Early Onset Hypertension= Early Onset Dementia

acromegaly, blood pressure, coarctation of the aorta, Heart Health, hypertension, sleep apnea, supplements

 

 

A new study out this week has found that being diagnosed with elevated blood pressure at a young age, is associated with risk of early dementia.

The study published in the American Heart Association journal, Hypertension analyzed 11,399 Chinese adults who were diagnosed with hypertension at 3 age groups: 1)when they were younger than age 35; 2) between ages 35 to 44 and 3) aged 45 to 54 years. Another 11,399 men and women without a history of high blood pressure served as the control group.  Brain MRI scans were performed in all participants. The results of the study indicated that in all 3 comparator age groups, those with hypertension exhibited smaller brain (volume) sizes with the largest difference observed in the group under age 35.

Among the subjects who developed any type of dementia during the study period, the risk was 61% higher in men and women 35-44 years of age who had been diagnosed with hypertension compared to similar aged normotensive controls. In addition, vascular dementia was increased 45-69% when hypertension was diagnosed between ages 35-54 years. To review this paper, click here.

The study supports early identification and treatment of high blood pressure – it stands to reason that control of hypertension at a young age would reduce development of dementia.

High blood pressure can occur under a variety of circumstances and may be associated with the following:

  1. Exercise induced hypertension (systolic pressure greater than 210 mmHg in men and 190 mmHg in women with exercise) is associated with a 35-40% increased risk of cardiovascular events and mortality.
  2. Hypertension of the eyes (ocular hypertension) raises the risk of glaucoma.  Risk factors for ocular hypertension include diabetes, hypertension, extreme nearsightedness and chronic steroid use.
  3. Black licorice can raise blood pressure and cause palpitations when 2 or more ounces are consumed per day.
  4. Herbal supplements that may raise blood pressure include ginseng, guarana, ma-huang and St. John’s Wort.
  5. Examples of commonly used drugs that may raise blood pressure include NSAIDs (ibuprofen), steroids (prednisone), decongestants (pseudoephedrine), antidepressants (fluoxetine) and anti-infectives (ketoconazole).
  6. The 4 “classic H signs” of Pheochromocytoma, Hyperhydrosis (excessive sweating), Hypertension, Heart palpitations and Headache are only observed in 40% of cases.
  7. Hypertension with disproportionate pulses (reduced in lower compared to upper extremities) could be due to narrowing of the aorta (coarctation). Coarctation is associated with exercise induced hypertension.
  8. Recent onset of high blood pressure associated with kidney stones, bone pain and abdominal pain (also known as “stones, bones and groans”) may be the result of high calcium levels due to an overactive parathyroid gland.
  9. Hypertension is observed in up to 70% of those affected with obstructive sleep apnea. Treatment of sleep apnea and its underlying causes, may effectively reduce blood pressure.
  10. Up to 30% of patients with hypertension do not respond effectively to 3 blood pressure medications. The most common condition associated with “resistant hypertension” is obstructive sleep apnea.
  11. A recently diagnosed elevation in blood pressure that exceeds 150/100 mmHg on 3 different days should be screened for the rare medical condition, primary aldosteronism (Conn’s Syndrome).
  12. A young woman with recent onset hypertension in association with tinnitus (ringing in the ears), dizziness, neck pain and poor kidney function may be due to another rare medical condition, fibromuscular dysplasia, recently been linked to spontaneous coronary artery dissection (SCAD).
  13. Consider a workup for acromegaly in someone who has recently developed hypertension along with an increase in shoe (and glove) size. Complications of acromegaly include resistant hypertension, diabetes, and an enlarged heart, thereby raising  the risk of arrhythmia (abnormal heart rhythm) and sudden death.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Did You Hear That? If Not, Blame it on Your Heart

audiology, blood pressure, cholesterol, Diabetes, fish consumption, Hearing, Heart Health, Nutrition, omega 3's, Uncategorized

As we age, the loss of high frequency sounds becomes a common sign of hearing impairment due to degenerative changes in the inner ear.  High frequency hearing loss is common in the U.S. (~1 in 5 adult men and women are affected) and the classic sign is a decreased ability to hear high pitched sounds (voices of children/women) as well as to decipher conversations in a crowded room.  Loss of low frequency sounds (voices of men, thunder, bass) is less common but is also an important cause of hearing loss.

A study from the Yale School of Medicine suggests that having a history of cardiovascular disease or at least 1 cardiovascular risk factor (diabetes, high blood pressure, history of smoking) also raises the risk of both high and low frequency hearing loss.

Bottom Line: While heart related risk factors may promote hearing loss, it still remains to be determined whether intensive management of these risk factors delays progression of this process.

Listed below are some tips related to hearing and cardiovascular health

  1. High frequency hearing loss is common in patients with diabetes (Type 1 and Type 2) due to disease of small blood vessels of the (cochlear) inner ear.
  2. Treatment of high cholesterol with statins has been shown to improve tinnitus (ringing of the ears).
  3. In a study of 274 men and women aged 45-64 years, hearing loss was 2-fold greater among those with hypertension (140/90 or higher) than with normal blood pressure.
  4. A study conducted in Korea found that obese men and women with elevated cholesterol and triglyceride levels were at increased risk of high frequency hearing loss.
  5. Data from the Nurses’ Health Study found that women who consumed 2-4 fish meals per week experienced a 20% lower likelihood of hearing loss compared to women who consumed less than 1 fish meal per month over the 18-year followup period.
  6. Cigarette smoking cessation eliminates the excess risk of hearing loss within 5-years of quitting.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland. 

Are the Benefits of Omega 3’s Outweighed by Potential Side Effects?

blood pressure, Brain Health, COVID-19, fish consumption, Health & Wellness, heart disease, Nutrition, omega 3's

In last week’s post, I highlighted differences between two omega 3 preparations, 1) purified EPA (Icosapent ethyl) and 2) combination of EPA/DHA as it relates to the risk of heart disease.

This past week we published a new study that examines the association between blood levels of omega 3 -fatty acids and the risk of major side effects (bleeding and atrial fibrillation).   Led by my colleagues Drs. Karan Kapoor and Michael Blaha, the study was designed to determine the extent to which these side effects might occur in participants of MESA (Multi-Ethnic Study of Atherosclerosis), a national study of men and women being monitored for the development of heart related events over a multi-year period.

Decades earlier, Danish physicians Jørn Dyerberg and Hans O. Bang reported that heart disease was rare but bleeding risk increased among Greenlandic Eskimos that they proposed was due to their high consumption of EPA from whale blubber, herring and other omega-3 enriched fish. These studies gained worldwide attention and laid the foundation for the hypothesis that omega-3 supplementation intake might reduce the risk of heart disease.

As an aside, I had the opportunity to meet Dr. Dyerberg when I presented some of our earlier work on triglycerides and heart disease at the International Society for the Study of Fatty Acids and Lipids in Lyon, France in 1998.

And although an increased risk of abnormal heart rhythms was not reported in Greenlandic Eskimos, two recent clinical trials that used high doses of purified EPA (REDUCE IT) or the combination of EPA/DHA (STRENGTH) identified an increased risk of atrial fibrillation.

Back to our study, not only was there a significantly lower (rather than higher) risk of major bleeding in men and women participants from MESA, but also the risk of atrial fibrillation was not increased.

Bottom Line: Adding omega 3 containing fish to your diet in place of saturated animal fat, is heart healthy- based on our current study it is also safe from major bleeding complications and atrial fibrillation. Purified EPA (Icosapent ethyl) as used in the REDUCE-IT study lowered the risk of cardiovascular events. Even though atrial fibrillation was slightly increased in REDUCE-IT, stroke rates-a primary complication of afib- were decreased.

Below are additional reasons why adding omega-3’s to your diet may improve overall health.

  1. We recently found supplementation with Icosapent ethyl to maintain bone mineral health in men and women with the Metabolic Syndrome.
  2. For each 1 serving per week increase in fish consumption, there is an approximate 7% lower risk of Alzheimer’s disease.
  3. Eating salmon 3x weekly may lower blood pressure by 3-5 mmHg.
  4. Consumption of fatty fish improves tear production and symptoms related to dry eyes.
  5. Adding 1.5 grams of omega-3 fatty acids daily is associated with reduced mental stress and anxiety.
  6. High blood levels of omega-3 fatty acids is associated with a trend towards reduced death from COVID-19.
  7. In men and women with heart failure, the addition of 1 gram of omega-3 fatty acids may reduce the risk of re-hospitalization for heart failure.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland and author of  Heal Your Heart….”: published by Penguin Random House.  He served on the International Steering Committee for the REDUCE-IT trial.

What is the New “Normal” When it Comes to Blood Pressure & Optimal Heart Health?

blood pressure, Health & Wellness, Heart Health, Nutrition, Uncategorized

“Back in the day…” is the way I like to regale stories of my medical school experience with current students.  In fact, just the other day I recalled that when I was a medical student, high blood pressure was defined by taking the age of the person and simply adding 100. In other words, a 60-year-old could have a systolic blood pressure up to 160 mmHg before many physicians would be concerned that it required treatment!

Fast forward a handful of decades later, and a systolic blood pressure of 160 mmHg is now considered very serious (Stage 2) and one that commonly requires multiple blood pressure medications in addition to a low sodium diet and healthier lifestyle. Yet many people with high blood pressure don’t appreciate the importance of following a low sodium diet. Back in the day, we permitted up to 4000 mg of sodium or ~1.5 teaspoons of salt daily (we called it a “no added salt” diet).

Today, if you are otherwise healthy, maintain a blood pressure of less than 120/80 and are younger than 50, it is reasonable to adjust your sodium intake ~2300 mg per day (1 teaspoon of salt).  However, if you are at least 50 years old or have a history of hypertension, diabetes or kidney disease, the recommendation is to consume less than 1500 mg of sodium (~2/3 teaspoon of salt) daily.

Listed below summarize 4 key findings related to blood pressure:

  1. A normal blood pressure is less than 120 (systolic)/80 (diastolic) mmHg.
  2. High blood pressure causes blood vessels to constrict/stiffen and leads to “premature vascular aging”.
  3. For every 20 mmHg increase in systolic (or 10 mmHg increase in diastolic) blood pressure, the risk of a heart attack/stroke doubles!
  4. In addition to heart attack and stroke, other feared complications of long-standing hypertension include kidney failure and heart failure.

Over the coming week, check out the “HeartHealth Tip of the Day” on Twitter: @mmillermd1 or Facebook: “healyourheartbook” for additional information on this topic.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For many more tips on how to optimize your heart health, check out his book,  Heal Your Heart…”: published by Penguin Random House.