High Blood Pressure

High blood pressure was once just a concern for people entering their middle-aged years. Now, with an epidemic of obesity and increasing cases of diabetes, it's a problem for young people too.

A recent federal study determined that having even slightly elevated blood pressure when you are young can lead to serious heart problems in middle age.

Persistently elevated blood pressure, or hypertension, is one that tops 140/90, a reading that measures the force of pressure in the heart as it contracts and as it relaxes between contractions. Hypertension has been long implicated as a risk factor in a range of cardiovascular diseases.

But the recent study suggests that pressure just below that threshold -- or high normal pressure -- begins to fuel heart damage in people as young as 20 and can lead to changes in heart muscle function in as little as 25 years.

One in 25 teens

According to the Nemours Foundation, a non-profit children's health organization, about one in 25 teenagers has elevated blood pressure. The foundation says there can be many reasons, but most have to do with an unhealthy lifestyle – a bad diet, excess weight, stress, and too little physical activity.

One risk factor for high blood pressure in teens may be spending hours each day on the Internet.

Researchers at Henry Ford Hospital in Detroit discovered teens who spend at least 14 hours a week on the Internet had an increased risk of elevated blood pressure. When they examined 134 teens who fit the category of heavy Internet users, 26 of them had higher than normal blood pressure.

These findings add to other research that seems to suggest an association between heavy Internet use and a number of health risks like addiction, anxiety, depression, obesity, and social isolation.

Dial it back

Andrea Cassidy-Bushrow, the study’s lead author, says the take-home message for teens and parents is moderation.

“Using the Internet is part of our daily life but it shouldn’t consume us,” she said. “In our study, teens considered heavy Internet users were on the Internet an average of 25 hours a week.”

Cassidy-Bushrow urges young people to take regular breaks from their computer or smartphone and engage in some form of physical activity. She also recommends parents place limits on their children’s’ time at home on the Internet.

“I think two hours a day, five days a week is good rule of thumb,” she said.

The study estimates teens spend an average of 15 hours a week online, either at school or at home. Forty-three percent of heavy Internet users were considered overweight compared to 26% of light Internet users.

If you’re one of the millions of people in the U.S. with high blood pressure, you may have heard one or two lectures from your doctor about how dangerous it can be. If left untreated, high blood pressure can have a profound negative impact on your heart; it can lead to serious issues like heart attack, heart disease, and congestive heart failure, to name a few.

However, a new study suggests that not every high blood pressure reading is cause for panic. In fact, researchers say that the trend of monitoring your blood pressure from home is actually leading consumers to go to the emergency room too much, especially when other emergency symptoms are not present.

“We encourage patients to monitor their blood pressure at home if they have been diagnosed with hypertension, but not every high blood pressure reading is an emergency,” said lead author Dr. Clare Atzema.

“Some of the increase in emergency visits is due to the aging of our population, but we suspect that recent public education campaigns recommending home blood pressure monitoring may have inadvertently contributed to the rise in visits for hypertension,” she added.

Hospital visits increase

For the purposes of the study, Atzema and her colleagues analyzed changes in the number of annual visits that Ontario emergency departments had for cases of hypertension. They found that the number of visits increased by 15,793 to 25,950 per year.

Inversely, they found that the number of patients admitted to the hospital following these visits decreased from 9.9% to 7.1%, suggesting that not every case warranted a trip to the ER.

The researchers also note that mortality incidences were very low for cases related to hypertension; they found that less than 1% of patients died within 90 days of going to the emergency room and 4.1% died within two years of their visit.

Better safe than sorry

The researchers advise consumers to go to the emergency room for blood pressure-related concerns only if a reading coincides with other emergency symptoms.

“Patients should be aware that unless their high blood pressure coincides with symptoms of medical emergency, such as chest pain, severe headache, nausea or shortness of breath, they probably do not need to visit the ER,” said Atzema.

However, she cautions that too much prudence can also be a bad thing when it comes to medical emergencies.

“We of course encourage them to follow up as soon as possible with their regular physician. If there is any doubt, come to the emergency department: we would rather have you come without an emergency than stay home with one.”

The full study has been published in the Annals of Emergency Medicine.

It's a grown-up affliction but an alarming number of children are beginning to feel its effects: hypertension, or high blood pressure.

The typical person suffering from high blood pressure is middle aged, stressed out and overweight. However, the average age of people with hypertension is steadily declining.

More than 50 million Americans are now believed to suffer from hypertension, putting them at increased risk for cardiovascular disease, end-stage renal disease, and cerebrovascular accidents.

And now doctors estimate that nearly 5% of the pediatric population has unhealthy levels of blood pressure.

Lifestyle factors

Hypertension can have many causes but it is primarily influenced by lifestyle factors. Being overweight, not eating properly and getting little or no exercise can all be contributors.

That may be why so many children are now affected. The rise in childhood hypertension coincides with the rise in childhood obesity.

“Hypertension puts a strain on the cardiovascular system, and makes children at risk for heart disease and chronic kidney disease later in life,” said Dr. Robert Woroniecki,of Stony Brook Children’s Hospital. “Conversely, sometimes chronic kidney disease leads to high blood pressure. Whatever the cause, the effects can dramatically influence a child’s health.”

High blood pressure poses a different sort of problem for children's health, but it poses a problem nonetheless. In adults, high blood pressure can mean the patient is at short-term risk of a heart attack or stroke.

Future problems

Not so with children but hypertension can still cause changes in your child’s body, putting them at risk for future complications. Once they reach middle age, these children may have even more severe health problems than do adults diagnosed during middle age.

High blood pressure has no symptoms, leading it to be sometimes called “the silent killer.” But being overweight or obese are big risk factors.

Woroniecki says children who meet this physical description should get regular blood pressure readings. Until recently pediatricians were not all that likely to screen their young patients for high blood pressure because it was so rare.

Difficult to diagnose

Diagnosing high blood pressure in children is more difficult than in adults. According to the Mayo Clinic, pediatric hypertension is defined as “blood pressure that's the same as or higher than 95% of children who are the same sex, age and height as your child.”

There isn't a simple target blood pressure reading the problem in all ages for children, because what's considered normal blood pressure changes as children grow.

But the condition in children can occur for the same reasons it shows up in adults -- being overweight, eating a poor diet and not exercising.

Other causes

While hypertension can be addressed in these children by having them make lifestyle changes, some cases are more complicated and may require medication. For example, the Mayo Clinic notes that high blood pressure in children under 10 is usually caused by an underlying medical condition.

For adolescents, the American Heart Association says age, body size and the degree of sexual maturation are major factors in determining blood pressure levels. Heavier and more sexually mature teenagers tend to have higher blood pressure.

The group cites research suggesting teens who are obese and have high blood pressure may develop thicker arteries by age 30. Fatty buildups in artery walls can lead to a variety of health problems including heart disease and stroke.  

Besides high unemployment, the U.S. is experiencing high rates of under-employment, with more people working part-time and earning less than they need to sustain themselves and their families.

Besides the economic ramifications, researchers at the University of California (UC) Davis say there appear to be health consequences as well. They found that employees earning the lowest wages have a higher risk of hypertension than workers with the highest wages, even if the high-wage jobs carry a lot of stress. The correlation between wages and hypertension was especially strong among women and workers under 45.

“We were surprised that low wages were such a strong risk factor for two populations not typically associated with hypertension, which is more often linked with being older and male,” said J. Paul Leigh, senior author of the study and professor of public health sciences at UC Davis. “Our outcome shows that women and younger employees working at the lowest pay scales should be screened regularly for hypertension as well.”

New focus of research

The study, published in the December issue of the European Journal of Public Health, is believed to be the first to isolate the role of wages in hypertension, which occurs when the force of circulating blood against artery walls is too high. According to the Centers for Disease Control and Prevention (CDC), hypertension affects approximately 1 in 3 adults in the U.S. and costs more than $90 billion each year in health-care services, medications and missed work days. It also is a major contributor to heart disease and stroke, both of which are leading causes of death and disability.

What's surprising is that hypertension has previously been assumed to afflict the stressed-out corporate executive, faced with the responsibilities of meeting profit projections or bearing other stressful burdens. But the UC study suggests it is the people working for them who are feeling the effects of the stress.

While there is a known association between lower socioeconomic status and hypertension, determining the specific reason for that association has been difficult, according to Leigh. Other researchers have focused on factors such as occupation, job strain, education and insurance coverage, with mixed results. Leigh’s study was the first to focus on wages and hypertension.

The role of wages

“By isolating a direct and fundamental aspect of work that people greatly value, we were able to shed light on the relationship between socioeconomic status and circulatory health,” said Leigh. “Wages are also a part of the employment environment that easily can be changed. Policymakers can raise the minimum wage, which tends to increase wages overall and could have significant public-health benefits.”

Leigh is not the first researcher to express concern that young people, especially, are not being adequately screened for high blood pressure. In November research presented at the American Heart Association's Scientific Sessions 2012 found that adults 18-24 years old with high blood pressure were 28 percent less likely to be diagnosed during doctor visits than those 60 and older.

"These young patients come to the clinic and their blood pressure is recorded," said Heather Johnson, M.D., lead researcher of the study. "They have high blood pressure, but there's no documentation of a diagnosis."

High blood pressure is a major risk factor for heart attack and stroke. While more prevalent in older Americans, about 29 percent of all U.S. adults have hypertension, according to American Heart Association statistics. About 11 percent of men and 7 percent of women 20-34 years old have high blood pressure.

Consumers spend billions of dollars on medication to control high blood pressure but getting plenty of vitamin D might help too. Research continues to suggest that the vitamin, present in dairy foods and sunlight, has benefits for the circulatory system.

In March researchers at Boston's Brigham and Women's Hospital conducted a study that suggested moderate amounts of vitamin D supplements could reduce high blood pressure. Since African Americans tend to have high higher incidence of hypertension, the study followed 250 African American adults.

"We found that vitamin D supplementation modestly but effectively lowered blood pressure," said Dr. John Forman, who led the research team. "And people who were taking a placebo had a slight increase in their blood pressure."

Vitamin D has long been thought to have some benefits when it comes to blood pressure. Some previous students on animals achieved that result, though the findings have not been universally accepted.

No proof

“In population studies, people with low levels of vitamin D seem to have a high risk of developing high blood pressure than those with higher levels of vitamin D,” according to researchers at the University of Maryland Medical Center. “However, there's no proof that low levels of vitamin D cause high blood pressure in healthy people.”

Dr. Sheldon G. Sheps, of the Mayo Clinic, agrees that the role too little vitamin D plays in developing high blood pressure is not exactly clear. But he says a vitamin D deficiency may be linked to heart disease and a higher risk of high blood pressure. It's too early to know, he says. More research is needed.

However, there appears to be a growing consensus that it could be beneficial. Researchers at Edinburgh University in the UK are so convinced that vitamin D is effective in reducing high blood pressure, as well as heart attack and stroke risk, that they suggest getting vitamin D from sunlight has benefits that may far outweigh skin cancer risks. Their research focuses on ultra violet (UV) rays, which reportedly release a compound in the body that lowers blood pressure.

Growing threat

High blood pressure is a growing threat, especially to the aging population. While being overweight, getting little exercise and consuming excessive levels of sodium are all contributors, not all of its causes are understood.

High blood pressure occurs when the heart has to work harder to move blood through veins and arteries, usually because of rigidity in the blood vessels. Prolonged high blood pressure can cause the heart to enlarge. The high pressure of the blood flowing through the veins can eventually cause a blood vessel to break, causing a stroke.

If increasing vitamin D intake can be shown to prevent high blood pressure, it could provide an easy and effective treatment. It might also save money on prescription medications.

What to do

There are many sources of vitamin D that could probe healthy in other ways, even if it doesn't reduce high blood pressure. Spending time outdoors, with exposure to the sun, is one way but should be measured against the risk of skin cancer.

Some foods also are rich sources of vitamin D. Dairy products, like milk, cheese and yogurt are good sources. You can also get vitamin D from salmon, tuna, flounder, cereal, pork, eggs, mushrooms and liver.

Vitamin D is also available in supplements. Popular brands cost about $25 for 120 capsules, a four month supply. As with any health or diet issue, discuss the role of vitamin D in your diet, and as a tool to control blood pressure, with your physician.

Among the types of medication people take for high blood pressure are beta blockers, which are a class of drugs that reduce stress levels within the body.

If you take one, you might be reducing your risk of Alzheimer's disease. A study involving autopsies of 774 elderly Japanese-American men, most of whom had suffered from high blood pressure, yielded interesting results.

Only 15 percent of the men had been taking beta blockers for their high blood pressure. Their autopsies revealed they suffered the least amount of brain damage.

The researchers found that all types of blood pressure treatments were clearly better than no treatment. However, men who had received beta blockers as their only blood pressure medication had fewer abnormalities in their brains compared with those who had not been treated for their hypertension, or who had received other blood pressure medications.

Less brain shrinkage

The brains of participants who had received beta blockers plus other medications showed an intermediate reduction in numbers of brain abnormalities. Study participants who had taken beta blockers alone or in combination with another blood pressure medication had significantly less shrinkage in their brains.

“With the number of people with Alzheimer’s disease expected to grow significantly as our population ages, it is increasingly important to identify factors that could delay or prevent the disease,” said study author Lon White, MD, of the Pacific Health Research and Education Institute in Honolulu. “These results are exciting, especially since beta blockers are a common treatment for high blood pressure.”

Beta blockers questioned as blood pressure treatment

In October researchers at the NYU Langone Medical Center questioned whether beta blockers were an effective means of combating high blood pressure. They studied patients taking the drugs and concluded they weren't helping -- at least they weren't lowering blood pressure.

Sripal Bangalore, MD, assistant professor in the Department of Medicine and leader of the research team, suggested the current use of beta blockers to treat high blood pressure is based on old studies.

“Our results found none of the patient populations studied showed benefit from taking beta-blockers, including patients with a history of heart attack,” Bangalore said in October, when his study was released. “This is concerning in light of current treatment patterns and reveals a need for more education among practitioners who treat patients at risk for heart attack and stroke.”

This latest study, however, supported by the National Institutes of Health, might have found an additional use for the drugs. But beta blockers are known to have side effects, which include increases in cholesterol levels, weight gain, upset stomach and headaches.

If you think you are at risk of developing Alzheimer's disease you should discuss beta blockers with your doctor to determine if it is medication you should be taking.

All of a sudden, the medical community is second guessing the recent low benchmarks for “safe” blood pressure. In short, some are suggesting “the lower the better” approach might not be the right one after all.

The latest questions appear in a study published in the online edition of JAMA Internal Medicine. Researchers at Wake Forest Baptist Medical Center report that lowering systolic blood pressure below 120 does not appear to provide additional benefit for patients.

Systolic pressure is the top number in a standard blood pressure reading such as 120/80.

“Frequently we treat patients’ blood pressure to the lowest it will go, thinking that is what’s best,” said Carlos J. Rodriguez, M.D., associate professor of public health sciences at Wake Forest Baptist and lead author of the study.

Lower not necessarily better

But the researchers found that pushing blood pressures to the lowest levels possible didn't provide any benefit to patients with risk of dangerous events like heart attack, heart failure and stroke.

“This calls into question the notion that lower is better,” Rodriquez said.

Previous studies had claimed a progressive rise in heart disease risk as systolic blood pressure (SBP) rose above 115. According to the Mayo Clinic, normal blood pressure is below 120/80, which is often difficult to achieve without medication.

However, that's a relatively recent change. Until 2003 most doctors considered 120/80 an ideal blood pressure and a systolic reading up to 140 to be satisfactory.

But a report that year from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure warned that blood pressure needed to be lower. It said systolic pressure as low as 120 might be risky. For millions of patients, that meant taking medication.

Drug industry influence?

It has to be asked what role the pharmaceutical companies might have played in developing these new standards. A 2005 investigation by The Seattle Times alleged 9 of the 11 authors of the new guidelines had drug company ties.

A new panel on hypertension issued new guidelines last December, suggesting patients over 60 were fine with a blood pressure reading of 150/90. Blood pressure goals were also eased for adults with diabetes and kidney disease.

In March researchers at Duke University ran an analysis and determined that an estimated 5.8 million adults no longer needed blood pressure medicine under the new guidelines.

Controversial

“Raising the target in older adults is controversial, and not all experts agree with this new recommendation,” said lead author Ann Marie Navar-Boggan, a cardiology fellow at Duke University School of Medicine. “In this study, we wanted to determine the number of adults affected by these changes.”

Based on their study, the Duke researchers estimated the proportion of U.S. adults in need of hypertension treatment would decrease from 40.6% under the old guidelines to 31.7% under the new recommendations, resulting in a pretty big hit for drug companies.

More bad news for drug companies

The new Wake Forest study is likely to be seen as more bad news in the pharmaceutical industry. It found that among people with high blood pressure, once SBP is below 140, lowering it below 120 did not reduce heart risks.

“Our study found that the optimal blood pressure range for people with hypertension is 120-139, which significantly reduces the risk of stroke, heart attack or heart failure,” Rodriguez said. “These findings suggest that you don’t need to go lower than that to have the benefits.”

If you are currently taking medication for high blood pressure, you should continue to do so. Never make changes in your medication based on news stories. However, you should discuss these new guidelines with your healthcare provider for advice about whether you need to stay on the medication.