Booster Shots

Oddities, musings and news from the health world

Category: hypertension

Added sugar may be the mystery ingredient causing hypertension, researchers say

July 1, 2010 |  2:01 pm

Blood pressure has been rising in the United States for more than 100 years. At the turn of the last century, about 5% to 10% of American adults were diagnosed with hypertension; today, the figure is about 30%. Why?

added sugars raise risk of high blood pressure hypertension Perhaps it’s because there’s so much more added sugar in our diets now than there was a century ago. Studies have linked consumption of fructose – the ingredient that makes up 50% of table sugar and 55% of high-fructose corn syrup – to high blood pressure in rats. But in people, the link has been elusive.

Researchers from the University of Colorado Denver checked to see whether added sugar intake was linked to blood pressure among the thousands of representative Americans who participated in the National Health and Nutrition Examination Survey between 2003 and 2006.

By comparing the diets and systolic blood pressure (the top number in a blood pressure reading) of all the volunteers, they found that those who ate and drank more fructose from added sugars (as opposed to healthy sources like fresh fruit) had higher blood pressure than those who didn’t. They also discovered that volunteers with higher blood pressure tended to have larger waistlines.

Overall, those who consumed at least 74 grams of fructose per day from added sugars were more likely to be hypertensive. Compared with a healthy blood pressure of 120/80 mmHg, those with diets high in added sugar were 77% more likely to have blood pressure of 160/100 or greater. (The NIH considers anything over 140/90 to be high blood pressure.) The association between added sugars and blood pressure held up even when controlling for other factors, such as total calories consumed, physical activity, other health problems and consumption of salt, alcohol and carbohydrates. 

So, how much junk food do you have to eat to hit 74 grams of fructose? Drinking 2½ 20-ounce bottles of Coke would do it. Among the volunteers in the NHANES study, half consumed more than 74 grams of fructose from added sugars each day.

Why worry about high blood pressure? It’s a risk factor for a whole bunch of health problems you’d probably rather avoid, including coronary artery disease, congestive heart failure, stroke and chronic kidney disease. The World Health Organization estimates that hypertension causes 7.1 million deaths each year.

The good news, the researchers said, is that it’s easy to reduce your risk. Simply cut back on foods with lots of added sugar.

The findings were published online Thursday by the Journal of the American Society of Nephrology.

-- Karen Kaplan

Photo: Sugary foods aren’t just bad for your waistline, they may threaten your blood pressure too. Credit: Anne Cusack / Los Angeles Times

The physical toll of loneliness

March 17, 2010 |  4:46 pm

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

Kwvevpnc 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

Kids with heart-disease risk factors don't get a free pass on their effects

February 11, 2010 |  5:27 pm

Doctors and public health officials have become increasingly concerned about the number of kids with the risk factors for heart disease -- high body-mass index, glucose intolerance, elevated blood pressure and high cholesterol. But they've been less clear on how those factors affect life span.

Logic might suggest that each of these factors would increase the likelihood that lives would ultimately be cut short.... But it's always wise not to assume.

Research sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases has clarified the long-term picture a bit. It found that, yes, childhood obesity, glucose intolerance and high blood pressure are in fact connected to an increased risk of adult premature death -- meaning before age 55. But not high cholesterol. See? Best not to assume.

Here's the full study, of almost 5,000 American Indian children, published Thursday in the New England Journal of Medicine.

The researchers point out that cholesterol levels are lower in American Indians than in other groups, but in any case, they're mostly focused on the effects of obesity. The study did little to allay their concerns.

In referring to the increasing global prevalence of childhood obesity, their conclusion states:

Our observations, combined with those of other investigators, suggest that failure to reverse this trend may have wide-reaching consequences for the quality of life and longevity. Such evidence underscores the importance of preventing obesity starting in the early years of life.

Here's more on heart disease risk factors in kids and teens, from the Texas Heart Institute. Helpful, do-something-about-this-now advice is included.

-- Tami Dennis

NYC’s proposed sodium cuts come with a tiny grain of salt

January 12, 2010 | 10:48 am

Salt New York City’s health department is devoting what energy it hasn’t spent on counting calories and discouraging sugary drinks to cutting consumers’ salt intake down to size.

The plan is to get restaurants and packaged food makers to reduce the amount of sodium (a major contributor to high blood pressure, and thus heart attacks and stroke) in packaged and restaurant food by 25% over five years. The city has released its proposed sodium targets for both restaurants and packaged foods. It has persuaded such varied bodies as the Alaska Department of Health and Social Services, the Los Angeles County Department of Public Health and the World Hypertension League to voice their support. And it’s requesting industry comment on the tentative salt cuts.

Cutting sodium intake is a valuable goal, but I’m a little skeptical as to how a voluntary program will make much difference -- especially one where each food item isn’t individually held to standard. The cuts are measured across a category, like “hamburgers” under restaurant food targets, or “sauces, dips, gravies and condiments” under packaged food).

But Dr. Sonia Angell, who heads the department's Cardiovascular Disease Prevention and Control Program, said the flexibility of this method makes the plan more palatable to the industry. Angell also added that a similar voluntary program in the United Kingdom has helped reduce Britons’ sodium intake (by 9%, says the UK) over the last few years.

For 70% of the U.S. population -- particularly African Americans, people with hypertension, and the 40-plus crowd -- 1500 mg is the daily ceiling.

But Americans are on average consuming upward of 3400 mg to 3500 mg a day, said Dr. Sonia Angell, director of the department’s cardiovascular disease prevention and control program.

Even though nearly 80% of our daily salt comes from packaged and restaurant foods, Angell said, much of that added sodium is unnecessary and doesn’t add much to food flavor. “You really don’t have a choice in the amount of sodium you eat,” she said in an interview. “You can’t take the salt out of the takeout burger you bought at a restaurant.”

People can add as much salt as they like once they bring their burgers home -- and that’ll probably be healthier on balance, since Americans take just 11% of their sodium through a shaker.

While we wait to see if the Big Apple’s experiment bears fruit, it might be worth monitoring your own sodium intake, whether you’re eating out or grabbing a TV dinner from the supermarket.

Consider this: McDonald’s double cheeseburger has 1150 mg of sodium. Throw in some French fries (size small: 160 mg) and 70% of the U.S. has already hit its recommended limit. One serving of mac and cheese made from Kraft’s boxed pasta has 580 mg of sodium. And who eats just one serving, anyway?

Here’s a link to the FDA guide to reading a nutrition label. But beware: If you’re like most Americans, who need to keep sodium down, you’ll need to mentally adjust that “percent of daily value” (%DV). For example, the sample panel says 470 mg is 20% of your daily value of sodium. Under the 1500 mg ceiling, it’s actually 31%.

Keep that in mind when you’re judging for yourself.

-- Amina Khan

Lowering blood pressure and cholesterol simultaneously can sharply reduce heart attacks and strokes

October 1, 2009 |  4:15 pm

An inexpensive combination of a cholesterol-lowering drug and one to reduce blood pressure can reduce the incidence of heart attacks and strokes by as much as 60%, but getting patients to begin the regimen and then to stay on it is an extremely difficult task, Kaiser Permanente researchers reported today. Giving the drugs to nearly 70,000 people with cardiovascular disease or diabetes prevented an estimated 1,271 heart attacks and strokes in one year, Dr. James Dudl of the Kaiser Permanente Care Management Institute and his colleagues reported in the American Journal of Managed Care.

The inspiration for the study came from the Archimedes Model, a sophisticated computer simulation of the human body that predicted that lowering blood pressure and cholesterol simultaneously in those at the highest risk for cardiovascular problems could reduce the incidence by 71%. But such a study had never been carried out in the real world before.

The Kaiser team chose two generic drugs, cholesterol-lowering lovastatin and blood-pressure-reducing lisinopril, and offered them to 170,000 members of their managed care programs in Northern and Southern California who suffered from heart disease or diabetes. Some of the patients were already taking one of the drugs, but none of those selected were taking both. About 75% of them were also taking daily aspirin, but the researchers did not include aspirin in the protocol because they had no way to monitor usage.

They began the program in 2004 and nearly 70,000 patients agreed to participate. The team monitored compliance for two years by checking on whether and how often patients refilled their prescriptions, then monitored health effects in the third year through the patients' health records. Some 47,268 patients had what the team termed "low exposure" to the drugs, taking them less than half the time. Their risk of hospitalization for heart attack or stroke was lowered by 15 events per 1,000 person-years, and an estimated 726 events were prevented.  An additional 21,292 patients had "high exposure" to the drugs, taking them more than half the time. Their risk was reduced by 26 events per 1,000 person-years, preventing an estimated 545 events.

"What was fairly amazing to me was that we got such a good drop in heart attack and strokes" despite the low adherence, Dudl said. "The issue now is how to increase adherence." The primary reasons for non-adherence, he noted, were things like, "I don't know why I was taking the drugs," "I forgot to refill the prescription," and "I worry about side effects." Those are issues "that have to be addressed with each patient, one by one." Kaiser now has a follow-up program focused on adherence, he said.

"We made it the simplest regimen we could," he added, with a standardized dose of each drug for everyone. "Can you imagine how difficult it would have been" if it were a more complicated regimen or physicians had to schedule multiple visits to adjust dosages for each patient. "It's a great example of how difficult it is for people to understand and do something that is beneficial to them."

-- Thomas H. Maugh II

Cutting salt saves lives and reduces costs

September 10, 2009 | 10:54 am

While we're on the subject of healthcare reform, why doesn't everyone cut back on salt? Wednesday, President Obama outlined his plans to provide better health coverage and cut healthcare costs. But cost-cutting starts at home. A new study published by Rand Corp. researchers concludes that if Americans reduced their salt intake to the recommended maximum amount, hypertension cases could be cut by 11 million with a savings of $18 billion in healthcare costs and 312,000 years of life gained.

Salt The Institute of Medicine recommends adults consume no more than 2,300 milligrams a day of salt. Salt increases blood pressure, which then raises the risk of heart and kidney disease. The average American gets about 1,000 milligrams more than is recommended. In the study, researchers used data from a government survey conducted between 1999 and 2004 about salt intake and other health measures to arrive at their conclusions.

About 70 million Americans have high blood pressure. But cutting salt is difficult to do because it's not just about putting the salt shaker away. Many processed and packaged foods contain high levels of salt -- even foods that are considered lower-calorie or "healthy." People would need to read food labels carefully to make a concerted effort to curb salt intake.

"Restaurant foods also contain high amounts of sodium, as the sodium density of restaurant foods was estimated to be 1,873 mg. per 1,000 calories in 1995," the authors wrote. Policies that improve the clarity of food labels and require restaurants to list nutritional information on their menus are needed to bring down sodium intake, they added. "Without more accessible information, voluntary actions by companies, or government regulation, consumers may have difficulty reducing consumption on their own."

The study is published in the current issue of the American Journal of Health Promotion. For more information on the link between salt and health, see this article by Emily Sohn in the Los Angeles Times' Health section.

-- Shari Roan

Photo credit: Glenn Koenig  /  Los Angeles Times

Traffic noise hurts

September 9, 2009 |  4:00 pm

Traffic The rumbling of cars, trucks and trains isn't just annoying, it can raise your blood pressure. A study appearing today in the journal Environmental Health found that people exposed to high levels of noise from roads near their homes are more likely to report suffering from chronic hypertension.

"Road traffic is the most important source of community noise," said the lead author of the study, Theo Bodin, from Lund University Hospital, Sweden, in a news release. "We found that exposure above 60 decibels was associated with high blood pressure among the relatively young and middle-aged, an important risk factor for cardiovascular diseases such as heart attack and stroke."

The researchers surveyed more than 24,000 adults living in Sweden. Based on the participants' home addresses, information was obtained about average road noise at their homes. The study found a modest link between hypertension and average traffic noise between 45 and 65 decibels. But the link grew stronger with higher levels of noise. The risk of hypertension was highest in relatively young or middle-aged people, whereas no effects were seen in the oldest age group.

Many urban dwellers experience traffic noise levels of 55 decibels or more, the authors note. And those numbers are growing.

-- Shari Roan

Photo credit: Los Angeles Times


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