Arrythmia

If you use sleeping pills and have hypertension, you may find it increasingly difficult to control your blood pressure. A study of older adults found an association between regular use of sleeping pills and the need for more antihypertension medication. Researchers enrolled 752 participants between 2008 and 2010 and followed them through 2012 and 2013. At the start of the study, 37 percent of the participants said they slept poorly, and 16.5 percent used sleeping pills on a regular basis. The mean number of antihypertension drugs used was 1.8. During the study, almost 20.7 percent of the participants increased the number of blood pressure medications they took. As reported online March 25, 2019, in Geriatrics & Gerontology International, the researchers found no connection between difficulty falling asleep or staying asleep and change in the use of blood pressure medication. However, they did find consistent use of sleeping pills was connected to higher risk of needing to add additional antihypertension medications to control blood pressure.

There's news that many people would like to hear. A small observational study of Greek patients presented at the annual meeting of the American College of Cardiology in March 2019 found that taking a daily nap can lower blood pressure.

French researchers analyzed the results of food questionnaires completed every six months by 44,551 adults ages 45 and older participating in an ongoing study on food habits. On average, more than 29 percent of their total calories came from ultra processed foods. During the seven-year study, 602 participants died. After carefully adjusting for other factors, the researchers concluded that every 10 percent increase in the amount of ultra processed foods consumed increased the risk of all-cause death by 14 percent. Ultra processed foods tend to be high in calories, carbohydrates, salt and fat and low in fiber and vitamins. In addition, they may contain harmful food additives and contaminants.

Our biological clock (circadian system) governs many physiological processes, including blood pressure. Blood pressure normally dips at night. People who do not experience this temporary drop (called "non-dippers") are at increased risk for developing heart disease. Researchers discovered that one of four main genes comprising the circadian system act differently in men and women. They found that male mice missing this gene (PER1) become non-dippers and have a higher risk of heart and kidney disease. In contrast, female mice missing the PER1 gene continue to show normal dips in blood pressure at night (American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, January 2019 ahead of print). This phenomenon may explain in part why premenopausal women, who are less likely to be non-dippers than men of the same age, have a lower risk of heart disease. After menopause, their risk climbs due to other factors and quickly erases this biological benefit.

Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and death from CVD. In fact, nearly one-third of U.S. deaths attributed to cigarette smoking are due to CVD. Although most smokers attempt to quit multiple times before they are able to call it quits, many do not stop smoking until they have developed smoking-related complications. Quitting smoking reduces subsequent CV events and mortality, regardless of duration or intensity of smoking, comorbidities or age. Patients benefit even when they quit smoking after they have developed CVD. This provides a strong rationale for quitting-if only the best way to accomplish this were known. Physicians have had little guidance to use in counseling patients on the most effective strategies to stop smoking. The American College of Cardiology addressed this need with an Expert Consensus Decision Pathway on TobaccoCessation Treatment (Journal of the American College of Cardiology, Dec. 25, 2018). It summarizes recommendations for a comprehensive approach to treating tobacco dependence with a chronic disease management strategy, monitoring tobacco use over time and making repeated efforts to encourage and assist smokers to quit using tobacco. The document gives physicians the information they need to answer smokers' questions about therapies for overcoming nicotine withdrawal, while bolstering self-control over smoking. It also discusses barriers to implementing and sustaining smoking cessation treatment that should be recognized and addressed to help smokers overcome their addiction to tobacco.

Obese individuals tend to have other risk factors for heart attack and stroke, such as diabetes, high blood pressure and high cholesterol levels. That has caused the role of obesity as a cardiovascular risk factor to be questioned. A study spearheaded at Cleveland Clinic suggests that it is. The authors conducted a meta-analysis of five studies with a total of 900,000 participants in which a genetic polymorphism associated with obesity was used to determine its potential link to cardiovascular outcomes. They found that as body-mass index rose above the mean, risk of type 2 diabetes and coronary artery disease (CAD) rose with it. No connection between obesity and stroke was seen. Although these results do not prove that obesity causes diabetes and CAD, they strongly suggest that obesity increases the risk these issues will develop (JAMA Network Open, November 2018).

Small calcium deposits in breast arteries are not associated with breast cancer, but they may be a marker of coronary artery disease (CAD) long before other symptoms appear. Researchers evaluated 2,100 asymptomatic women ages 40 and older using mammography and computed tomography angiography imaging of the coronary arteries, among other tests.

If there are specific concerns that you would like to have addressed, please write them down before you leave home and raise them early in the appointment. Please don't wait until the end of the visit to speak up. Knowing what's on your mind helps us plan our time with you, and you will be more likely to leave the office satisfied, if your questions have been answered.

It's very common for people to need multiple anti-hypertension medications to lower their blood pressure into an acceptable range. If you resent taking medications, try diet and exercise. Researchers studied 129 overweight adults with blood pressures between 130 and 160 millimeters of mercury (mmHg) systolic and 80 and 99 mmHg diastolic, but who were not taking anti-hypertension medication. The researchers randomized one-third to the DASH diet (an eating plan designed to lower blood pressure) plus supervised exercise three times a week and behavioral counseling for weight loss. One-third were randomized to the DASH diet only. The remainder made no changes to their diet or exercise habits. Over a 16-week period, those who participated in the diet, exercise and counseling group lost an average of 19 pounds and reduced their blood pressure by an average of 16/10 mmHg. The diet-only group lowered their blood pressure an average of 11/8 mmHg. Blood pressure in the group that made no changes dropped only 3/4 mmHg.

Patients with heart failure with preserved ejection fraction (HFpEF) find their ability to walk and carry out the American Journal of Medicine suggests lack of vitamin D may be partly responsible. Vitamin D is thought to play a role in cardiovascular and muscle function, but its relationship with exercise capacity has been unknown. Researchers measured vitamin D levels in 112 HFpEF patients and 37 matched controls, all of whom took a six-minute walk test and had their peak oxygen capacity measured. Vitamin D levels were found to be significantly lower in HFpEF patients than in controls. More than 90 percent of HFpEF patients had insufficient vitamin D levels or were frankly deficient. These low levels were associated with more severe exercise intolerance. This study laid the groundwork for a randomized, controlled clinical trial to evaluate whether vitamin D supplementation could be effective in improving exercise tolerance.

Depression after a heart attack can have serious, even deadly, consequences. However, the effect of antidepressants on outcomes has been unknown. A 300-patient study published in the July 24/31 issue of JAMA suggests that treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) significantly reduced the risk of a major cardiac event. Patients who had recently suffered a major or minor heart attack were randomized to the antidepressant or placebo for 24 weeks and then followed for a median of eight years. All-cause death, deaths from heart disease, heart attacks and revascularizations with angioplasty and stenting were tracked. At the end of the study, 40.9 percent of the patients on escitalopram had met one of these outcomes, compared with 53.6 percent of those who had received the placebo. When individual outcomes were examined, the SSRI beat placebo in all measures. However, only reduction in heart attack (8.7 percent vs 15.2 percent) was statistically significant.

Patients with type 1 diabetes require multiple insulin injections a day. This can make it difficult to keep blood glucose levels within the ideal range. Now theres a smartphone app that can help. The Guardian Connect continuous glucose monitoring system works hand-in-hand with the Sugar:IQ app to analyze how patients glucose levels are responding in real time to food intake, insulin and other variables. Data are sent to the cloud for processing, and the information is returned to the app for viewing on an iPhone. The system helps patients identify foods and habits that cause their glucose to spike, as well as times of the day or week when glucose levels fluctuate. This allows them to adjust their insulin use accordingly. In a pilot study, patients using the system spent 33 minutes more per day in the ideal glucose range and had one less hyperglycemic event per month. When the Sugar:IQ app explained the dangers of hypoglycemia, the number of hypoglycemic events dropped in more than half of app users. The system, which has been approved by the U.S. Food and Drug Administration (FDA), is now being retooled for Android users.