High Blood Pressure

AurobindoPharma USA and Acetris Health are expanding an earlier recall of Valsartan and Amlodipine and Valsartan tablets, which are used to control high blood pressure and for the treatment of heart failure.

Trace amounts of an unexpected impurity, N-nitrosodiethylamine (NDEA) -- a probable human carcinogen – have been found in the product.

The following products, packaged in bottles, are being recalled:

The recalled products were distributed nationwide.

What to do

Patients should continue taking their medication, as the risk of harm to their health may be higher if the treatment is stopped immediately without any alternative treatment. Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

AurobindoPharma is notifying its customers by phone and in writing and arranging for return of all recalled products. Instructions for returning recalled products are given in the recall letter.

Consumers with medical questions regarding this recall may contact AurobindoPharma at (866) 850- 2876, Option 2 or by email at pvg@aurobindousa.com.

Recent studies have noted the health risks associated with consuming alcohol -- even in moderation. Now, consumers can add blood pressure to the list of potential issues.

According to a new study, consuming as few as seven to 13 drinks per week can lead to high blood pressure.

“I think this will be a turning point for clinical practice, as well as for future research, education, and public health policy regarding alcohol consumption,” said researcher Dr. Amer Aladin. “It’s the first study showing that both heavy and moderate alcohol consumption can increase hypertension.”

Moderation is still a risk

To gauge the relationship between alcohol consumption and blood pressure, the researchers utilized six years worth of data from the Center for Disease Control and Prevention’s (CDC) National Health and Nutrition Examination Study (NHANES).

The researchers included over 17,000 participants in the study, dividing them into three groups based on how much they drank: one group for those who never drank, another group for those who drank moderately (seven to 13 drinks per week), and a third group for heavy drinkers (14 or more drinks per week).

The researchers evaluated blood pressure using the American College of Cardiology (ACC) and American Heart Association’s (AHA) 2017 guidelines, which lowers the barometer for what was traditionally considered hypertensive to 130/80 mm Hg, and places a normal blood pressure at 120/80 mm Hg.

The biggest takeaway from the study was that the more the participants drank on a weekly basis, the greater their likelihood of developing stage 1 or stage 2 hypertension. Heavy drinkers were the most affected, as the researchers found that these participants had a nearly 70 percent chance of developing stage 1 hypertension. They were also nearly 2.5 times as likely to develop stage 2 hypertension.

Moderate drinkers fared only slightly better, showing an over 50 percent risk of stage 1 hypertension and double the risk of developing stage 2 hypertension. The researchers hope these findings are beneficial for consumers moving forward, and that they pay close to attention to both their blood pressure readings and alcohol intake in the future.

“This study is not only large, but diverse in terms of race and gender,” Dr. Aladin said. “The results are very informative for future research and practice. If you are drinking a moderate or large amount of alcohol, ask your provider to check your blood pressure at each visit and help you cut down your drinking and eventually quit.”

Maintaining healthy blood pressure

Keeping blood pressure within a healthy range can be difficult for many consumers, but researchers have figured out several ways to make the process a bit easier.

Researchers recently found that both blueberries and napping can be effective for lowering blood pressure. Laws that regulate smoking indoors have also been linked to lowering blood pressure.

Torrent Pharmaceuticals Limited is recalling 60 lots of Losartan potassium tablets and 54 lots of Losartan potassium/ hydrochlorothiazide tablets

The products, used to treat high blood pressure, contain trace amounts of an unexpected impurity, N-Methylnitrosobutyric acid (NMBA), that are above the acceptable daily intake levels released by the FDA.

There are no reports to date of adverse events related to this recall.

The following products are being recalled:

The recalled products were distributed nationwide to Torrent’s wholesale distributor, repackager and retail customers

What to do

Patients who are taking the medications should continue to do so, as the risk of harm to their health may be higher if the treatment is stopped immediately without any alternative treatment.

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

Torrent is arranging for return of all recalled products to Qualanex. Instructions for returning recalled products are given in a letter being sent to all customers.

Consumers with medical questions regarding this recall may contact Torrent Pharmaceuticals at (800) 912-9561 from 8:00 am – 5:00 pm (ET) or by email at Medinfo.Torrent@apcerls.com

Macleods Pharmaceuticals Limited is recalling one lot of Losartan Potassium/Hydrochlorothiazide combination tablets, a high blood pressure treatment.

Trace amounts of an unexpected impurity -- N-nitrosodiethylamine (NDEA) -- were detected found in the product. NDEA, which occurs naturally in certain foods, drinking water, air pollution, and industrial processes, has been classified as a probable human carcinogen by the International Agency for Research on Cancer.

There are no reports of adverse events related to this recall.

The following product, which is packaged in bottles, is being recalled:

• NDC: 33342-0052-10
• Manufacturer: Macleods Pharmaceuticals Limited
• Product Description: Losartan Potassium/ Hydrochlorothiazide combination tablets 100mg/25mg, 90 count bottles
• Lot/Batch: BLM715A
• Expiration Date: Jul -2019

The recalled product was sold nationwide to Macleods wholesale distributor and retail customers.

What to do

Macleods Pharmaceuticals is notifying its customers by phone and/or in writing. Instructions for returning recalled products are given in the recall letter.

Consumers with questions regarding the return of the recalled product may contact Qualanex at (888) 280-2042 from 7:00 am to 4:00 pm (CST) Monday – Friday or by email at recall@qualanex.com.

Torrent Pharmaceuticals Limited is expanding its earlier recall of Losartan potassium tablets USP to include six lots of Losartan potassium and hydrochlorothiazide tablets, USP.

Trace amounts of an unexpected impurity, N-nitrosodiethylamine (NDEA), which has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC) classification.

There have been no reports of adverse events.

The following products, used to treat hypertension, hypertensive patients with Left Ventricular Hypertrophy and for the treatment of nephropathy in Type 2 diabetic patients, are being recalled:

The recalled products were distributed nationwide to Torrent’s wholesale distributor, repackager and retail customers.

What to do

Patients who are on Losartan should continue taking their medication, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment.

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

Torrent Pharmaceuticals is notifying customers by phone and in writing, arranging for return of all recalled products to Qualanex. Instructions for returning recalled products are given in the recall letter.

Consumers with medical questions or reporting an adverse event may contact Torrent at (800) 912-9561 8:00 am – 5:00 pm (ET), or by email at Medinfo.Torrent@apcerls.com

Questions regarding the return of the recalled product may be be directed to Qualanex at (888) 280-2040 from 8 am - 9:00 pm (ET).

Prinston Pharmaceutical, doing business as Solco Healthcare, is recalling one lot of Irbesartan and seven lots of Irbesartan HCTZ tablets.

The products contain a trace amount of N- nitrosodiethylamine (NDEA) above the acceptable daily intake levels released by the FDA. NDEA has been classified as a probable human carcinogen by the International Agency for Research on Cancer.

Prinston Pharmaceutical has not received any reports of adverse events related to this recall to date.

The following products, used to control high blood pressure and for the treatment of heart failure, are being recalled:

The recalled product, which can be identified by checking the product name, manufacturer details and batch or lot number on the bottle, were distributed nationwide.

What to do

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication. Patients who are on Irbesartan should continue taking their medication, until their pharmacist provides a replacement, or their doctor prescribes a different medication that treats the same condition. The risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any alternative treatment.

For a return label, consumers may contact the company at (609) 451-1000 or by email at customerservice@solcohealthcare.com.

Aurobindo Pharma USA is recalling 80 lots of Amlodipine Valsartan Tablets USP, Valsartan HCTZ Tablets, USP and Valsartan Tablets USP.

Trace amounts of an unexpected impurity, N-nitrosodiethylamine (NDEA) -- a probable human carcinogen -- were found in the finished drug product.

There are no reports of adverse events related to this recall.

The following products, which are packaged in bottles, are being recalled:

What to do

Patients who are prescribed the recalled medications, which are used to control high blood pressure and for the treatment of heart failure should continue taking them, as the risk of harm to the patient’s health may be higher if the treatment is stopped immediately without any alternative treatment.

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

The company is notifying customers by phone and in writing with instructions for returning recalled products.

Patients with medical questions regarding this recall or to report an adverse event may contact Aurobindo Pharma USA at (866) 850-2876 (Option 2) or by email at pvg@aurobindousa.com.

Consumers with questions may contact Inmar\CLS-Medturn at (877) 208-2407 9 am -5:00 pm (ET) or by email at rxrecalls@inmar.com.

Mylan Pharmaceuticals is recalling select lots of Valsartan-containing products, used in the treatment of high bloodpressure.

The products contain trace amounts of an impurity, N-nitrosodiethylamine, which has been classified as a probable human carcinogen.

The following batches of products, distributed in the U.S. between March 2017, and November 2018, are being recalled:

What to do

Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication.

Patients who are on valsartan should continue taking their medication, as the risk of harm to the patient's health may be higher if the treatment is stopped immediately without any alternative treatment.

Consumers in possession of recalled product should contact Stericycle at (888) 406-9305 Monday through Friday 8 a.m. – 5 p.m. (EST) for the return of the recalled product.

As over 100 million Americans suffer from high blood pressure, consumers should be informed of any potential treatment options available to them.

Recently, researchers from the University of Utah Health found that adhering to the latest blood pressure guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) may be the key to preventing millions of cardiovascular issues in the coming years.

“Treating high blood pressure is a major public health opportunity to protect health and quality of life for tens of millions of Americans,” said lead researcher Adam Bress. “Achieving these lower goals will be challenging.”

Following the guidelines

The ACC/AHA guidelines lowered the standards for what is considered high blood pressure in an effort to have healthcare professionals try to help patients at earlier stages.

According to the researchers, most cardiovascular issues occur in patients whose blood pressure is above 140/90 mm Hg -- what was previously considered hypertensive. However, under the new guidelines, patients’ blood pressure would be considered hypertensive at 130/80 mm Hg, while a healthy reading would be 120/80 mm Hg.

The researchers used information from the ACC/AHA guidelines, the seventh Joint National Committee (JNC7), the eighth Joint National Committee (JNC8), and several population-based databases to predict the ways cardiovascular health can be improved in the coming years.

They foresee over three million cardiovascular issues could be prevented if patients stick to the ACC/AHA’s 2017 guidelines.

While adhering to these guidelines could be beneficial to millions of Americans, researchers from the ACC/AHA also suggest that many more people will be classified as having high blood pressure. More young people will now be included in this demographic, and the researchers expect more men to be affected than women.

Putting patients first

Though the researchers think these findings could help millions of people prevent future health complications, they are also aware of the risks associated with diagnosing more people with high blood pressure.

Not only is cost a major factor, but healthcare providers that prescribe high blood pressure medication will need to monitor all patients to ensure that they don’t experience any adverse side effects.

Overall, Bress and his team believe that medical professionals need to work together with their patients to determine the best course of treatment.

“A conversation and shared decision making between provider and patient about benefits and risks of increasing the dose of a medication or adding a new medication to achieve a lower target are important,” Bress said. “Benefits to reduce the risk of heart attacks, stroke, and heart failure are clear and may often outweigh risk of minor, transient side-effects.”

Maintaining healthy blood pressure

Recent studies have explored the countless benefits associated with consumers maintaining healthy blood pressure. For diabetes sufferers, keeping blood pressure under control was found to reduce the number of patients who experience extreme hypertension -- which often leads to organ failure.

“Given the fact that the presence of severely elevated blood pressure is the strongest driver of damage to vital organs in individuals with diabetes, the most important intervention for preventing hypertensive emergencies would be to better manage patients’ blood pressure,” said lead researcher Irina Benenson.

A recent study also found that teens with high blood pressure could actually be at risk for organ damage. Researchers determined that testing teenagers’ blood pressure has often provided inconclusive results, as many whose numbers fall within normal levels were found to be suffering from organ damage.

Changes to diet, exercise, and weight were found to effective for treating teens’ high blood pressure, though medication is sometimes necessary.

Torrent Pharmaceuticals Limited is expanding an earlier recall to include all lots of Valsartan/Amlodipine/HCTZ, Valsartan/Amlodipine and Valsartan tablets.

Trace amounts of N-Nitrosodimethylamine impurity were found in an active pharmaceutical ingredient (API).

NDMA is classified as a probable human carcinogen (a substance that could cause cancer).

The company has not received any reports of adverse events to date related to this recall.

Valsartan is used to control high blood pressure and for the treatment of heart failure. In combination with amlodipine or amlodipine plus hydrochlorothiazide, it is used to control high blood pressure.

The following products, packaged in bottles and distributed nationwide, are being recalled:

What to do

The company is arranging for return of all recalled products to Qualanex LLC, with instructions for returning recalled products are given in the recall letter.

Consumers with questions regarding this recall or reporting an adverse event may contact Torrent at (800) 912-9561 from 8:00 am – 5:00 pm, or by email at Medinfo.Torrent@apcerls.com.

For general questions regarding the return of the recalled products, contact Qualanex at (800) 505-9291 from 8 am -5:30 pm (ET).

Torrent Pharmaceuticals Limited is recalling 14 lots of Valsartan/Amlodipine/HCTZ tablets.

Trace Amounts of N-Nitrosodimethylamine impurity were found in an active pharmaceutical ingredient (API).

NDMA is classified as a probable human carcinogen (a substance that could cause cancer).

The company has not received any reports of adverse events to date related to this recall.

Valsartan is used to control high blood pressure and for the treatment of heart failure. In combination with amlodipine plus hydrochlorothiazide, it is used to control high blood pressure.

The following products, packaged in bottles and distributed nationwide, are being recalled:

The products can be identified by checking the product name, manufacturer details and batch or lot number on the bottle.

What to do

The company is arranging for return of all recalled products to Qualanex LLC, with instructions for returning recalled products given in a recall letter being sent out.

Consumers with questions regarding this recall or reporting an adverse event may contact Torrent at (800) 912-9561 from 8:00 am – 5:00 pm, or by email at Medinfo.Torrent@apcerls.com.

For general questions regarding the return of the recalled products, contact Qualanex at (800) 505-9291 from 8 am -5:30 pm (ET).

Camber Pharmaceuticals is recalling Valsartan tablets, USP, in 40-mg, 80-mg, 160-mg and 320-mg doses.

Trace Amounts of N-Nitrosodimethylamine impurity were found in an active pharmaceutical ingredient (API).

NDMA is classified as a probable human carcinogen (a substance that could cause cancer).

The company has not received any reports of adverse events to date related to this recall.

Valsartan, which was distributed nationwide by Qualanex LLC, is a prescription medication used to treat high blood pressure and congestive heart failure, and is packaged in 30-ct & 90-ct bottles

The following lot numbers and expiration dates are being recalled:.

What to do

Consumers should contact their doctor for further guidance and potential change of treatment before they stop taking this product.

Consumers with questions regarding this recall may contact Qualanex at (800) 505-9291 Monday to Friday between 9am – 5pm (CT) or by email at recall@qualanex.com.

High blood pressure is generally seen as a condition that only affects adults, but a September study presented to the American Heart Association (AHA) shows that even adolescents could face dire risks from the condition.

Study author Dr. Elaine M. Urbina said that standard diagnostic testing is insufficient, meaning many teens who test within normal limits may be suffering from organ damage.

"Some adolescents may have organ damage related to blood pressure and are not targeted for therapy," Urbina said. "Imaging of the heart may be useful in youth in the high-normal range of blood pressure to determine how aggressive therapy should be."

Organ damage at “normal” levels

Testing for high blood pressure is different for adolescents and children than it is for adults. Instead of basing judgments on systolic and diastolic readings alone, doctors consider factors such as height, age, and gender to place teens in blood pressure “percentiles.”

In coordination with current standards, Urbina and her colleagues defined teens placed below the 80th percentile as having “normal” blood pressure levels. Teens falling between the 80th and 90th percentiles were considered to be in the “mid risk” group, while those measuring above the 90th percentile were in the “high risk” group.

After analyzing patient data for 180 teen participants, the researchers found evidence that teens falling in the “normal” blood pressure range were still at risk of organ damage. They also found that teens in the mid-risk and high-risk groups often had heart and vessel damage, which are serious risk factors for organ failure.

Treating high blood pressure in teens and children

The AHA says that treating high blood pressure in teens and children primarily involves managing lifestyle factors such as diet, weight, and exercise. In certain cases, a pediatrician may also prescribe medications to treat the condition.

For parents, a good first step is to ensure that their children are not at cardiovascular risk by calculating their blood pressure percentile. Researchers at the Baylor College of Medicine have created age-based pediatric blood pressure reference charts to help consumers determine if certain teens fall within normal, prehypertension, hypertension levels.

For more information on high blood pressure in children, consumers can visit the AHA’s website here.

As we have recently reported, cardiologists are increasingly concerned about a condition known as "masked hypertension."

That's when a patient shows a normal blood pressure reading the one or two times a year it is taken at the doctor's office but has above normal readings during much of his or her daily routine. Doctors have said regular blood pressure checks are one way to identify patients who unknowingly suffer from high blood pressure.

Back in May, the Food and Drug Administration (FDA) issued 510(k) clearance for a new medical device that might prove to be a useful tool in this effort. CareTaker Medical says its Wireless Continuous Non-Invasive “Beat-by-Beat” Blood Pressure (“cNIBP”) and Heart Rate Monitor can provide constant blood pressure monitoring.

The device uses a low-pressure finger cuff that is attached to a small device worn on the wrist. It measures the heart rate on a remote display. It was designed for use in hospitals and during patient transit, but the company says it can also be used after a patient is discharged.

A game changer

“CareTaker is a real game changer, allowing physicians to remotely monitor medical-grade Continuous Blood Pressure and Heart Rate from anywhere, using only a patient friendly-finger cuff” said Dr. Jay Sanders, an adjunct professor of medicine at Johns Hopkins and President Emeritus of the American Telemedicine Association.

In the past, he says most doctors had to settle for intermittent blood pressure readings using arm cuffs, which he says which can produce misleading results.

"In remote monitoring settings, the ability to gather continuous blood pressure and vital sign data from such an integrated easy-to-use device will provide better information and improve patient compliance while reducing cost and workload,” Sanders said.

The company says its device provides "ICU quality" continuous readings without catheters or cumbersome wires that were typically part of previous continuous blood pressure reading devices. In an email to ConsumerAffairs, the company said the device is not a pulse transit time method, "but instead a completely new way of tracking blood pressure."

Researchers at Stony Brook and Columbia universities used 24-hour ambulatory blood pressure monitors to conclude that as many as 17.1 million people might suffer from masked hypertension.

Hypertension, or high blood pressure, is called "the silent killer." Elevated blood pressure can eventually lead to heart attack and stroke, and millions of people with hypertension don't know it.

There is very effective medication to control blood pressure -- and a healthy lifestyle also helps -- but first you have to know that your blood pressure is too high.

As we first reported back in early December, doctors have begun to worry about what they call "masked hypertension." A patient goes to the doctor and his blood pressure reading is a perfectly acceptable 129/82.

But then he goes about his daily life -- going to work, picking up the kids, cleaning out the garage, and while he's doing all that his blood pressure might be an unhealthy 147/96. He doesn't know, of course, because he doesn't have a blood pressure cuff at home to measure it.

Numbers are alarming

Researchers at Stony Brook and Columbia universities have studied this phenomenon by attaching 24-hour ambulatory blood pressure monitors to subjects in their study. They now say that not only is the condition real, the numbers associated with it are alarming.

They found 12.3% of people display a normal blood pressure reading in the clinic, are not taking blood pressure lowering medicines, have never had a heart attack or stroke, but have high blood pressure during their daily activities. This amounts to about one in eight adults over age 21 -- approximately 17.1 million people in the U.S.

Lead investigator Joseph Schwartz of Stony Brook says the study is breaking new ground in estimating the size of the problem. He says it could lead to new guidelines to help identify patients with high blood pressure and improve hypertension preventive methods.

What to do

Until then, it is helpful to know the hypertension risk factors. People over age 50 are at risk of developing hypertension. So are those who are overweight or obese, or have a sedentary lifestyle with little physical exercise.

Diet can also be a big risk factor. Eating unhealthy foods, especially those high in sodium, can increase the risk for hypertension. African-Americans are at a higher risk than other races.

If you think you might fall into one of those risk categories, consider investing in a home blood pressure monitoring cuff and learn how to properly use it.

Measuring your blood pressure two or three times a week, at different times of the day, might let you know if you are suffering from "masked hypertension," even though your readings at the doctor's office look just fine.

Hypertension, or high blood pressure, is a growing health concern in the U.S., mainly because of lifestyle factors. A poor diet, lack of exercise, and obesity are all contributing factors.

High blood pressure is easily treatable, but first you have to know if you are affected by it. Blood pressure is measured using a cuff that applies pressure to your arm or wrist. Unless you have one of these cuffs at home, the only time you take a reading is when you visit a healthcare provider.

Researchers at Stony Brook University and Columbia University wondered if occasional measurements at a doctor's office provided an accurate determination of whether someone suffered from high blood pressure.

They enlisted a group of patients who had normal readings on their infrequent measurements in a clinical setting and placed wearable monitors on them to measure blood pressure around the clock. They say they discovered that for some subjects, their blood pressure was outside the normal range during daily activities, even though it seemed normal at the doctor's office.

Reverse of 'white coat hypertension'

The researchers say it's the reverse of so-called “white coat hypertension,” when the slight stress of being in a doctor's office results in higher blood pressure readings. When blood pressure spikes during normal day-to-day activities, the researchers call it “masked hypertension.”

The only way to uncover masked hypertension is with around the clock monitoring, using a wearable device. The researchers say that compared to blood pressure measured infrequently in a clinic, ambulatory blood pressure is a better predictor of future heart disease.

In the study, nearly 16% of patients with normal clinic blood pressure were found to have “masked hypertension.” It was more common in men than women. Interestingly, it also affected younger, normal weight participants more than those who were older and overweight.

Debunking a widely held belief

“These findings debunk the widely held belief that ambulatory blood pressure is usually lower than clinic blood pressure,” said lead author Dr. Joseph Schwartz.

Schwartz said healthcare providers need to know that there appears to be a tendency for blood pressure during normal activities to be higher than clinic blood pressure in healthy patients who are being evaluated for high blood pressure during well-patient visits.

It's an important issue because high blood pressure, left untreated, can lead to more serious health conditions, such as heart attack and stroke.

Consumers with high blood pressure spend billions of dollars each year on prescription medication to keep it in check.

But what if there were a medical procedure that made that unnecessary? Researchers at the University of Bristol in the UK say there may be.

The scientists have concluded that carotid bodies, a small cluster of nerves and cells next to the carotid artery, are a cause of high blood pressure. This revelation, they say, offers a new target for treatment.

The research team says removing one carotid body from some patients with high blood pressure caused an immediate and sustained drop in blood pressure.

“The falls in blood pressure we have seen are impressive – more than you would see with pharmacological medication – and demonstrate the exciting potential there now is for targeting the carotid body to treat hypertension,” said Dr. Angus Nightingale, of the Bristol Heart Institute.

The theory

The theory goes like this: the carotid bodies monitor levels of oxygen in the blood. When oxygen levels fall they sound the alarm, instructing the brain to step up the level of breathing and blood pressure.

But in some cases, the monitored fall in oxygen level is a false reading. The way the scientists explain it, it's like the thermostat on your furnace being set too high.

Professor Julian Paton, one of the researchers, says it's a novel approach but one that could potentially be a game-changer for the treatment of high blood pressure. Currently, he says, medication only treats the symptoms of high blood pressure. Removing the corotid bodies, he says, gets at the root cause.

Wouldn't help in every case

Nightingale makes clear the procedure would not be the answer for every case, but also says that the research team has developed some tests that would help identify patients for whom it would be effective. But that's not to say there isn't a role for drugs.

“Although this surgical approach to controlling high blood pressure was successful, we don’t think this will be the solution in the long term,” Nightingale said. “We now need to find a drug that dampens down an overactive carotid body and resets the blood pressure thermostat to a normal level.”

Hypertension is one of the leading causes of death worldwide and a major contributor to strokes. The Centers for Disease Control and Prevention (CDC) estimates 70 million Americans have high blood pressure, the treatment of which cost $46 billion in health care services, medications, and missed days of work in 2011.

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.

There is no debate over the danger of high blood pressure. It's a killer. The debate is over what constitutes high blood pressure.

A series of studies has set different benchmarks, with different levels of risk. The latest study –this one produced by a branch of the National Institutes of Health (NIH) – could add to the confusion.

In what's being called a landmark clinical trial, researchers monitored the blood pressure of thousands of patients. In particular, they paid attention to systolic pressure – the top number in a blood pressure reading.

The study found that patients over age 50 who used medication to achieve a systolic reading of 120 reduced their rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third. They reduced the risk of death by almost a quarter, as compared to the target systolic pressure of 140. That's a significant reduction in risk.

“This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI).

Other research

But it isn't the only study out there. In 2014 an AMA panel of experts issued its Evidence-based Guideline for the Management of High Blood Pressure in Adults, determining that physicians were shooting too low, especially when they insisted their older patients achieve a blood pressure of 120/80. The panel said 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.

As expected, this was controversial. A month later researchers at Duke University added to the controversy when they proclaimed that there were 5.8 million Americans taking blood pressure medication who really didn't need the pills.

Based on the study sample, the researchers determined that the proportion of U.S. adults considered eligible for hypertension treatment would decrease from 40.6% under the old guidelines to 31.7% under the new recommendations. In other words, a lot fewer patients need to be taking drugs for high blood pressure.

What is normal?

The fact is, if you are 60 years old and in excellent physical condition, with regular exercise and a healthy lifestyle, you might be able to achieve a systolic reading of 120 without the aid of medication. But if you are a few pounds overweight and spend most of your time at a desk or in a chair, chances are good that you'll need a pill or two to get to 120/80.

So whether a normal blood pressure is easy or difficult to maintain without medication is of enormous importance – to drug manufacturers.

The sale of medication to control blood pressure is a huge part of the pharmaceutical industry. The government reports that in 2010, more than 58 million adults were treated for hypertension and spent more than $20 billion on medication to control blood pressure. According to Statista, the top five selling prescription blood pressure medications brought in $5.27 for pharmaceutical companies in 2011.

And there has been research suggesting that, in the end it might not matter all that much. As we reported in June, researchers at the University of Alabama Birmingham concluded that once you develop hypertension, even if it is eventually controlled with medication, it significantly increases the chance of having a stroke. In addition, the reearchers contend the risk of stroke went up 33% with each blood pressure medicine required to treat blood pressure to goal.

What to do

That doesn't mean that if you have elevated blood pressure you should ignore this latest study, but you probably shouldn't take it at face value either. Instead, have an informed conversation with your health care provider.

Make sure he or she is aware of the 2014 Evidence-based Guideline that raised blood pressure targets for older adults and discuss this latest research as well.

Over the years ConsumerAffairs has reported extensively on blood pressure research. Check out our articles here.

In recent years doctors have determined that older adults can enjoy health with higher elevations of blood pressure than had previously been considered normal.

In 2013 a medical panel on hypertension, or high blood pressure, issued guidelines 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 2014 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.

Sub-clinical heart damage

But researchers are careful to point out that the same cannot be said for young adults. In fact, a federal study led by Johns Hopkins researchers says mild elevations in blood pressure considered to be in the upper range of normal during young adulthood can lead to sub-clinical heart damage by middle age, a condition that could lead to full-blown heart failure.

Elevated blood pressure is one that tops 140/90, a reading that measures the force of pressure in the heart as it contracts – that's the top number – and as it relaxes between contractions, the bottom number. High blood pressure has been long implicated as a risk factor in a range of cardiovascular diseases.

What is different about the new study is its suggestion that pressure just below that threshold, what is called 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.

Troubling

Investigators are especially troubled because their findings come from a group of patients, most having had no hypertension. They are concerned that a pattern of high normal blood pressure in early adulthood could be indicators of 2 forms of heart failure, a condition marked by the progressive weakening heart muscle and the organ's gradual loss of blood-pumping ability.

“Our results suggest the heart muscle may be more exquisitely sensitive to the effects of even subtle elevations in blood pressure than we thought,” said principal investigator Joao Lima.

To review, the most recent clinical guidelines issued by the Joint National Committee in 2014 define hypertension as blood pressure above 140/90, which is higher than it has been in recent years. The guidelines also call on clinicians and patients to aim for a pressure below 150/90.

The Johns Hopkins team says these guidelines are not “one size fits all.” They do not apply to all ages, and what constitutes normal should probably change with age, they say.

“Our results suggest that 'high-normal' blood pressure may be too high and far from normal for some people,' said lead author Satoru Kishi, M.D., a cardiologist at Mitsui Memorial Hospital in Tokyo who worked on the study as a research fellow at the Johns Hopkins University School of Medicine. “A concerning number of young adults with pressures in the high-normal range develop insipient heart dysfunction in middle age.”

Young people may suffer from elevated blood pressure because of lifestyle issues. Diet and body mass are big influencers.

Young people who are overweight or obese, eat an unhealthy diet and get little exercise may experience elevated blood pressure levels. In the past these levels were seen as fairly normal. The Hopkins team says now they should be cause for concern.

Millions of people take medication that successfully controls their blood pressure. But new research suggests they haven't eliminated their risks of suffering a stroke.

Researchers at the University of Alabama at Birmingham (UAB) say developing hypertension, even if it is eventually controlled with medication, significantly increases the chance of having a stroke.

The researchers followed up with participants in a major blood pressure study for more than 6 years. Three-quarters of the participants' blood pressure was controlled by medication. The remain quarter had uncontrolled hypertension. At the end of the 6 years more than 800 had suffered a stroke.

The researchers conclude that the harder hypertension is to control, the more likely the patient is to eventually suffer a stroke, even if medication returns blood pressure to normal levels.

Stroke risk rises with each pill

Dr. George Howard, a professor in the Department of Biostatistics in the UAB School of Public Health, found the risk of stroke went up 33% with each blood pressure medicine required to treat blood pressure to goal.

People with normal blood pressure without having any kind of treatment are two and a half times less likely to have a stroke than people on three or more blood pressure medications.

That's bad news for people who have suffered hypertension for years but have finally reduced their blood pressure to normal levels with the help of multiple pills.

“You’re in as much trouble by the time you are on three medications that achieve excellent control as you are when you have hypertension and it is untreated, which is amazing,” Howard said.

False sense of security

Howard's point is this: relying on medication to control blood pressure presents a false sense of security.

The way to reduce strokes, he says, is to prevent hypertension in the first place. His four steps for preventing high blood pressure are:

• Taking part in moderate physical activity
• Keeping weight in normal rages
• Reducing salt intake
• Eating a diet rich in fruits, vegetables and low-fat dairy products and reduced in saturated and total fat.

“It’s everything we know we should be doing,” Howard said. “And over the past 14 years, stroke deaths are down 42%, likely because of this general shift of everybody in the population working toward having lower blood pressures.”

Drug sales booming

But the sale of medication to control blood pressure is a huge part of the pharmaceutical industry. The government reports that in 2010, more than 58 million adults were treated for hypertension and spent more than $20 billion on medication to control blood pressure.

Last year researchers at Duke University irked the phamaceutical industry when they suggested millions of Americans are taking blood pressure medication they don't need.

That's because health guidelines had just raised what was considered normal blood pressure. The Eighth Joint National Committee said adults over 60 could be healthy with blood pressure readings of 150/90 instead of the previous 140/90.

“As individuals, we need to take the right actions for our health,” Howard said. “Individuals and society need to work together to keep people from becoming hypertensive.”

In other words, we need to address what is causing our blood pressure to rise to unhealthy levels, not lower it with drugs.

Doctors aren't completely sure what can lower your blood pressure but they know of a lot of thing that can raise it – being overweight, consuming too much sodium and not getting enough exercise.

Scientists now say they have additional data suggesting two foods can help lower blood pressure – one that you might like eating, the other perhaps not so much.

Researchers at Florida State University say just one cup of blueberries each day could be important in reducing blood pressure and reducing arterial stiffness.

Perhaps not quite as appetizing is beet juice. But British scientists say drinking a cup of it each day has been shown to significantly lower blood pressure among patients with high blood pressure.

Blueberries or beet juice?

Probably for most consumers, the blueberry option is preferable.

“Our findings suggest that regular consumption of blueberries could potentially delay the progression of prehypertension to hypertension, therefore reducing cardiovascular disease risk,” said Sarah A. Johnson, assistant director of the Center for Advancing Exercise and Nutrition Research on Aging (CAENRA) and postdoctoral fellow in the Department of Nutrition, Food and Exercise Sciences at Florida State University (FSU).

The team of FSU nutrition and exercise scientists published their findings in the Journal of the Academy of Nutrition and Dietetics.

Postmenopausal women

Johnson started her project because of her interest in functional foods — foods that have a positive impact on health beyond basic nutrition. She found that many of these foods can prevent and reverse negative health outcomes, especially for postmenopausal women.

“Cardiovascular disease is the leading cause of death in the United States,” she said. “Once women go through menopause, this puts them at an even greater risk for it. Our findings suggest that the addition of a single food, blueberries, to the diet may mitigate the negative cardiovascular effects that often occur as a result of menopause.”

In her study participants who received blueberry powder – the equivalent of a cup of blueberries a day – experienced a 5% decrease in systolic blood pressure. They saw an even greater decrease in diastolic pressure.

Previous studies

Previous studies on blueberries have shown positive effects on cardiovascular risk factors including blood pressure, but they all included large amounts of blueberry powder consumption, anywhere from 50 grams to 250 grams. In the case of 250 grams, that would translate to more than 11 cups of fresh blueberries, which may not be realistic for people to consume on a regular basis.

Scientists at Queen Mary University of London say a daily 250ml glass of beet juice also contributes to a significant drop in blood pressure. They say beet's high content of inorganic nitrate is what provides the medicinal effect.

While previous studies have suggested blueberries have a positive effect on blood pressure, the researchers says this is the first to indicate dietary nitrate supplementation from beet juice has a similar effect.

For years doctors have known that obesity is a strong link to cardiovascular disease, and with it conditions like hypertension, or high blood pressure.

Now, doctors are learning more about why carrying too much weight contributes to high blood pressure, a major risk for stroke and heart attack.

An international team of health researchers has published findings that focus on the role of leptin, a substance produced by fat cells.

Leptin is key

It turns out that leptin levels in the body are significantly elevated following weight gain. The increase in leptin acts in the brain to increase blood pressure.

The researchers reached their conclusion when they ran a series of experiments on both animal and human subjects. First, they set up roadblocks in the brain to keep the leptin signals from getting through. They even went so far as to remove leptin receptors from the brain.

Interrupting that communication had a dramatic effect. It reduced both high blood pressure and obesity.

80% of hypertension cases

The research team maintains as much as 80% of common hypertension is linked to excess body fat. This study breaks new ground because it describes how obesity raises blood pressure.

More importantly, it could lead to new approaches for treating both conditions.

"Our data suggest that pharmacological approaches based on altering the effect of leptin in the dorsomedial hypothalamic region of the brain, could potentially represent a therapeutic target for the treatment of obesity induced hypertension and potentially could be exploited to alleviate the incidence of obesity induced cardiovascular diseases," said Professor Michael Cowley, of Australia's Monash University.

Translated, that means it may be possible to produce a drug that would stop leptin from telling the brain to raise the body's blood pressure. If so, it would come as welcome news to millions of Americans.

Epidemic of hypertension

The Centers for Disease Control and Prevention (CDC) estimates some 67 million American adults – about 31% of the adult population – have high blood pressure and only about half of them have their condition under control.

The condition affects men and women more or less equally over their lifetimes. However, for people younger than 45 years old, the condition affects more men than women. For people 65 years old or older, high blood pressure affects more women than men, the CDC says.

Because it is so closely linked to heart disease and stroke, more than 348,000 American deaths in 2009 included high blood pressure as a primary or contributing cause, working out to about 1,000 deaths a day.

In addition to heart-related illness high blood also pressure increases your risk for kidney disease.

Natural remedies

High blood pressure is usually treated with medication but changes in lifestyle are also very effective in bringing it under control. A healthy diet, regular exercise and maintaining a normal weight will do as much as anything to keep your blood pressure under control.

How high is high blood pressure? Recently, there has been some disagreement about that in medical circles. We recently looked into that question here.

According to the cardiac researchers presenting at last weekend's American Heart Association Scientific Sessions, we're making progress in some areas of heart health but stepping back in others.

First, the good news. Since the Baby Boom population first entered middle-age and obesity has become more common, hypertension – or high blood pressure – has been a growing problem. But those dangerous blood pressure readings appear to be coming down.

Dropping blood pressure

Findings presented over the weekend show that more than half of those diagnosed with hypertension are now getting readings below 140/90 millimeters of mercury (mm Hg), which is considered safe.

A reading of 120/80 is considered optimal and the findings show that between 2003 and 2012, the percentage of hypertension patients able to achieve that rose from 13% to 27%.

"This is definitely good news," the researchers conclude.

That's because hypertension is linked to heart attack and stroke. As fewer people have high blood pressure, that risk has declined.

But the percentage of patients with high blood pressure that remains uncontrolled remains high, at 48%. The federal Healthy People 2020 initiative has a goal of reducing that to 38%. High blood pressure affects about 1 in 3 adults in the United States.

Irregular heart beats jump

While there was good news on the blood pressure front, doctors report emergency room visits for irregular heartbeat surged in recent years and are currently creating a major health care burden.

Atrial fibrillation (AF), the most common kind of arrhythmia or irregular heartbeat, can lead to blood clots, stroke, heart failure and other heart-related complications.

When they studied the data, researchers found that 65% of those making a trip to the ER for an irregular heartbeat ended up in the hospital. It has increased in later years, rising from 62.5% in 2006 to 67% in 2011.

Getting worse

The rate of AF emergency room visits steadily increased 24%, from 133 visits per 100,000 persons in 2006 to 165 visits per 100,000 persons in 2011.

When you add it all up, more than 2.7 million Americans were admitted for AF between 2006 and 2011.

The one bright spot was the decrease in in-hospital death rates after a patient was admitted with AF.

There were some common characteristics of patients who were admitted with AF. They tended to be elderly, female, had Medicare or Medicaid insurance and lived in areas with low median income.

According to the American Heart Association an irregular heartbeat can produce a wide range of symptoms. They include fatigue, dizziness, lightheadedness, fainting, chest pain, shortness of breath and a rapid heartbeat.

The Association says that while most cases are harmless, some arrhythmias are extremely dangerous and require treatment and management.  

There are many reasons people go to a hospital emergency room and in recent years, spiking blood pressure has become a fairly common one.

Data presented at the American Heart Association's High Blood Pressure Research Scientific Sessions earlier this month showed the number of ER cases of essential hypertension, high blood pressure with no known cause, increased by 25% over a 5-year period.

That means a lot of people who suddenly discover their blood pressure is dangerously high are seeking immediate medical attention. Dr. Sourabh Aggarwal, M.D., Chief Resident in the Department of Internal Medicine at Western Michigan University School of Medicine in Kalamazoo, says there's a clear takeaway from this development.

What it shows

"This shows we are not doing a good job in controlling high blood pressure in the outpatient setting," she said. "We need better high blood pressure care in this setting."

When patients go to the ER for treatment of high blood pressure, they are less likely than in the past to be admitted. This may have to do with more effective treatments, including medications. Researchers reached their conclusion after collecting data on about 3.9 million ER visits from 2006 to 2011 in which high blood pressure was the first listed diagnosis.

The research does not show what specifically sent the people to the hospital but the American Heart Association recommends going to the ER if you have blood pressure above 180/110 mm Hg, which is considered a hypertensive crisis.

High blood pressure, often called a silent killer because it typically has no symptoms, affects 76.4 million U.S. adults. It's a major risk factor for stroke, heart attack and heart failure.

It's also on the increase, as more Americans are overweight and sedentary. While high blood pressure can have many causes, those 2 are among the most common.

Small weight gain

The American Heart Association event produced other significant new information about hypertension. Researchers said they found that gaining as little as 5 pounds can raise the blood pressure of otherwise healthy adults.

“To our knowledge, for the first time, we showed that the blood pressure increase was specifically related to increases in abdominal visceral fat, which is the fat inside the abdomen,” said Naima Covassin, Ph.D., the study’s lead author and a research fellow at the Mayo Clinic in Rochester, Minn. “Our research suggests that healthy people who are more likely to gain weight in the stomach area are also more likely to have their blood pressure increased.”

The study found that test subjects who gained weight increased the systolic blood pressure by 4 points compared to test subjects who didn't gain weight. Where the weight was gained was also a factor.

People who added fat in the stomach area had the greatest increase in their blood pressure. While the small weight gain did increase blood pressure, it didn't have any effect on insulin or blood sugar levels.

“The public awareness of the adverse health effects of obesity is increasing; however, it seems most people are not aware of the risks of a few extra pounds,” Covassin said. “This is an important finding because a 5 to 7 pound weight gain may be normal for many during the holiday season, the first year of college or even while on vacation.”

And as you get older, it gets harder to shed pounds, even as few as 5. Better to avoid gaining it in the first place, if possible.

A new study finds that adults who consume a high-protein diet may be at a lower risk for developing high blood pressure, and researchers involved in the study say the results suggest it's time to take a new look at dietary recommendations.

"These results provide no evidence to suggest that individuals concerned about the development of HBP (high blood pressure) should avoid dietary protein. Rather, protein intake may play a role in the long-term prevention of HBP," said Lynn Moore, associate professor of medicine at the Boston University School of Medicine. "This growing body of research on the vascular benefits of protein, including this study, suggest we need to revisit optimal protein intake for optimal heart health," she added.

In the latest study, published in the American Journal of Hypertension, researchers found participants consuming the highest amount of protein (an average of 100 g protein/day) had a 40% lower risk of having high blood pressure compared to the lowest intake level.

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.

Overweight and normal

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 and normal weight individuals.

They also found that consuming more dietary protein 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% reductions in risk of HBP.

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, High blood pressure 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.

You see them everywhere: the supermarket, drug stores, discount superstore. It's those blood pressure monitoring kiosks where you stick your arm in the cuff and get a reading.

But here's something to keep in mind: The next time you do that, you could get an inaccurate reading unless the cuff is your size.

Correct cuff size is a critical factor in measuring blood pressure. Using a too-small cuff will result in an artificially high blood pressure reading; a too-large cuff may not work at all or result in an inaccurately low blood pressure reading.

The Food and Drug Administration (FDA) wants you to know that blood pressure cuffs on public kiosks don’t fit everyone -- and might not be accurate for every user.

“They are easily accessible and easy to use,” says Luke Herbertson, PhD, a biomedical engineer at FDA. “But it’s misleading to think that the devices are appropriate for everybody. They are not one-size-fits-all.”

Serious business

Blood pressure is an important indicator of cardiovascular health. High blood pressure (hypertension) is called a “silent killer” because it may not show any symptoms. It increases the risk of stroke, heart attack, heart failure, kidney failure and death. The higher the blood pressure, the greater the risk.

Hypertension affects nearly one in three adults in the United States, and in most patients, it is found only when they have their blood pressure checked.

The need for accuracy

In a clinic or a medical office, this is done by using blood pressure cuffs of various sizes to ensure the reading is accurate. For example, a toddler’s blood pressure is checked by using an extra-small children’s cuff, but a football lineman’s arm may require an extra-large adult cuff.

Not so at kiosks. Most have just one fixed-size cuff that fits arms of only a certain size. The blood pressure reading is reliable only if the user’s arm is within the range that has been validated for that cuff size. Moreover, not all kiosks have the same size cuff. There is no such thing as a “standard” cuff to fit a “standard” arm.

If the cuff doesn’t fit your arm properly, your reading won’t be accurate.

“Different kiosks have different cuff sizes that will fit different people -- so it’s important to know the circumference of your upper arm because not all devices are alike,” says Stephen Browning, a biomedical engineer at FDA. “Many people will be outside the arm size range for a particular kiosk, and the information from that kiosk won’t be reliable for them.”

Other factors, including how someone uses a device, might cause an inaccurate reading. “The user might not have placed the cuff on his arm properly or might not be sitting properly. These things will affect accuracy,” Herbertson says.

That’s why people shouldn’t overreact to any one reading from a kiosk.

“Hypertension isn’t diagnosed solely based on one reading. Inaccurate blood pressure measurements can lead to the misdiagnosis of hypertension or hypotension (low blood pressure), and people who need medical care might not seek it because they are misled by those inaccurate readings,” Browning says.

“Next time you see your doctor, get his or her opinion about whether blood pressure kiosks are right for you and if so, learn to use them properly—using the right size cuff so you can get accurate readings,” Herbertson advises.

What to do

Consumers use kiosks for various reasons. They might have been advised by their doctor to monitor changes to their health. They may be concerned about hypertension. Or they may just be curious about their blood pressure.

Health care providers diagnose hypertension based on several blood pressure measurements over a period of time. Remember that one measurement -- from a kiosk or other device -- doesn’t a diagnosis make.

Like your heart rate, your blood pressure can change quickly. It might be higher during a stressful meeting, after a brisk walk or because you’re sick. Those variations are normal. That’s why people with hypertension monitor their blood pressure frequently. And health care providers often depend on the patient’s own readings to augment the reading in a doctor’s office, so kiosks can be useful in many circumstances.

Although blood pressure kiosks have their limitations, they can provide valuable information when used properly and under the guidance of a health care provider.

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.

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.  

Smoking can cause high blood pressure. So can drinking too much alcohol. Being overweight and consuming too much sodium also greatly increases your risk.

Beyond that, doctors have been puzzled when hypertension shows up in people who don't smoke, drink, or have poor diets. But gradually new potential triggers are emerging.

Researchers publishing their results in the American Heart Association journal Circulation have advanced the theory that living on a street with a foreclosed home can cause your blood pressure to rise.

Specifically, the researchers say that a foreclosed property may cause a neighbor's systolic blood pressure, the top number in a blood pressure reading, to rise.

Stressing over the neighborhood

Stress has always been a hypertension risk factor but the study takes health in a new direction. Instead of blood pressure being influenced by an individual's personal behavior, the researchers suggest that environmental factors play a bigger role that previously believed.

It may have taken the 2008 housing collapse to bring it to light. Because of the massive scale of the U.S. housing crisis public health officials have tried to reach a better understanding of how foreclosure activity might impact health.

The number of foreclosures spiked in the United States in 2007-10 when more than 6 million homeowners fell behind on their mortgages and banks took ownership of the homes, or foreclosed.

Researchers looked at data from 1,740 participants in 1987-2008 who were part of the Framingham, Mass., Heart Study. They distinguished between bank-owned foreclosures that typically sit vacant and foreclosures purchased by third-party buyers, which are generally put into productive use.

Proximity matters

They found that for every vacant foreclosed property within 328 feet of a participant's home there was an average increase of 1.71 mm Hg in systolic blood pressure. If a property was purchased and occupied there was no difference.

The findings have renewed focus on the role that stress plays in hypertension.

"The increases in blood pressure observed could be due in part to unhealthy stress from residents' perception that their own properties are less valuable, their streets less attractive or safe and their neighborhoods less stable," said Mariana Arcaya, study lead author and Yerby Postdoctoral Research Fellow at the Harvard Center for Population and Development Studies. "Safety could also be a concern that affects their ability to exercise in these neighborhoods."

Increased awareness needed

The takeaway from this, according to Arcaya, is that healthcare providers should be aware of real estate trends in the areas they serve. Patients living in neighborhoods still recovering from the housing crisis may need extra monitoring.

High blood pressure, often called “the silent killer, affects nearly 76 million people in the United States. It's a major contributor to heart disease and stroke.

While stress is a risk factor that should get more attention, doctors continue to link the condition lifestyle choices, particularly diet.

Phosphate link

Scientists in Austria recently identified a hormone, FGF23 (Fibroblast Growth Factor 23), as a trigger for elevated blood pressure. When the level of FGF23 is raised, as through a high phosphate diet, calcium and sodium accumulate, putting strain on the cardiovascular system.

Foods that are rich in phosphate – things like cheese, Parmesan, cola, baking powder and most processed foods – are triggers for FGF23.

When large quantities of phosphates are consumed, production of the FGF23 hormone is stimulated, which has a negative effect on the cardiovascular system.

Reinhold Erben, the head of the Unit of Physiology, Pathophysiology and Biophysics at the Vetmeduni Vienna, says consumers should control their phosphate consumption, since it is now shown to be important to health.

You might think of watermelon as a summertime treat but a new study finds it's a beneficial snack year-round, especially for obese people with high blood pressure.

The 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 pressure on the aorta and on the heart decreased after consuming watermelon extract,” Figueroa said.

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.

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.

“That means less overload to the heart, so the heart is going to work easily during a stressful situation such as cold exposure,” Figueroa said.

Consumers spend billions of dollars a year on prescription medication to treat all sorts of conditions. But are some of us taking pills – and spending money – needlessly?

A couple of recent studies suggest we may be. The separate research projects, released late last week, studied prescription medications for high blood pressure and those treating erectile dysfunction. They may cause some heartburn at drug companies.

For example, researchers at Duke University say 5.8 million U.S. adults may no longer need to take medication to treat high blood pressure. The reason?

In February the Eighth Joint National Committee voted to relax the blood pressure goal in adults 60 years and older to 150/90, instead of the previous goal of 140/90.

The Duke researchers analyzed a number of previous studies of hypertension patients and their blood pressure readings to reach the conclusion that many who are now taking medication don't need it. But that doesn't mean you should throw away your pills. The researchers make clear they aren't advocating that.

Admittedly 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.”

The Duke study, in collaboration with McGill University, reviewed a database with more than 16,000 participants whose blood pressure measurements were listed. Based on the sample, the researchers conclude the proportion of U.S. adults who should be treated for high blood pressure would decrease from 40.6% under the old guidelines to 31.7% under the new recommendations.

“The new guidelines do not address whether these adults should still be considered as having hypertension,” Navar-Boggan said. “But they would no longer need medication to lower their blood pressure.”

Discuss it with your doctor

Whether a patient needs to continue taking medication is a decision to be made only after discussing it with a doctor. But if millions of people now paying for prescription medication no longer had to, that could be very bad news for the pharmaceutical industry, not to mention very good news for consumers.

The news may be equally as bad for the makers of drugs to treat erectile dysfunction. A new report in the Journal of Sexual Medicine suggests men can reverse their erectile dysfunction by lifestyle changes without relying completely on medication.

Gary Wittert, head of the Discipline of Medicine at the University of Adelaide, in Australia, says his research team found a large number of men in their study were naturally overcoming erectile dysfunction issues without taking medication.

“The remission rate of those with erectile dysfunction was 29%, which is very high,” he said. “This shows that many of these factors affecting men are modifiable, offering them an opportunity to do something about their condition."

The researchers found that even in cases where medication was required to treat erectile dysfunction, it was more effective if the men adopted improved lifestyle behavior.

Simple steps

Lifestyle changes include losing weight, getting more exercise, drinking less alcohol, eating a more nutritious diet and getting a good night's sleep.

Treating both high blood pressure and erectile dysfunction are profitable businesses. According to the Agency for Healthcare Research and Quality, Americans spent $20.4 billion in 2010 to treat high blood pressure.

According to government statistics, worldwide sales of the three most popular drugs to treat erectile dysfunction total $1 billion per year.

It bears repeating that no one who is currently taking prescription medication should stop on their own. But it might be a question to raise with your health care provider.

Numbers are a big part of health. Height, weight, pulse, blood pressure – doctors can tell a lot about how we are doing physically by the numbers assigned to these properties and functions. And at least one doctor thinks you should know these numbers too.

Dr. Martha Gulati, director of preventive cardiology and women’s cardiovascular health at The Ohio State University Wexner Medical Center, says five sets of numbers in particular can help individuals know if they are in danger of developing heart disease.

Body mass index

The first number is your body mass index, or BMI. When the Wexner Medical Center commissioned a survey, it found nearly two thirds of the public not only didn't know their number, but didn't know what BMI was. So, what is it?

“Basically, it's calculating the amount of weight you're carrying for your body surface area,” Gulati told ConsumerAffairs.

In simple terms, it's a number that tells you how fat you are. When you enter your weight and height into a calculator like this one, you arrive at a number. A number below 25 is considered normal weight. Twenty-five to 30 is overweight and a BMI of 30 or above is considered obese. Gulati says a BMI is just a way to get a difficult conversation started.

“A lot of women don't like to talk about their weight and believe it or not, a lot of doctors don't talk about weight because they don't want to embarrass their patient,” Gulati said. “But if you can't talk about it in a doctor's office, where can you talk about it?”

Blood pressure

The second number is blood pressure, measured using two numbers. The systolic pressure – the pressure when you heart is pushing blood through your veins – and the diastolic pressure, when your heart is at rest, is displayed as 120/80, which is considered a normal blood pressure.

Readings up to 140/90 are considered pre-hypertension and are usually addressed through diet and exercise. Readings over 140/90 usually are treated with medication.

Cholesterol

The third number is your cholesterol. It's a natural substance produced in your body. Unfortunately, you can get too much cholesterol from food. Some people actually produce too much cholesterol on their own and getting it from food just adds to the problem.

Over time cholesterol can clog arteries, bringing on heart disease and sometimes a heart attack. High cholesterol can be treated with medication but Gulati says it’s important to know your total cholesterol number and your low-density lipoprotein, or LDL, number – the so-called “bad cholesterol” that can cause problems. A healthy cholesterol number is below 200. A healthy LDL number is below 100.

Blood sugar

People with diabetes have to constantly keep up with their blood sugar number. That's an indicator of how much glucose is in the blood and too much causes diabetes.

But even if you don't have diabetes you need to be aware of this number, especially if you are overweight. But it's not an easy number to access.

“A lot of times physicians are checking these numbers but not always telling their patients what they are,” Gulati said. “They may say 'your blood work is normal,' but it's not enough to know it's normal, you really need to know what the numbers are.”

A healthy fasting blood sugar number is under 100 after not eating for eight hours.

Waist circumference

Finally, you should know the number of inches around your waist. But not the area where your belt goes. No, a more accurate measure of your gut is putting the tape measure across your belly button. Gulati says physicians should be measuring it on a more regular basis but concedes it's rarely done.

“What we're doing is measuring for central obesity,” she said. “If you carry your weight in the center of your abdomen instead of your hips, being an apple shape instead of a pear shape, that tells me you are pre-disposed to developing diabetes and heart disease.”

Knowing these numbers, of course, is only half the battle. Then you have to do something about it. Fortunately, there's a lot you can do.

A careful diet, keeping track of calories – numbers again – and getting regular exercise will help maintain a healthy weight and cardiovascular system.  

Most of us have two arms, so why is it that blood pressure is generally measured in only one arm? It's a good question and, in fact, a new study finds that it would be better to measure the pressure in both arms.

Why? Research published in the March issue of The American Journal of Medicine suggests that there is an association between a difference in interarm systolic blood pressure and a significant increased risk for future cardiovascular events -- heart attacks and the like.

A link between interarm blood pressure differences and cardiovascular risk has been long suspected, but little data existed to support the hypothesis until now.

This new study examined 3,390 participants aged 40 years and older from the Framingham Heart Study. All subjects were free of cardiovascular disease at baseline, but investigators found that participants with higher interarm systolic blood pressure differences were at a much higher risk for future cardiovascular events than those with less than a 10 millimeters of mercury (mmHg) difference between arms.

"In this large prospective, community-based cohort of middle-age men and women free of cardiovascular disease, an increased interarm systolic blood pressure difference was found to be present in nearly 10% of individuals and is associated with increased levels of traditional cardiovascular risk factors," explains lead investigator Ido Weinberg, MD, Institute for Heart Vascular and Stroke Care, Massachusetts General Hospital, Boston. 

Researchers also found that participants with elevated interarm blood pressure difference were older, had a greater prevalence of diabetes mellitus, higher systolic blood pressure, and a higher total cholesterol level.

According to these findings, investigators suggest practitioners should consider including blood pressure readings in both arms in order to get the most accurate readings possible and detect any differences in interarm blood pressure.

"Even modest differences in clinically-measured systolic blood pressures in the upper extremities reflect an increase in cardiovascular risk," says Weinberg. "This study supports the potential value of identifying the interarm systolic blood pressure difference as a simple clinical indicator of increased cardiovascular risk."

British researchers have sounded an alarm over the growing threat of hypertension, or high blood pressure, comparing it to the HIV epidemic that exploded two decades ago.

Their report, in the International Journal of Epidemiology, suggests high blood pressure could be as devastating to global health as HIV. Peter Lloyd-Sherlock of the University of East Anglia, Shah Ebrahim and Heiner Grosskurth of the London School of Hygiene and Tropical Medicine (LSHTM), find another similarity. They say the response of most governments to high blood pressure is little better than the reaction to HIV/AIDS 20 years ago – too little, too late.

Similarities

High blood pressure is not an infectious disease – you don't get it from human contact. But like HIV, the researchers say, it can lead to fatal and disabling illness. They estimate that the number of world-wide deaths attributable to hypertension over the next 20 years may substantially exceed the number resulting from HIV/AIDS.

Despite those numbers, the three researchers say there is “denial” and misunderstanding about the impact of hypertension, despite the two conditions having a number of things in common. Though they have different origins, both diseases can be treated and managed as chronic conditions through a combination of drug treatment and lifestyle changes.

“It has been suggested that valuable lessons for hypertension could be taken from HIV/AIDS policies,” the researchers write. “Yet there is little indication that these are being taken on board. Our response to the global epidemic of hypertension seems little better than our response to HIV/AIDS two decades ago: too little too late. Can we not wake up earlier this time, before millions have died?”

The condition

High blood pressure is a condition in which the heart uses excess force to pump blood through the circulatory system. It can lead to coronary heart disease, heart failure, stroke, kidney failure and other health conditions.

The excessive pressure of the blood moving through the system can weaken artery walls, leading to a rupture and causing a stroke.

According to the National Heart, Lung and Blood Institute, part of the National Institutes of Health, about one in three adults in the U.S. suffers from high blood pressure. Since there are no signs or symptoms, you can have it for years without knowing it.

Blood pressure is measured using a cuff device that records the higher systolic pressure – when the heart is pushing blood through the body – and lower diastolic pressure – when the heart is at rest between beats. A reading of 120/80 or lower is considered normal.

Hypertension causes

High blood pressure is often caused by lifestyle factors. Smoking, unhealthy foods, being overweight or obese, too little exercise and too much alcohol are all factors that can raise blood pressure. Stress is another factor that can significantly raise risks.

Because high blood pressure is largely behavior-influenced, the researchers speculate government officials are reluctant to spend taxpayer funds to help people “who eat and drink too much.”

“HIV was faced with political denial and public misunderstanding in the early years of the pandemic, especially in some poorer countries,” the researchers write. “There is a similar pattern of denial with hypertension.”

The denial, they claim, is misguided, especially the view that hypertension does not affect poorer social groups. They say there is substantial evidence that hypertension is highly prevalent among poorer groups and that they are less likely to have access to effective treatment.

A lot of people look for reasons to avoid physical activity. But here's a good reason to seek it out.

New research in the American Heart Association journal Hypertension suggests being active in your leisure time could help keep your blood pressure at a healthy level.

Researchers looked at results from 13 studies on the effects of physical activity on blood pressure. The studies involved 136,846 people in the United States, Europe or East Asia who initially had healthy blood pressure. More than 15,600 developed high blood pressure during follow-up periods ranging from two to 45 years.

Bettering your odds

However, those who exercised more than four hours per week in their leisure time had a 19% lower risk of high blood pressure than those who exercised less than one hour per week. People who had one to three hours per week of leisure exercise had an 11% lower risk than those with under an hour of activity.

This suggests that more is better: The more recreational physical activity you get, the more you are protected from developing high blood pressure.

Almost 78 million U.S. adults have high blood pressure, defined by the American Heart Association as blood pressure readings at or above 140 millimeters of mercury for the upper number or 90 or higher for the bottom number. Because it typically has no symptoms, the condition goes undetected or untreated in many people.

"Hypertension is a risk factor for cardiovascular and kidney disease -- thus, it is important to prevent and control hypertension," said Wei Ma, M.D., Ph.D., study co-author and associate professor at the Shandong University School of Public Health in Jinan, China. "To try to lower your risk of high blood pressure, you should exercise more in your leisure time."

Work vs. fun

Researchers didn't find a solid link between physical exertion at work and risk of high blood pressure. Health guidelines urging people to get more exercise don't distinguish between activity at work and for leisure, said Bo Xi, M.D., Ph.D., lecturer at the Shandong University School of Public Health in Jinan, China, and a co-author with Ma. But, "given the new findings, perhaps they should."

Physical activity on the job, such as farm or industrial work, can involve exertion like heavy lifting, prolonged standing and repetitive tasks.

Recreational exercise may affect several factors tied to high blood pressure -- helping people keep off extra pounds, improving poor insulin sensitivity or reducing the blood vessels' resistance to blood flow, Ma said.

Although the new research linked recreational exercise and lower blood pressure, it didn't show that the exercise prevents the condition. People who exercise for fun may just have healthier lifestyles, Xi said.

In a new study, the drug aliskiren did not slow the development of high blood pressure and coronary artery disease compared to a placebo.

Aliskiren inhibits the production of renin, an enzyme secreted by the kidneys that can cause tightening of the arteries, which in turn contributes to high blood pressure. But in a study of 613 patients, no significant improvement was seen, according to a study published by JAMA. The study is being released early online to coincide with its presentation at the European Society of Cardiology Congress 2013.

“These findings do not support the use of aliskiren for regression or prevention of progression of coronary atherosclerosis,” the authors conclude.

No significant difference

Aliskiren is commonly used in patients who show early signs of high blood pressure and coronary heart disease, in an effort to slow the progression of disease. Guidelines generally recommend reducing blood presure to 140/90.

Stephen J. Nicholls, M.B.B.S., Ph.D., of the South Australian Health and Medical Research Institute, Adelaide, Australia, and colleagues conducted a study to determine if renin inhibition with aliskiren would slow progression of coronary atherosclerosis in patients whose blood pressure was considered optimally controlled to current treatment targets.

The randomized, multicenter trial compared aliskiren with placebo in 613 participants with coronary artery disease, systolic blood pressure between 125 and 139 mm Hg (prehypertension range), and 2 additional cardiovascular risk factors. The trial was conducted at 103 academic and community hospitals in Europe, Australia, and North and South America.

The researchers found that there was no significant difference between the treatment groups. 

In a related editorial, Jean-Claude Tardif, M.D., and Jean Gregoire, M.D., of the Montreal Heart Institute, Montreal, Canada, comment on the findings and discuss two other trials in which aliskiren was not effective in improving clinical outcomes in patients with cardiovascular disease.

They suggest that, pending further study, "the role of renin inhibition in this context should be limited."

"Because aliskiren does reduce blood pressure, perhaps this agent could be reserved for use in patients with coronary disease and hypertension who cannot tolerate ACE inhibitors and angiotensin receptor blockers,” they suggested.

What to do

If you are taking aliskiren, talk with your physician about this study. While it was not shown to prevent the progression of heart disease, aliskiren does reduce high blood pressure. 

Consumers should never self-diagnose or self-treat based on a single research study or, for that matter, any information they find on the Internet. Only your physician can diagnose and treat illness.

It's been said that the eyes are the windows to the soul. Now, some doctors believe that the eyes may also be a window to a person's stroke risk.

Researchers who took part in a study reported in the American Heart Association journal Hypertension believe retinal imaging may someday help assess if you're more likely to develop a stroke -- the nation's No. 4 killer and a leading cause of disability.

"The retina provides information on the status of blood vessels in the brain," said Mohammad Kamran Ikram, M.D., Ph.D., lead author of the study and assistant professor in the Singapore Eye Research Institute, the Department of Ophthalmology and Memory Aging & Cognition Centre, at the National University of Singapore. "Retinal imaging is a non-invasive and cheap way of examining the blood vessels of the retina."

Hypertension the key

High blood pressure is the single most important risk factor for stroke worldwide. However, it's still not possible to predict which high blood pressure patients are most likely to develop a stroke.

Researchers tracked stroke occurrence for an average 13 years in 2,907 patients with high blood pressure who had not previously experienced a stroke. At baseline, each had photographs taken of the retina, the light-sensitive layer of cells at the back of the eyeball. Damage to the retinal blood vessels attributed to hypertension -- called hypertensive retinopathy -- evident on the photographs was scored as none, mild or moderate/severe.

During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain.

Finding a link

Researchers adjusted for several stroke risk factors such as age, sex, race, cholesterol levels, blood sugar, body mass index, smoking and blood pressure readings. They found the risk of stroke was 35 percent higher in those with mild hypertensive retinopathy and 137 percent higher in those with moderate or severe hypertensive retinopathy.

Even in patients on medication and achieving good blood pressure control, the risk of a blood clot was 96 percent higher in those with mild hypertensive retinopathy and 198 percent higher in those with moderate or severe hypertensive retinopathy.

"It is too early to recommend changes in clinical practice," Ikram said. "Other studies need to confirm our findings and examine whether retinal imaging can be useful in providing additional information about stroke risk in people with high blood pressure."

Hypertension, or high blood pressure, has been called the silent killer because many who have it are unaware they have a condition that can shorten their life. Recognizing that you have the condition, however, is just the first step. Next, you have to treat it.

First, let's define our terms. When we say “high blood pressure” we are talking about a blood pressure reading above 140/90 – the 140 being the systolic number, which measures the the pressure in the arteries when the heart beats. The 90 is the diastolic number, which measures the pressure between beats.

While the National Heart, Blood and Lung Institute – part of the National Institutes of Health (NIH) – declares 140/90 to be normal, most physicians now want their patients to have a reading of 130/80 or below.

Get healthy

Adopting a healthy lifestyle is an effective first step in both preventing and controlling high blood pressure. If lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to add blood pressure medications. In fact, most people with high blood pressure take one or more prescription medications.

One of the older class of medications is the beta blocker. Beta blockers reduce nerve impulses to the heart and blood vessels, slowing the heart, so it doesn't work as hard.

Angiotensin converting enzyme, or ACE, inhibitors prevent the formation of a hormone called angiotensin II, which can cause blood vessels to narrow. The ACE inhibitors cause the vessels to relax and blood pressure goes down.

Angiotensin antagonists shield blood vessels from angiotensin II. As a result, the vessels become wider and blood pressure goes down. Calcium channel blockers, or CCBs, keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down.

Alpha blockers reduce nerve impulses to blood vessels, which allows blood to pass more easily, causing the blood pressure to go down. Alpha beta blockers work the same way as alpha blockers but also slow the heartbeat, as beta blockers do. As a result, less blood is pumped through the vessels and the blood pressure goes down.

Cheap and under-used

Perhaps the simplest drug is a diuretic, also called a water pill. It works in the kidneys and flushes excess water and sodium from the body. It's cheap and, according to one blood pressure expert, under-used. In 2012 Dr. Samuel J. Mann, a nationally-known hypertension specialist at New York-Presbyterian Hospital/Weill Cornell Medical Center, questioned the widespread use of today's most popular hypertension drugs.

"Despite their best intentions many physicians continue to place their hypertensive patients on blood pressure medications, drug combinations or doses that may not be the best treatment available to them, Mann said. "I believe that with the medications we have, we can do much better than we are doing.

Mann's view may be gaining wider acceptance. Many physicians are now emphasizing a healthy diet, reducing sodium consumption, maintaining a healthy weight and reducing alcohol use.

Doctors at the Mayo Clinic have come up with “10 ways to control blood pressure without medication.” They include losing weight, reducing sodium, getting regular exercise and maintaining a healthy diet. 

If you are currently taking blood pressure medication, don't stop taking it without consulting with your doctor first. Even if you continue to take medication, making lifestyle changes to promote a normal blood pressure can only improve your health.

It isn't just older folks who should be worried.

New research in the American Heart Association journal Hypertension finds the risk of elevated blood pressure among children and adolescents rose 27 percent during a thirteen-year period.

The culprits may be higher body mass, larger waistlines and eating too much sodium or salt.

High blood pressure is a risk factor for stroke, heart disease and kidney failure and accounts for about 350,000 preventable deaths a year in the U.S.

"High blood pressure is dangerous in part because many people don't know they have it," said Bernard Rosner, Ph.D., lead author of the study and professor of medicine at Harvard Medical School. "It's a very sneaky thing. Blood pressure has to be measured regularly to keep on top of it."

What's 'normal?'

In adults age 20 and older, blood pressure should normally be less than 120/80 mm Hg. However, among children and teens blood pressure norms vary according to age, sex and height.

While the researchers noted "elevated" readings, the children could not be called hypertensive because blood pressure readings must be high three times in a row for an official diagnosis.

Researchers compared more than 3,200 children ages 8-17 in the National Health and Nutrition Examination Survey (NHANES) III in 1988-1994 with more than 8,300 in NHANES in 1999-2008. They accounted for differences between the two groups in age, sex, race/ethnicity, body mass, waistline and sodium intake.

The findings

Researchers found:

• Boys were more likely to have elevated blood pressure, but the rate increased more markedly in girls from the first study to the second.
• More children were overweight in the second study, and both sexes -- especially girls -- had bigger waistlines.
• Children whose body mass or waistline measurements were in the top 25 percent for their age group were about twice as likely to have elevated blood pressure as children with measurements in the bottom 25 percent.
• Black children had a 28 percent higher risk of elevated blood pressure than non-Hispanic white kids.
• In both studies, children with the greatest sodium intake were 36 percent more likely than those with the lowest intake to have elevated blood pressure.
• More than 80 percent of children in both studies had a daily sodium intake above 2,300 milligrams; however, fewer children in the later study had an intake above 3,450 milligrams.

"Everyone expects sodium intake will continue to go up," Rosner said. "It seems there's been a little bit of listening to dietary recommendations, but not a lot."

What to do

Americans eat an average 3,400 milligrams of sodium daily -- more than twice the 1,500 or less that the American Heart Association recommends. Two-thirds of sodium intake is from store-bought foods and one-quarter from restaurant offerings.

Studies have linked excessive sodium in the diet to high blood pressure, and have suggested reducing sodium intake in children's and adolescents' can lower average systolic (top number) blood pressure by 1.2 mm Hg and average diastolic (bottom number) pressure 1.3 mm Hg.

It sounds so simple, yet fewer than one in three people manage to do it.

According to new research in the American Heart Association journal Circulation, you might be able to cut your risk for heart disease by half or more by simultaneously controlling your high blood pressure and high cholesterol.

Researchers also found that prescribing medications to better manage blood pressure and cholesterol would greatly benefit people who are older, diabetic, have cardiovascular disease or are Hispanic or black. And they say going to the doctor at least twice a year could help.

Millions affected

Undertreated high blood pressure and cholesterol affect millions, posing a major public health threat, said Brent M. Egan, M.D., lead study author and a professor of medicine and pharmacology at Medical University of South Carolina in Charleston, S.C.

"The reality is, we know more than enough to prevent 75% of heart disease and strokes, but we're not doing everything we could be doing or even doing it at a reasonable level," he said. "We've made some gradual improvements over the years, but there is still a lot of progress to be made."

High blood pressure affects about 33% of the U.S. adult population and doubles the risk for heart disease. About 32 million people have dangerously high total blood cholesterol levels of 240 mg/dL or higher. Previous research indicates that treating high blood pressure reduces the risk of heart disease by 25% and treating high cholesterol in hypertensive patients can lower the risk by more than 35%, researchers said.

Monitoring cholesterol

Cholesterol readings need closer attention, Egan said. "If patients' cholesterol tests show a good high-density lipoprotein (HDL) level, which is the healthy, protective cholesterol, then the low-density lipoprotein (LDL) number might get overlooked. Unfortunately, not all HDL is equally protective and some people with a normal HDL are at high risk. In those patients, there might be a false sense of assurance that cholesterol really isn't a problem.

“But LDL and non-HDL readings are the ones to really watch,” he notes. “Patients seeing their doctors for blood pressure treatment should ask about their LDL and non-HDL levels and make sure both are under control at the same time."

The findings are based on data of more than 17,000 adults who participated in the National Health and Nutrition Examination Surveys during in 1988-94, 1999-2004 and 2005-10.

In addition to reviewing patients' blood pressure and cholesterol levels, researchers considered race, age, insurance status, whether patients smoked, had diabetes, had diagnosed heart disease and/or chronic kidney disease, and if they visited a doctor every year.

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.