Control high blood pressure? Getting there. Prevent it in the first place? Eh...

As a population, we may be slow to grasp the importance of watching our blood pressure, but we can eventually get the message. That's one upshot of a new report assessing U.S. progress in treating and controlling hypertension.

Using data from the ever-mineable National Health and Nutrition Examination Survey, researchers at the Medical University of South Carolina found that, among adults with high blood pressure, only 27.3% had it under control in the 1988-94 study period. But that number had risen to 50.1% by the 2007-08 study period.

Way to go, hypertensives!

That's not to say that rates of hypertension are falling. Rates rose from 23.9% of adults in the 1988-94 study period to 28.5% in 1999 and 2000. But, hey, then they held fairly steady through 2007 and 2008. That's ... something.

Way to go, people who could've become hypertensive and didn't!

The researchers note that the improvements are not, repeat not, because people are exercising and eating right. Ha. They write:

"Healthy lifestyles are an unlikely explanation for lower [blood pressure] and better control among patients with hypertension, because eating patterns became less "DASH-like" and obesity increased over time."

Think, instead, "blood pressure medication." 

The improvements in the overall blood pressure picture can be traced in no small part to increased awareness and treatment, the researchers conclude. Some groups need more assistance in getting the awareness message; others need more help in getting the treatment message:

"Data suggest that initiatives to improve [blood pressure] control among Hispanic individuals should emphasize screening and referral to a primary care medical home, whereas more emphasis on treatment effectiveness is needed for black individuals."

The report offers much data -- by ethnicity, age, gender ... and you can peruse it all. Here's the full blood-pressure study, published in Wednesday's Journal of the American Medical Assn.

Oh, and here's more information on the aforementioned DASH diet; a guide from Mayo Clinic on choosing blood pressure medication; and our recent, helpful-if-I-do-say-so-myself advice on controlling blood pressure.

-- Tami Dennis

Photo credit: Los Angeles Times

Drinking fewer sugary beverages could be linked to lower blood pressure

Sugar-sweetened beverages get blamed for various health woes, obesity being one. But a new study finds there may be a link between drinking fewer sugar-sweetened beverages and lowering blood pressure.

The study included 810 men and women age 25 to 70 who were part of a lifestyle intervention study and had prehypertension or stage I hypertension. At the beginning of the study, participants drank an average of 10.5 ounces a day of sugar-sweetened beverages.

Overall, drinking one less serving, or 12 ounces, of sugar-sweetened beverages per day was associated with 1.8 drop in systolic blood pressure, and a 1.1 drop in diastolic blood pressure over 18 months. After the researchers adjusted for the weight loss the study participants experienced, there was still a significant difference seen in lowered blood pressure -- 0.7 for systolic, and 0.4 for diastolic. There was no relationship seen between a change in drinking diet beverages and differences in blood pressure.

Researchers tried to determine if the culprit in the sugar-sweetened beverages was the sugar, or the caffeine. A link was seen between lower blood pressure and consuming less sugar (glucose, fructose, sucrose, and combined forms of sugar), but not between caffeine consumption and a change in blood pressure.

Those who drank more sugar-sweetened beverages also tended to eat more calories, but less protein, dairy products, fruits and vegetables, and dietary fiber.

"Our findings suggest that reducing sugar-sweetened beverages and sugar consumption may be an important dietary strategy to lower blood pressure and further reduce other blood pressure-related diseases," said Dr. Liwei Chen, lead author of the study, in a news release. Chen is an assistant professor at Louisiana State University Health Science Center-School of Public Health in New Orleans.

The study was released today in the journal Circulation: Journal of the American Heart Assn.

-- Jeannine Stein

Photo credit: Jacquelyn Martin / Associated Press

Is salt the secret ingredient in KFC's original recipe?

You already worry about the calories in fast food (at least, you know you should). Now the good folks at the New York City Department of Health and Mental Hygiene are giving us something else to agonize over – the salt content of those calorie-laden fast-food meals.

The report couldn’t be more timely. Just last week, the Institute of Medicine released a report urging the Food and Drug Administration to set limits on the amount of sodium that’s acceptable in processed foods, and the FDA pledged to put pressure on the food industry. Sodium intake is important because too much salt can cause high blood pressure, an important risk factor for heart disease.

The U.S. Department of Agriculture’s current dietary guidelines suggest that Americans limit their salt intake to 2,300 milligrams per day – about the equivalent of one teaspoon. The American Heart Assn. says a better cap is 1,500 mg per day. At the moment, both recommendations are a fantasy – the average American consumes 3,500 mg of sodium each day.

More than 75% of that salt comes from prepared foods, including restaurant offerings. So the health department sent interviewers out to 300 restaurants throughout New York City’s five boroughs and asked lunchtime patrons to show them their receipts. They got 6,580 receipts for meals that included at least one entrée.

How salty were those meals? The average lunch contained 1,750 mg of sodium, and 20% topped the 2,300 mg the government recommends for an entire day, the researchers report in Tuesday’s edition of Archives of Internal Medicine.

The saltiest meals were purchased at Kentucky Fried Chicken and Popeye’s – 55% of chicken chain lunches exceeded 2,300 mg of salt. The average chicken lunch had 66 more calories than the average burger-chain lunch (999 vs. 933) but contained 900 mg of additional salt, the researchers calculated.

Is it possible to eat at fast-food chains without going overboard on sodium? Apparently so. One in every 36 meals was limited to 600 mg of salt, an amount the FDA considers healthy. But the researchers didn’t say what was in those healthier meals.

In addition to KFC and Popeye’s, the researchers collected receipts from patrons of Burger King, McDonald’s, Wendy’s, Au Bon Pain, Subway, Domino’s, Papa John’s Pizza Hut and Taco Bell.

-- Karen Kaplan

Photo: Fried chicken restaurants like this one served up the saltiest meals in a survey by New York City health officials. Credit: Kathy Willens / Associated Press

High blood pressure treatment just got cheaper

For many of the one-in-three American adults who have high blood pressure, a cheaper alternative to brand-name medications is about to come available.

Losartin, the angiotensin II receptor blocker marketed under the brand names Cozaar and Hyzaar (the latter of which combines losartin with the diuretic hydrochlorothiazide) for more than a decade, will become available in generic formulations, following an FDA decision announced this week.

Four drug makers have won the FDA's blessing to make and market the hypertension drugs in generic forms. Wasting no time, the first firm to receive broad FDA approval to market the generic drug, Teva, announced Thursday the launch of its losartin potassium-film-coated tablets in 25-milligram, 50-milligram and 100-milligram strengths.

If you're a patient being treated with other brand-name angiotension receptor blockers for hypertension --Atacand, Avapro and Diovan -- you may have to wait for less expensive drugs. Atacand won't be available in generic form before 2011 at the earliest, and Avapro and Diovan are not expected to reach the market in generic form before 2012.

The FDA's Office of Generic Drugs states flatly that generic drugs are the same as the brand-name first-to-market drugs they copy -- same active ingredient, same means of action, same safety and effectiveness profile -- they're just way, way cheaper. But the formulations in which those active ingredients are packaged do change when they are reproduced as generics. For a very small number of people and with a few types of drugs, pharmacologists acknowledge that that can make a difference in how -- or even how well -- a drug works (you can read more about this here).

So, if the size, shape, color or brand marking of your regular prescription blood pressure medication changes in the next few months (and if it suddenly becomes less expensive), rejoice over your lower bill. But also, be sure to ask the pharmacist if you have been switched to a generic version of the drug your physician originally prescribed. And for a couple of weeks after switching to a generic, check your blood pressure a bit more regularly to make sure your hypertension is still under control with the medication.

One more warning: There are five other classes of medications used to treat high blood pressure, and all do so by different means than the angiotension II receptor blockers. Insurance companies and pharmacy benefits managers are aggressive in trying to switch patients to a new generic drug if it can save money, even if it means switching a patient to a new class of drugs. The practice is called therapeutic substitution. Sometimes, it can often save you money while managing your condition just fine. But for some individuals, another class of medication won't work as well or may not be recommended.

Again, ask your pharmacist if you don't recognize the medication you're getting, and check with your physician if the switch is something you haven't discussed.  

You might never guess you have high blood pressure, because it's a medical problem with few discernible symptoms. But it seriously increases your risk of stroke and a range of other cardiovascular diseases. You should check out this series of L.A. Times Health articles for everything you need to know about blood pressure.

-- Melissa Healy

Kraft will cut sodium by 10%? That's great! But you're far from off the hook

Today's announcement by Kraft Foods that it will reduce the salt in its North American products by an average of 10% is welcome news. Or rather, for consumers, a welcome small step.

For lovers of processed food -- which is to say most Americans -- a 10% salt reduction in one manufacturer's products (even by ubiquitous Kraft) won't do much to improve overall health. As the American Heart Assn. points out: "The majority (up to 75%) of sodium that Americans consume comes from sodium added to processed foods by manufacturers."

More from that organization here, complete with information on how much sodium the average American consumes a day (we'll come back to this) -- and what "low-sodium," "reduced sodium," etc., actually mean on a food label.

Here's today's story, which notes that the Kraft announcement follows similar efforts by ConAgra Foods and Campbell Soup. As examples, the story says the salt in Oscar Mayer Bologna will be cut by 17%, Easy Mac Cups by 20%  and Velveeta by 10%.  

Sounds good, but if the 420 milligrams of sodium in a one-ounce serving of Velveeta is cut by 10%, that still leaves the cheese-product aficionado with 378 milligrams of sodium. Numbers are courtesy of Calorie Count. And, again, that's per one-ounce serving. It seems unlikely that true Velveeta lovers consume just one ounce. (Say what you will, the stuff melts like a dream.)

You may sniff. Perhaps you haven't touched Velveeta since you learned the difference between "cheese" and "cheese-like." Perhaps you're horrified by the very existence of a product called Easy Mac Cup. Fine. Ever buy tomato sauce? Soups? Condiments? (Really, who makes their own condiments?) If so, check the labels. Really. Just check the labels.

A diet heavy on the processed foods could take that hit of 10% and still have plenty of sodium left over to work its magic on heart disease and stroke risk. So too could the diets not "heavy" on processed foods.

In fact, most Americans are advised to consume only about 1,500 to 2,300 milligrams of sodium per day.

Enough of the lecture. This is where we turn helpful...

Note that sodium can be tricky. It's not always labeled simply "sodium," much less "salt." It can also be listed as:

- Monosodium glutamate (MSG)

- Baking soda

- Baking powder

- Disodium phosphate

- Sodium alginate

- Sodium nitrate or nitrite 

So says the Mayo Clinic in Sodium: Are you getting too much? part of its guide to nutrition and healthy eating. That's why the "% Daily Value" for sodium comes in handy.

Similarly, WebMD offers a fine guide to watching your sodium when eating out. (One tip: Skip the casseroles.)

And the L.A. Times recently offered this package on controlling blood pressure (it's about so much more than food), plus a blog roundup of recent research about the perils of America's love affair with salt.

Our attention to this whole salt-consumption is obviously growing; hence the manufacturers' attention to it. That's great. And needed, as you'll see -- because here's where we share how much sodium the average American consumes every day... are you  ready? 3,436 milligrams.

We really need to learn to make our own pasta sauce.

-- Tami Dennis

Photo: I know, I know, but some people swear by the stuff. So less salt in it is a good thing.

Credit: Bloomberg

 

The physical toll of loneliness

Loneliness doesn't just cause wear and tear on the psyche -- it may also affect blood pressure, as a new study reveals.

Researchers surveyed 229 people ages 50 to 68 who were part of the Chicago Health, Aging, and Social Relations Study, a longitudinal study of white, black and Latino men and women. They were given a survey in which they were asked to rate their feelings about questions such as, "I lack companionship," "I feel in tune with the people around me," and "My social relationships are superficial." Other features about the participants were noted, such as smoking status, physical activity levels, body mass index and cardiovascular health.

The participants were monitored for five years. Researchers noted an association between feelings of loneliness and high blood pressure. People who ranked as feeling most lonely had blood pressure levels 14.4 points higher than those who felt least lonely. Increases in systolic blood pressure were cumulative, so those who had higher levels of loneliness at the beginning of the study had greater blood pressure increases over the years. The findings held true when researchers accounted for factors such as age, race and ethnicity, gender, cardiovascular risk factors and depression.

"Loneliness is characterized by a motivational impulse to connect with others but also a fear of negative evaluation, rejection and disappointment," said Louise Hawkley, senior research scientist with the Center for Cognitive and Social Neuroscience at the University of Chicago, in a news release. Hawkley, lead author of the study, added, "We hypothesize that threats to one's sense of safety and security with others are toxic components of loneliness, and that hypervigilance for social threat may contribute to alterations in physiological functioning, including elevated blood pressure."

The study appears in the March issue of the journal Psychology and Aging.

-- Jeannine Stein

Photo: PR Newswire

Low-carb diets may trump low-fat in lowering blood pressure

Need more low-carb diet versus something else comparisons? You're in luck. A new study found that following a low-carb diet may be better for lowering blood pressure than taking an over-the-counter weight loss medication and sticking to a low-fat diet.

Both plans showed similar drops in weight and improvements in other health factors, but the low-carb diet came out ahead in lowering blood pressure. Researchers placed participants in two groups -- one consisted of 57 people who ate a low-carbohydrate diet and were allowed to consume unlimited amounts of meat and eggs, but initially only 20 grams per day of carbohydrates (they could add a few extra grams if the cravings got too bad).

The other 65-person group was limited in the intake of fat per day -- 30% or less of total calories, as well as restricted consumption of saturated fat (10% or less) and cholesterol (300 mg. or less). In addition the group took the over-the-counter weight loss drug orlistat. The study lasted for 48 weeks.

The low-carb group dropped an average of 5.9 points of systolic blood pressure (the top number that measures the heart's contractions) and 4.5 points on diastolic blood pressure (the bottom number measuring the heart at rest, between heartbeats). The other group dropped 1.5 points on systolic and 0.4 points on diastolic. More people in the low-carb group decreased their blood pressure medication.

On most other results the two groups were similar -- the low-carb set lost about 9.5% of body weight while the medication/low-fat diet group lost about 8.5%, and cholesterol and trigylceride levels improved.

In the study, researchers said they thought the two groups would show similar drops in blood pressure since both lost about the same amount of weight, and because orlistat has been shown to slightly lower blood pressure. They speculate that the low-carb diet may have a diuretic effect, or that the lower serum insulin levels that occur with a low-carb diet could have an effect on sodium retention.

The study was published in the January 25th issue of the Archives of Internal Medicine.

-- Jeannine Stein

Photo credit: Irfan Khan / Los Angeles Times