blood pressure. Or, put another way, a meat-based diet is associated with higher blood pressure."

As with the DASH diet, the effect of switching to a vegetarian diet appears to be fairly rapid, and that's likely the result of two factors.