2020 BOOKS


Blood Pressure Readings: Know Your Numbers

By Richard Johnson 

To keep our heart health, we should pay attention to the maintenance of the normal blood pressure as it may provoke a heart disease or stroke. So, keeping control of it is vitally important. To know the situation, you have to check your numbers at least once in several months. But how can you know if your numbers are good or not? And why is it so significant to know them at all? Let's have a look!

How are the blood pressure indexes deciphered?

Our arterial pressure reading consists of two numbers: systolic pressure and diastolic pressure. The first one is the pressure in your blood vessels at the moment when a heart pushes out the blood whereas the latter number is the pressure in your arteries in the intervals between the heart beats, in the moment of rest.

Norm or hypertension: how can you know?

For diagnosing hypertension there is no need to pass any tests as blood pressure is measured with the help of sphygmomanometer - a special device, which is easy to use even at home. With its help you will be able to monitor your blood pressure without turning to the doctors.

To understand the meaning of blood pressure readings that you'll get, you have to know what is considered normal and what is not.

American Heart Association differentiates five categories of blood pressure:

1. Numbers, which do not exceed 120/80 mm Hg are considered normal;

2. Indexes from 120 to 129 mm Hg in systole and less than 80 mm Hg in diastole may be interpreted as elevated blood pressure;

3. Numbers between 130-139/80-89 mm Hg signal about the first stage of hypertension;

4. The second stage of the ailment is when the figures reach 140/90 mm Hg or higher;

5. Blood pressure readings over 180/120 mm Hg are the sign of hypertensive crisis and demand immediate medical attention.

What factors promote the development of hypertension?

Any rise in our blood pressure may signal about the wrong lifestyle choices we make. Besides, there is a number of other factors, which may cause hypertension:

• Weight. Excessive body mass influences the condition of our blood vessels and heart;

• Age. Hypertension mostly affects people over 60, yet the number of patients over 30 or even younger is growing steadily;

• Alcohol consumption and smoking;

• Underlying health conditions (heart disease, atherosclerosis, kidney issues).

What should be done to get your blood pressure back to the norm?

The treatment of hypertension is not fast. In some cases, you may need a life-long therapy and take some pills on the daily basis. Besides, your healthcare provider will likely to recommend you to make lifestyle changes, in particular:

• Drop smoking if you have such a harmful habit.

• Do physical exercises at least 30 minutes a day.

• Make changes in your nutrition. Add fresh fruits and veggies, olive oil, lean meat and try to avoid full fat dairy products, processed food and fast food. Sugar-sweetened beverages should also be excluded.

• Learn to manage stress.

• Reduce the amount of caffeine you take.

Unfortunately, such measures may be effective only for elevated arterial pressure and the first stage of hypertension (to some extent). If your numbers have crossed 140/90 mm Hg, you are sure to start medical therapy of hypertension.

High blood pressure is a heart disease that affects mainly people over 40 years, though nowadays it becomes a more frequent problem in younger people. To recognise the signs of hypertension and start managing the condition as earlier as possible, please, learn more about this heart disease on Cardiogod.com.


As COVID-19 cases increase, preventing a second heart attack or stroke is vital

American Heart Association

NewMediaWire

As hospitals, health professionals and healthcare systems, governments and leaders work to reduce community spread of the coronavirus in the U.S. and protect the most vulnerable individuals, the American Heart Association offers further tips for heart attack and stroke survivors regarding secondary prevention. Reducing risk of another event and staying as healthy as possible is more important than ever to avoid busy hospitals. Based on current information, it appears elderly people with coronary heart disease or hypertension are more likely to be infected and to develop more severe symptoms. Stroke survivors may face increased risk for complications if they get COVID-19.

After a heart attack or stroke, as many as 1 in 4 survivors will have another one. Lifestyle changes and working closely with your doctor to manage your health can help minimize the risk of a repeat event.

“A heart attack or stroke is a life-changing event,” said Nieca Goldberg, MD, American Heart Association volunteer and medical director of NYU Women’s Heart Program. “What many people don’t realize is the hidden risks that led to your first event may be managed and, by doing this, you may reduce your risk of having another one.”

Because up to 80% of heart attacks and stroke are preventable, it’s important to follow your doctor’s recommendations for reducing your risk. Talk to your doctor about a secondary prevention plan, and consider other steps like these from the American Heart Association’s secondary prevention program:

Take your medications as prescribed. Certain medicines can lower your risk of another cardiac event. That’s why it’s important to understand your medications and take them correctly. Taking aspirin as recommended by a doctor is one way to help prevent another attack. No one should start, stop or modify an aspirin regimen without first speaking with their doctor. Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen. You will want to have enough of your medicines to last a prolonged period. If you do not currently have enough of your prescription medications on hand to last for a prolonged period, work with your doctor and pharmacist to see if you can get a larger amount prescribed. To avoid possible exposure to COVID-19, using a mail-order system may be an option. Check the CDC for updates on recommendations for accessing medication.

Manage your risk factors. After a heart attack, it’s important to manage risk factors such as high blood pressure, high cholesterol and diabetes by taking medications as prescribed, quitting smoking, eating as healthy as possible and being active.

Keep your follow-up appointments. Keeping your follow-up appointments helps your doctors keep track of your condition and recovery. Call your doctor’s office prior to scheduled appointments to see if a virtual visit is possible.

Participate in a cardiac rehabilitation program virtually. Cardiac rehabilitation is a medically supervised program designed to help you recover after a heart attack. Ask your provider if there are exercises you may do while at home.

Get support. It’s normal to feel scared, overwhelmed or confused after a heart attack or stroke and the current situation is stressful enough. Getting support from loved ones or people who have also experienced a heart attack or stroke can help you cope. During this time when many local support group meetings are canceled, connect with other survivors and caregivers through the American Heart Association’s free online Support Network.

Get the latest American Heart Association information and recommendation on COVID-19 here.

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The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on  heart.org,  Facebook,  Twitter  or by calling 1-800-AHA-USA1.  



What Causes Hypertension (and How to Treat It)

By  

High blood pressure is a big deal... because its puts stress on your heart and your arteries, raising your chances of a heart attack or stroke. Over time, high blood pressure can damage and narrow your arteries reducing blood flow around your body. And since all the tissues and organs in your body need blood to work, that means things like your brain, your kidneys, your eyesight and your sex life can be affected, reducing the quality of your life and shortening it significantly.

Salt... as used in cooking, in preserving and processing foods, and as a flavour enhancer... is sodium chloride, which consists of sodium 40% and chlorine 60% by mass. Salt dissolves in water and breaks up into its sodium and chlorine ions. Your body cannot make sodium chloride and depends on your diet for a healthy supply of this nutrient.

As virtually every diabetic knows, a type 2 diabetic has a better than 80% chance of also being hypertensive, ie suffering from high blood pressure. And we all know that, besides taking a daily medication to control our blood pressure, we should eat a low salt diet because excessive salt intake is the main cause of high blood pressure.

But is excessive salt intake really the main cause of high blood pressure? Recent studies suggest that this might not be so.

Is too much salt really the cause of high blood pressure?

In the 2017 issue of the American Journal of Medicine it was claimed in a paper titled Is Salt a Culprit or an Innocent Bystander in Hypertension? that the notion that excessive salt consumption leads to hypertension is based on opinion, not on fact.

The paper cited a Cochrane Review of almost 170 studies which noted that sodium restriction only lowers blood pressure by 1% to 3% in people with normal blood pressure (normotensives) and between 3.5% and 7% in people with high blood pressure (hypertensives).

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.

Sugar, the paper went on to claim, is the more likely primary cause of hypertension.

This study derived some support from a previous study of 133,000 adults, published in The Lancet in 2016, which found that a high sodium intake, compared with a moderate sodium intake, was associated among hypertensives with a greater risk of cardiovascular events and death. But no such association occurred among normotensives.

However, a low sodium intake was associated with a greater risk of cardiovascular events and death in both hypertensives and normotensives. This suggests that that lowering sodium intake is best targeted at populations with hypertension who consume high salt diets.

The notion that there is no good science to back up the hypothesis that salt is one of the major causes of hypertension is open to challenge. Indeed, sodium is an essential ion for nerve conduction, muscle contraction and cell signalling, so restricting your intake of salt unduly could be harmful.

Clinic studies showing that excessive salt intake increases BP

Recent estimates suggest that, globally, 62% of cerebrovascular disease and 49% of ischaemic heart disease are attributable to elevated blood pressure.

All foods contain some degree of salt but meat (about 0.3g per kg on average) contains more than vegetables. An individual's intake of salt in Palaeolithic times was less than 1g per day. About 5,000 years ago the use of salt in the diet began to rise after the Chinese discovered that it could be used to preserve food. Over time, as the use of salt spread, daily intake rose to a peak of about 12g/day in the 19th century.

But when refrigeration was invented in the late 19th, salt was no longer necessary for preserving food and daily average intake began declining, a trend that continued until comparatively recently. Consumption is now back to 19th century levels due to the rising popularity of highly salted processed foods and currently about 75% of our daily intake of sodium comes from salt found in processed foods... sausages, rashers, meat puddings, crisps, chips, pizzas, salty cheese etc.

The association between salt intake in the diet and blood pressure was first shown in 1904 when Ambard and Beaujard experimented with high and low salt diets on six patients... high salt diets made BP (blood pressure) go up and low salt diets had the reverse effect.

In 1948, a researcher named Kempner treated 500 hypertensive patients with diets consisting of rice and fruit that contained little salt. These diets improved BP, decreased heart size, and ameliorated hypertensive retinopathy. But unfortunately the rice diet didn't catch on as it was pretty tasteless.

Since then, many animal studies have shown a causal relationship between dietary sodium and hypertension. There have also been extensive studies on the effect of salt intake on BP in humans and the BP lowering effect of a low salt diet has been demonstrated many times.

Indeed, thousands of subjects have been involved in large international studies on sodium intake and hypertension, such as the INTERSALT study of more than 10,000 subjects aged 20 to 59 which showed that there is a positive correlation between salt intake and BP levels. This study, published in the British Medical Journal in 1988, also shows that BP increases with age only if it is accompanied by increased salt intake.

Another well-conducted landmark study was the DASH (Dietary Approaches to Stop Hypertension)-Sodium trial, a 12-week well controlled feeding trial provided the most robust evidence about the effect of salt intake on human BP. It was published in the New England Journal of Medicine in 2001.

Despite recent reservations, the link between salt intake and BP levels seems to have been demonstrated scientifically and fairly conclusively in the last few decades. So how can the contradicting results of recent studies be explained?

Is there another factor influencing BP levels?

Sodium and potassium... two essential electrolytes

Your body removes unwanted fluids and waste products by filtering your blood through your kidneys, where the unwanted fluids are sucked out and sent with the wastes to your bladder to exit as urine. A combination of two essential electrolytes, sodium and potassium, are needed to enable this to happen.

Your kidneys use osmosis to draw the water containing the wastes out of your blood. Osmosis is a process by which molecules of a solvent pass through a semipermeable membrane from a less concentrated solution into a more concentrated one. This process uses a mixture of sodium and potassium to pull the water across a wall of cells from the bloodstream into a collecting channel that leads to the bladder. This ratio of the two electrolytes needs to be within a narrow range for the osmosis process to work successfully.

The problem with eating a lot of salt is that it raises the amount of sodium in your bloodstream and wrecks the delicate balance between sodium and potassium, reducing your kidneys' ability to remove the water, so the water and wastes remain in your bloodstream. The result is higher blood pressure due to the extra fluid in your blood and extra strain on the delicate blood vessels leading to the kidneys.

Over time, this extra strain can damage the kidneys, bringing on kidney disease. This reduces their ability to filter out toxic waste products, which then start to build up in the body. If kidney disease is left untreated and your blood pressure isn't lowered, you end up with kidney failure... you are no longer able to be filter the blood and the body slowly becomes poisoned by its own toxic waste products. The only solution is regular dialysis, a messy, painful and tedious procedure.

Your intake of potassium is important

The DASH-Sodium trial (mentioned above) showed that a systematic change of diet to boost intake of fibre, magnesium, calcium, and potassium could reduce blood pressure significantly. This effect was further boosted by limiting sodium intake.

This has since been confirmed by many studies. Individual and Combined Effects of Dietary Factors on Risk of Incident Hypertension, a study published by the US National Library of Medicine, National Institutes of Health in October 2017, concluded that the secret to lower blood pressure in the long-run was to eat a diet that is both low in sodium and high in potassium.

Research in recent years has shown that potassium intake directly regulates how much salt (sodium) the kidneys excrete. High potassium intake forces the kidney's to excrete more sodium. In other words, increasing dietary potassium is just as important as decreasing sodium when it comes to reducing blood pressure.

The need to keep potassium levels stable

Unlike sodium, which circulates dissolved in water in the blood, potassium is concentrated inside your body's trillions of cells. This concentration inside the cells is maintained by a 'pump' that acts across the cells' membranes (outer walls).

A normal concentration of potassium in blood plasma is between 3.5 and 4 millimoles per litre... half or double these concentrations is dangerous and can, indeed, be deadly.

If you have too little potassium, you will first notice it in your muscles... for example, your muscles will feel weaker and lifting heavy objects may be difficult.

But if you have much too much potassium in your blood, you can up with cardiac arrest. Some states in the USA use massive potassium injections to execute prisoners on death row.

But don't get over worried. Insulin helps transfer potassium as well as glucose into your body's cells. The kidneys also excrete potassium. Healthy kidneys are very efficient at maintaining the correct amount of potassium in your body. But if your kidneys are not functioning properly (and you are not on dialysis), rising potassium levels can be lethal.

As we already mentioned, high potassium intake lowers blood pressure, and there is a direct link between a low-potassium, high-sodium diet and raised blood pressure. Thus controlling the body's potassium level is important for health.

But it is only recently that the role the kidneys play in maintaining the levels of sodium and potassium has been discovered.

If you have lost a lot of potassium recently, the kidneys need to hold onto the body's remaining potassium... indeed they prioritise the retention of potassium over sodium. When the level of potassium is too low, a sensor in the kidneys tells the renal tubules (the kidneys pipeline) to absorb more sodium, which subsequently minimises the loss of potassium. But this retention of sodium raises blood pressure.

Conversely, if you ingest a lot of potassium, the body retains less sodium in order to promote the excretion of potassium. This explains why consuming potassium-rich foods has a beneficial impact on your blood pressure... it drives more sodium to be excreted.

The best treatment

So the dietary advice of a low-salt diet has not changed, but now it comes with additional advice to ensure that you have an adequate intake of potassium also.

The take-away is that eating plenty of potassium is just as important as limiting salt or sodium intake... and, as luck would have it, there are plenty of ways you can get lots of potassium into your body without resorting to supplements.

Fruits are best... apricots, bananas, oranges, lemons, grapefruit, plums, grapes, figs, olives, blueberries, peaches, gooseberries, tomatoes, apples, prunes, and raisins all contain varying levels of potassium.

Good vegetable sources... include potatoes with the peel on, cauliflower, lettuce, cress, spinach, beetroot, and celery.

Other good sources of potassium are... nuts, almonds, legumes, oats, whole wheat, and fresh meat.

Paul D Kennedy is a type 2 diabetic. He used his skills as an international consultant and researcher to find a way to beat his diabetes using diet alone and, about eight years ago, he stopped taking medications to control his blood glucose levels. You can find out more from beating-diabetes.com or by contacting Paul at paul@beating-diabetes.com. His book Beating Diabetes is available as a Kindle e-book or a printed book from Amazon. The printed edition is also available from Create Space online book store.


CALENDAR OF EVENTS 2020