New Information on Blood Pressure

A new study about blood pressure will change the way doctors practice medicine. A single study will change the way I practice medicine, with guidelines from the American Heart Association and the National Institutes of Health soon to follow, says Marc Siegel in an article written for Slate and posted on Business Insider. Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at New York University’s Langone Medical Center.


It's easy to get confused by the overly dramatic daily news about health and medicine. One day coffee is great for you; the next day it interferes with sleep and leads to illness.

One day the plague is back; the next day it's Ebola or West Nile virus that is capturing attention. Healthcare stories ebb and flow as seen through the skewed eye of TV news.

But every now and then, a story comes along that literally changes the way I and other doctors practice medicine. It is difficult to overstate the importance of such a story.

One of the clues that we are in the medical-research big leagues is when a study is stopped early for dramatic, clear findings. That is what occurred this past week with the National Institutes of Health-sponsored Systolic Blood Pressure Intervention Trial, or Sprint.

Another clue is when the study is prospective (studying patient outcomes looking forward rather than looking backward at past behavior), successfully divides participants into two distinct groups, and provides an important answer to a lifesaving health question.

In this case the question is: What is a healthy blood-pressure goal? Doctors and their patients have long wondered what the magic number is for people at risk for heart attacks and strokes. Convention as well as guidelines have always been to keep a patient's blood pressure below 140 millimeters of mercury systolic.

By systolic I mean that first jet of blood pressure that shoots into the elastic arteries when the heart pumps; it's the first number given of a pair when blood pressure is measured. The diastolic blood pressure, or the lower number, is a measurement of the pressure left in the arteries when the heart rests.

One-third of all Americans suffer from high blood pressure, and everyone has a loved one with high blood pressure, so this concern is relevant to the entire country. Just half of those who are diagnosed with high blood pressure have it under control. Now we are redefining what "under control" means.

The Sprint study looked at more than 9,000 patients in 30 medical centers around the country from 2010 to 2013. When blood pressure was lowered to below 120 systolic as opposed to 140 systolic, there was a 30% decrease in heart failure, heart attacks, and strokes as well as a 25% decrease in death.

The study included the elderly, with an average age of 68. Fortunately, even with aggressive blood-pressure management, side effects did not increase.

In my experience, fear of side effects such as dizziness, impotence, and fatigue keeps many high-blood-pressure sufferers from maximizing their treatment options. Targeted diet, exercise, and weight loss are good first-line approaches, but many people require medication as well.

Now that I know there is a dramatic difference between a systolic blood pressure of 140 and 120 in those I treat, I will be much more proactive in trying to persuade my patients to target the lower number.

A single study will change the way I practice medicine, with guidelines from the American Heart Association and the National Institutes of Health soon to follow.

That's a pretty good day for a new health report in the media. It's also a solid reminder to me and other medical reporters not to hype the next diet or vitamin study. When a medical home run like this one comes along, I want to be taken seriously when I get excited.

MyAchingKnees comment: My blood pressure was always around 138/96 for the almost 30 years I would get routine checkups. I was routinely flagged for week long BP measurements and tracking. Eleven years ago I started taking high quality nutritinal supplements. My routine BP has always been around 122/82 since then. In fact, nurses taking my BP during vitals triage for medical and dental appointments always remark that I have good BP. Wasn't always that way. If people out there have high BP, I would suggest finding and taking a high quality nutritional supplement to see if they can obtain the same results.

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Too Much Salt Can Kill You

I was brought up to know that using too much salt is bad for you but often found myself using quite a bit of it. I think I'm going re-think my habitable after reading this article titled "Salt Can Be Fatal, says Study", by Elise Solé, on the Shine Staff, posted on Healthy Living on Yahoo!

A pinch of salt can perk up your morning omelet—but that innocent shaker is responsible for 2.3 million deaths around the world and 85,000 deaths per year in the United States, says a study released Thursday from Harvard's School of Public Health.

One in ten people die from heart attack, stroke, or other type of cardiovascular disease as a result of eating too much sodium, according to lead study author Dariush Mozaffarian, M.D., Ph.D., Associate Professor in the Department of Epidemiology at Harvard University.

Despite the fact that the World Health Organization recommends limiting sodium to less than 2,000 milligrams a day and the American Heart Association recommends 1,500 mg per day, the global national average for the U.S. is 4,000 mg of sodium," Mozaffarian told Shine. For perspective: One teaspoon of salt has 2,325 mg of sodium.

Researchers analyzed 247 national surveys of sodium intake in 66 countries between 1990 and 2010, then looked at studies that measured how high amounts of sodium affect blood pressure and the risk of cardiovascular disease, including heart disease and stroke. They also obtained the number of deaths from cardiovascular disease from the Global Burden of Disease study.

"Out of all the countries, the United States ranked 19th out of 30 of the largest countries for the most salt consumption relating to cardiovascular death," says Mozaffarian. "When people think of limiting salt, foods like potatoes chips and French fries come to mind but those mainly contain salt on the surface," he says. "Salt isn't just used for taste; it's also used as a preservative in packaged foods like bread and canned foods such as soup which Americans eat a lot of."

Salt is a hard habit to shake, for a few reasons: For starters, along with sweet, sour, bitter, and savory, salt is one of the five basic tastes. Just like some people have a sweet tooth, others crave salt often. Second, a salty tooth may be biologically-determined. Some studies suggest that babies whose mothers suffer from morning sickness have above-average salt appetites because vomiting decreases sodium levels in her body and in the fetus. And other research suggests that stress or anxiety can make us reach for the salt and eventually, just like anything else, adding salt to our meals becomes habitual.

Unsurprisingly, the Salt Institute's vice president of science and research Morton Satin says: "This misleading study did not measure any actual cardiovascular deaths related to salt intake, since, by the authors' own admission, no country anywhere in the world consumes the low levels of salt they recommend...The Salt Institute does not consider this misleading modeling exercise helpful in furthering our knowledge of the role of salt on our health. On the contrary, it is disingenuous and disrespectful of consumers."

If you do want to cut down on your sodium intake, try these tips:

Avoid balsamic vinegar: On salad choose red-wine vinegar instead of its more popular counterpart balsamic, Carly Feigan, a New York City based Clinical Nutritionist told Shine. "Red wine vinegar already contains salt so it will quell your cravings," she says. "Balsamic has a high sugar content and triggers sugar cravings which may have you reaching for more high-sodium packaged foods."

Spice up your meals: The capsaicin in hot sauce will give your eggs or pizza a fiery kick causing skin tingles, flushed skin, and the release of feel-good hormones (called endorphins) and could possibly extinguish the need for extra salt. Feigan's pick: Frank's hot sauces which have the lowest sodium per teaspoon.

Eat a clean diet: Whole foods such as fruits, vegetables, lean meats, and beans contain natural sodium which should satisfy your bodies' natural cravings so you won't reach for the shaker as often.



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Sugar Laden Ddrinks Kill 25,000 Each Year?

I have a sister-in-law who drinks 12 or more regular Pepsi's a day.  No kidding. This article off the web is for her: 

In a study that's sure to shake up the soda ban debate, Harvard researchers have linked the sugary drinks to 180,000 deaths a year worldwide, 25,000 in the United States alone.

"We know that sugar-sweetened beverages are linked to obesity, and that a large number of deaths are caused by obesity-related diseases. But until now, nobody had really put these pieces together," said Gitanjali Singh, a postdoctoral research fellow at the Harvard School of Public Health in Boston and lead author of the study presented today at the American Heart Association's annual meeting in New Orleans.

Singh and colleagues spent five years putting the pieces together. Using data from national health surveys around the world, the team tied sugar-sweetened beverages to 133,000 deaths from diabetes, 44,000 deaths from cardiovascular diseases and 6,000 deaths from cancer in 2010.

The study adds to mounting evidence that sugar-sweetened beverages, loaded with calories that carry little nutritional value, are a public health hazard.

"I think our findings should really impel policymakers to make effective policies to reduce sugary beverage consumption since it causes a significant number of deaths," said Singh, adding that she thinks "cause" is an appropriate word despite the limitations of the association study.

The American Beverage Association criticized the study, which has yet to be published in a peer-reviewed journal, calling it "more about sensationalism than science."

"It does not show that consuming sugar-sweetened beverages causes chronic diseases such as diabetes, cardiovascular disease or cancer - the real causes of death among the studied subjects," the industry group said in a statement. "The researchers make a huge leap when they take beverage intake calculations from around the globe and allege that those beverages are the cause of deaths which the authors themselves acknowledge are due to chronic disease."

The study comes one week after a judge blocked New York City Mayor Michael Bloomberg's proposed ban on supersized sodas, and one day after Mississippi Gov. Phil Bryant signed a bill preventing municipalities from setting limits on soda and salt content.

"It is simply not the role of government to micro-regulate citizens' dietary decisions," Bryant said in a statement. "The responsibility for one's personal health depends on individual choices about a proper diet and appropriate exercise."

But some experts say evidence-based policies could curb soda consumption and save lives. Dr. Dariush Mozaffarian, senior author of the new study, said he now plans to study the effects of sugary drink regulation and taxation on health and health care costs.

"I think that's the kind of information that policymakers need," said Mozaffarian, who is an epidemiologist at the Harvard School of Public Health.

In the meantime, Americans can take steps on their own to cut sugary drinks and shed pounds.

"It may not be easy at first, but your body will thank you," said ABC News' chief health and medical editor Dr. Richard Besser. "Study after study links intake of sugary drinks to poor health effects."

"It is quite frightening to see the rise in chronic diseases as people around the world consume more and more sugary drinks," Besser added. "It reminds me of the way lung cancer is on the rise around the world as more and more people smoke cigarettes."



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