A: You’re not alone in feeling a little nervous in the doctor’s office. Some people even experience what’s called “white coat syndrome,” which refers to a person having higher blood pressure readings in a physician’s office compared with at-home readings. Feeling anxious not only can increase blood pressure, but it also can impair listening and remembering. There are some strategies that can help you overcome your stress. For example, while you are waiting for your provider, take a few deep slow breaths to help you stay calm. Because feeling stressed can make your mouth feel dry, bring some water to sip. It’s also helpful to have a dedicated health-care notebook.

Before your appointment, jot down your health concerns and questions. During the appointment, refer to the notebook to ensure you’ve addressed your concerns and take notes of your doctor’s recommendations. If you forget what you were told, you can refer to it later.

Consider bringing a friend or a family member to the appointment, especially if there are serious concerns to discuss. This person can provide information that you might forget or overlook and remind you of questions you wanted to ask. If you want to discuss something privately, you can always ask your relative or friend to leave the room.

You need to—and have a right to—understand what your provider says. It’s important that you understand any treatments your provider recommends, any risks associated with treatments and if there are any other choices. If you don’t understand, ask your provider to explain. Repeat any instructions back in your own words. If you’ve misunderstood, your provider will realize this, and explain in different words. You can also ask for written summary to refer to at any time. If you have any questions or concerns about a treatment or medication, call your healthcare provider right away.

The post Improving Communications with Doctors appeared first on University Health News.

A Massachusetts General Hospital (MGH) report, published recently in the American Heart Association journal Stroke, notes that “BP is a matter of brain health,” adding that high blood pressure is a major risk factor for stroke and dementia. “Having high blood pressure impairs your thinking,” explains neurologist Jonathan Rosand, MD, co-founder of the McCance Center for Brain Health at MGH and a co-author of the Stroke article. “Its impact on the brain is profound.”

Numerous other studies have been published in recent years underscor­ing the connection between brain health and blood pressure control. In addition, researchers are also reveal­ing how cutting back on sodium con­sumption can significantly reduce blood pressure in many people. One study, published at the end of 2023 in JAMA, suggests that cutting a tea­spoon of sodium—about 2,300 mil­ligrams (mg)—out of your daily diet may lead to a drop in your systolic blood pressure (the top number in your BP reading) by 6 to 7 millime­ters of mercury (mmHg).

The Centers for Disease Control and Prevention reports that the average American consumes at least 3,400 mg of sodium daily. The federal recommendation is no more than 2,300 mg of sodium per day. “If you can reduce your sodium intake to somewhere between 2,000 and 3,000 mg per day, you should see a drop in blood pressure,” Dr. Rosand says. “How much of a drop depends on the person.”

Sodium and the Body

Some people are considered “salt sensitive,” meaning their blood pressure rises and falls significantly based on their sodium consumption. Other individuals are known as “salt resistant,” which means their sodium intake has relatively little impact on their blood pressure readings. However, most people will experience a reduction in their blood pressure when they cut back on their sodium.

But just what is the connection between sodium and blood pressure? Sodium encourages the body to retain fluids, which in turn can raise your blood pressure. High blood pressure stresses your blood vessels, Dr. Rosand explains. That stress triggers an inflammatory response in the body, which can interfere with healthy brain function. Researchers continue to implicate inflammation as a risk factor for dementia.

Where Is the Salt?

If you want to keep better track of your sodium intake, you should take a closer look at the menu the next time you eat out. “The number one source of sodium is restaurant food,” Dr. Rosand says, adding that many establishments still don’t include sodium totals (or other important nutritional information) on their menus.

For those that do include sodium amounts, take note and think about what else you’ve eaten that day and what your daily total is approaching. Dr. Rosand adds that there is no harm in asking how much sodium is in a particular entree. If that information is hard to come by, make careful choices and don’t hesitate to ask for salad dressing on the side or to have a dish without cheese. Salad dressing and other condiments, cheese, bread, and meat are notoriously high in sodium, whether you order them from a restaurant or buy them from the grocery store.

You can also reduce your sodium intake by changing a few habits, Dr. Rosand says. For example, don’t automatically reach for the saltshaker before you’ve tried your food, either at home or eating out. You may find that it tastes delicious without your automatic salt addition.

And when you’re cooking, Dr. Rosand suggests experimenting with lemon juice and various herbs and spices to give your food more flavor without adding salt.

Make BP Management a Priority

For the health of your brain, heart, and blood vessels, get serious about your blood pressure. If you’re unsure of your BP, have it checked soon and consider investing in a home BP monitor. And keep in mind that regular exercise, maintaining a healthy weight, cutting back on sodium, and taking one or more antihypertensive medications can usually get your BP under control.

“I would ask patients if they knew anyone with dementia or a stroke and then what would they do to lower their risk,” Dr. Rosand says. “Then I’d explain that normalizing blood pressure is one of the quickest and most effective ways to help them do that.

The post Does Lowering Your Sodium Intake Really Keep Your Blood Pressure in Check? appeared first on University Health News.

A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.

Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.

Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.

Real—Dangerous for Some

White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.

In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)

Blood Pressure—How High is Too High?

To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)

The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.

The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80.  Normal for patients over the age of 80 may be higher.

Diagnosis— Multiple Readings

Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.

When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)

Treatment—Lifestyle Changes, Medications

If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:

• Lose weight.
• Sit less, exercise more.
• Eat more fruits and vegetables, less red meat and processed foods.
• Limit daily salt intake to 2300 mg.
• Don’t smoke.
• Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)

If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.

Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.

How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.

White Coat Syndrome—Answers and Actions

It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.

Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/uhn-blog-whats-the-right-blood-pressure-for-you-it-depends/

https://universityhealthnews.com/daily/heart-health/is-the-blood-pressure-reading-from-your-doctors-visit-accurate/

The post White Coat Syndrome – Real? Dangerous? Treatable? appeared first on University Health News.

Jot down your answers, check them against the answer key, then look at the box on this page to see what your score says about your nutrition knowledge. You’ve got this!

1. True or False? On a Nutrition Facts label, the “Serving Size” is designed to align with recommended portion sizes.

2. In addition to taking statin medication as necessary, the best way to improve your LDL cholesterol level is to:

a. Consume a healthy dietary pattern

b. Increase your physical activity level

c. Achieve or maintain a healthy body weight

d. All of the above

3. True or False? Obesity is a result of a lack of willpower.

4. Strength training (weightbearing activity) helps build muscle strength and preserve muscle mass and bone density. Examples include:

a. Lifting weights

b. Brisk walking

c. Doing pushups and wall squats

d. A and C

5. Which supplements have been demonstrated to prevent or slow cognitive decline?

a. Ginko biloba

b. Omega-3 fatty acids

c. Green tea powder

d. None of the above

6. Which of the following increases stroke risk?

10–12 NUTRITION SUPERSTAR. You really know your stuff! We promise to keep adding to your impressive knowledge base and keep you up-to-date with the latest evidence-based info. 7–9 HEALTH HERO. Great job! Reading this newsletter has given you a strong base of nutrition knowledge to help you stay healthy. 4–6 SERIOUS STUDENT. You’ve been paying attention! Keep increasing your nutrition knowledge and learning how to make the best choices for your health and wellbeing. 1–3 MOTIVATED BEGINNER. Read upcoming newsletters to expand your knowledge about how diet and other lifestyle choices can keep you healthy and decrease your risk of developing common chronic conditions.

a. High blood pressure

b. High blood glucose

c. High LDL cholesterol

d. All of the above

7. What kind of studies can prove that a particular food or nutrient impacts human health (cause and effect)?

a. Animal studies

b. Randomized controlled trials that compare an intervention group to a control group

c. Studies conducted in a lab

d. Observational studies that look at large numbers of people over time

8. Not getting enough good quality sleep has been associated with which of the following?

a. Increased risk for heart attack

b. Higher risk of cognitive decline

c. Weight gain

d. All of the above

9. Why is high blood pressure known as “the silent killer?”

a. It usually has no symptoms

b. It can affect the vocal chords, so some people with hypertension cannot speak

c. It is difficult to diagnose

d. A and C

10. Which parts of a food label can help you choose healthier packaged foods?

a. The Nutrition Facts panel

b. The ingredients list

c. All front-of-package claims a. A and B

11. What is “metabolic syndrome?”

a. The leading cause of obesity

b. A genetic condition that causes a slow metabolism

c. A group of conditions that together indicate higher risk for type 2 diabetes, heart disease, heart attack, and stroke

d. An intestinal disorder

12. Which of the following can help you change your behavior?

a. Make a clear, realistic plan

b. Prepare in advance, when possible

c. Prioritize the new behavior

d. All of the above

How did you do?

10–12 NUTRITION SUPERSTAR. You really know your stuff! We promise to keep adding to your impressive knowledge base and keep you up-to-date with the latest evidence-based info.

7–9 HEALTH HERO. Great job! Reading this newsletter has given you a strong base of nutrition knowledge to help you stay healthy.

4–6 SERIOUS STUDENT. You’ve been paying attention! Keep increasing your nutrition knowledge and learning how to make the best choices for your health and wellbeing.

1–3 MOTIVATED BEGINNER. Read upcoming newsletters to expand your knowledge about how diet and other lifestyle choices can keep you healthy and decrease your risk of developing common chronic conditions.

Quiz Answers

1. “False.” Serving sizes that appear on food labels are defined by the U.S. Food and Drug Administration as “the amount of food customarily consumed in one sitting for that food.” This amount may or may not align with the portions in dietary recommendations or with what is best for you.

2. “d” (All of the above). To prevent and treat high LDL cholesterol levels, choose minimally processed fruits, vegetables, nuts/seeds, whole grains, beans/lentils, seafood, and nontropical plant oils in place of red meats, processed meats, butter, lard, palm and coconut oils, and refined breads, crackers, cookies, and cakes. Watch portions of these foods to help manage weight and find ways to increase your physical activity level.

3. “False.” Obesity is a disease, not a personal failing. It is essentially a result of normal human biology combined with an unhealthy food environment. Adipose tissue (body fat) is an organ that secretes hormones and other molecules that can lead to metabolic changes that make it difficult to maintain weight loss.

4. “d” (A and C). Lifting free weights and using the resistance of your own bodyweight working against gravity (such as in pushups and squats), along with weight machines, bands, and yoga, are resistance activities that build strength. Experts recommend at least 30 minutes of strength training activities per week, divided into at least 2 sessions, including exercises that work muscles in both the upper body and lower body.

5. “d” (None of the above). There is currently no strong evidence that any supplements on the market can prevent or slow cognitive decline. If you do choose to try supplements, look for labels that indicate a supplement has been independently tested (by companies like Consumerlabs.com and USP) and tell your healthcare provider, as some supplements can interfere with the action of prescription drugs like blood thinners and some diabetes medications.

6. “d” (All of the above). High blood pressure, blood sugar, and high LDL cholesterol levels all contribute to the development of atherosclerosis (hardening of the arteries) which increases risk for ischemic stroke (a blocked blood vessel in the brain). Additionally, the increased pressure on vessel walls from high blood pressure raises risk for hemorrhagic stroke (caused by a rupture blood vessel in the brain).

7. “b” (Randomized controlled trials). Only intervention trials can prove cause and effect. There is no guarantee a reaction seen in a test tube or in animals will have the same effect in the human body. Observational studies are a great way to find associations between factors and generate hypotheses, but they don’t prove cause and effect.

8. “d” (All of the above). Getting less than seven hours of good quality sleep is associated with higher risk for heart attack and dementia. Some studies have also found an association with an increase in overeating and unhealthy food choices, leading to weight gain. If you are experiencing trouble with sleep, discuss it with your healthcare provider.

9. “a” (It usually has no symptoms). People can’t usually feel when their blood pressure is too high (a top number over 130 or a bottom number over 80), so getting annual blood pressure readings is important. Even without symptoms, high blood pressure increases risk for heart attack, stroke, heart failure, and dementia.

10. “d” (A and B). The federally mandated Nutrition Facts panel helps you find healthier choices (such as those with more dietary fiber and less sodium, saturated fat, and added sugars). The ingredient list can help determine how processed a food is and what the main ingredients are (ingredients are listed in order from highest to lowest amount by weight. Front-of-package claims do not guarantee a food is healthy. A food labeled “organic” or “gluten free,” for example, could still be ultraprocessed and/or high in sugar, salt, or saturated fat and low in fiber and whole grains.

11. “c” (A group of conditions that together indicate higher risk for type 2 diabetes, heart disease, heart attack, and stroke). Metabolic syndrome is not a disease or condition of its own, but a cluster of factors, including a large waist circumference (over 35 inches for women and over 40 for men), high blood pressure (over 130/80 mmHg), fasting blood glucose over 100 mg/dL, blood triglyceride levels of 150 mg/dL or higher, and low HDL (“good”) cholesterol (under 50 mg/dL for women and 40 for men).

12. “d” (All of the above). To help behavior change stick, set a realistic goal and make a reasonable plan for achieving it. Make the new behavior a priority (for example, put your morning walk on the calendar and treat it like a business meeting that can’t be scheduled over). Make the new behavior easier by being prepared (for example: lay out exercise clothes the night before or batch cook and freeze healthy meals).

The post Check Your Nutrition Knowledge! appeared first on University Health News.

1. Determine What Matters Most to You

To develop its program, the PPC interviewed many patients, family members and health-care providers, and asked what issues were most important to them when they needed to make a medical decision. Their responses fell into four categories: maintaining the ability to connect with others, enjoying life, preserving or improving function, and managing health.

• Connecting refers to your relationships with others and the time you spend with them. These may be personal, professional, and spiritual connections.

• Enjoying life is anything you do— from reading to gardening to playing sports to creating art to mentoring others— that results in feelings of self-satisfaction, well-being, and a sense of purpose.

• Function includes physical, cognitive, and psychosocial function. Changes in any of those areas can impact one’s sense of self, dignity, and independence. How would you feel if you couldn’t be as physically active as you are now? What if you needed some help to be able to live at home? How much is your identity dependent on what you can do?

• Managing health can be timeconsuming if you have multiple chronic conditions. Some medical decisions force us to choose which is more important to us: how well we function (quality of life) or how long we live (quantity of life). The balance that is acceptable to you may change as you age.

2. Use Your Priorities to Develop Health Goals

Health goals aren’t numbers like blood pressure readings, cholesterol levels, or pounds on the scale. They’re the activities that are most important to you, the ones you want your medical care to facilitate, not constrain. One of the best ways to develop a health goal is to ask yourself, “How would I want to be spending my time and energy if I weren’t feeling this symptom or dealing with this medical care activity?” Be specific—exactly what do you want to do, and how often do you want to do it? Be realistic about what is possible given your current state of health, and be flexible, too—try to identify what might replace your preferred health goal if you couldn’t do it anymore.

My patient Sam provides a good example of this process. Sam’s current health goal is to attend his nephew’s graduation in June and celebrate with the family. However, Sam has lung disease and can’t walk around the block even once without becoming so winded he needs to rest. The problem is made worse by the fact he has difficulty using his inhaler. So, Sam’s realistic health goal is that he wants to be able to attend his nephew’s graduation, but his poor breathing is a barrier to this goal. By modifying his health goals to include limitations brought on by his current state of health, Sam is able to clarify what he and his pulmonologist need to focus on if he is to achieve his goal.

3. Review Your Health-Care Regimen

Some people are willing to do anything to help them achieve their health goals, but others find some things are just not worth the trouble. One way to think about this is to identify what medical care you consider helpful and what feels burdensome. Helpful care is care you can do without too much difficulty and that helps you with your health goals— for example, taking pain medication may improve your knee pain so that you can go golfing. Burdensome care includes health tasks you feel are too difficult, uncomfortable, time-consuming and unhelpful. This could include following a restricted diet, having a colonoscopy, or going to clinic for weekly treatment.

You may not have strong feelings about whether a test or treatment is helpful or burdensome until you actually experience it. Sometimes you can try out a treatment or type of care by working with your medical provider and setting a time limit for determining whether your treatment response is good enough or the dose or treatment should be changed or even stopped. You may choose to stop when the burdens outweigh the benefits or the care becomes inconsistent with your priorities. Make discussing the pros and cons of any medical treatment a regular part of your discussions with your health-care provider.

4. Match Suggestions with Goals

Let’s return to Sam. He and his pulmonologist decide that he should accomplish two shorter-term goals in service of getting to his nephew’s graduation. The first is to be able to walk around the block three times a week without needing to rest. To do this, Sam needs to regularly attend pulmonary rehabilitation (a program of exercise education and support for people with lung disease). The second is to learn to correctly use his inhaler so that he gets the full dose of medication.

Sam enrolls in pulmonary rehabilitation, but he continues to have difficulty using his inhaler. Two months before the graduation, he’s still unable to get around the block twice without stopping to rest. His pulmonologist then suggests that Sam use a wheelchair to attend the graduation and also recommends that Sam switch to using a nebulizer machine that will convert his medication to mist that can be more easily inhaled. This is where Sam draws the line between what is helpful and what is burdensome. He needs to decide if following his pulmonologist’s advice will help or interfere with achieving his goal of getting to the graduation. He has always said he would never use a walker, let alone a wheelchair, and that he didn’t want to be “chained by machines” for his health.

5. Determine Acceptable Trade- Offs

Trade-offs are what you are willing or unwilling to do to diagnose or treat a medical problem based on your sense of what is helpful and what is too burdensome. Trade-offs are not written in stone and can change as your circumstances change. They can also be temporary, like Sam using a wheelchair just for the graduation. If Sam understood that the nebulizer isn’t a “chain” but is used for just five minutes a few times a day, he might be willing to see if it helps.

You and your health-care provider can make decisions that align with your goals by basing them on your priorities, your understanding of your options, and your sense of your likely future health status, and then determining what trade-offs you are willing to accept. But there is other important information you and your provider need to discuss before making a decision. For example, if you are considering a diagnostic or screening test, what are the next steps if the test is abnormal? Are they steps you would want to take? If you are considering a treatment, what is the likelihood that you will benefit from it, and what are its risks? What are your other options? If you are discussing surgery, what are the best, worst, and usual case scenarios for outcomes and recovery if you have the surgery? What if you don’t have the surgery?

Envisioning what it would be like to live in a different state of health and function can help you decide on trade-offs when you’re making a medical decision. For example, if you have pain from incurable cancer and have a remaining life expectancy of three to six months, radiation might provide pain relief but could cause you to be severely fatigued. Is this acceptable to you? Would you rather try pain medication? What if the pain medication makes you confused or increases your daytime sleeping? Would you be willing to take a lower dose of medication and live with some pain to be more awake and mentally clear? Thinking through these trade-offs will help you make a decision that is more in line with your health priorities and goals.

The post What’s the Right Medical Care for You? appeared first on University Health News.

If overcoming depression were that easy, we wouldn’t have 280 million people across the globe with depression (according to World Health Organization estimates). Unfortunately, many people share your relatives’ view of this common mental disorder. Don’t let their misunderstanding cause you to question the seriousness and legitimacy of what you are going through.

If you want to educate people close to you about depression, start by explaining that depression is a real health problem, no different in many ways than heart disease or other chronic conditions. People with depression aren’t choosing to be sad. You can also say that depression usually requires treatment, sometimes with medication and sometimes with psychotherapy or often a combination of the two.

If you are in therapy, think about bringing a relative to one of your sessions. Hearing the subject discussed by a mental health professional may be helpful. One other consideration is that a misunderstanding of depression does not equate to a lack of love or affection. Your family members probably just want you to be happy. Educating them about depression may help them see depression in a different way.

After years of seeming to remain as sharp as she did decades ago, my 88-year-old mother finally seems to have started having memory and attention issues. Do these changes tend to progress quickly or gradually?

The fact that your mother is 88 and is only now perhaps showing early signs of cognitive decline is impressive. And the signs you describe certainly sound like normal, age-related changes in memory and thinking skills. How quickly or slowly these changes progress can’t always be predicted. If she is starting to develop mild cognitive impairment (MCI), you may notice a steady decline in things like memory and attention until dementia sets in. However, some people with MCI hit a cognitive plateau, so to speak, and do not advance to dementia.

Understand also that changes in memory, cognition, and personality can be caused by a wide range of factors. These include medication side effects, metabolic imbalances, vitamin deficiencies, and other health issues that may be treatable. Sometimes addressing the underlying cause can reverse cognitive changes. If the changes you’re seeing are becoming more significant or are already at that point, you may want to talk with her primary care physician. A review of your mother’s medications and a workup that includes blood tests and other screenings may be appropriate.

Q

I know “white coat hypertension” means your blood pressure rises due to anxiety at a doctor’s appointment when it’s normal at other times. But what’s “masked hypertension?”

A

Masked hypertension is a common phenomenon in which blood pressure appears normal during a medical appointment but increases in other places and at other times. It’s a risk factor for stroke or other damage to the brain. We don’t always know why a person develops masked hypertension, but one explanation may be that blood pressure spikes at a stressful job or in a stressful home situation, while a doctor visit may actually prove to be a more relaxing environment. Some people also experience significant blood pressure increases if they drink alcohol excessively, which could explain higher blood pressure readings at home.

Masked hypertension is usually diagnosed by wearing an ambulatory blood pressure monitor under medical supervision. Older adults and people with diabetes are more likely to have masked hypertension, and may be the ones who would benefit most from ambulatory blood pressure monitoring.

The post Ask the Doctor: April 2022 appeared first on University Health News.

“PAD is very common; an estimated 8 to 12 million people are affected in the U.S, and approximately one in every 20 Americans over the age of 50 has PAD,” explains Dmitriy Feldman, MD, FACC, director of endovascular services and an associate professor of medicine at Weill Cornell Medicine. “It is important to know if you have PAD, because the presence of PAD signifies a future risk for having a heart attack or a stroke.”

The risk of having PAD increases with age, current or prior smoking, diabetes, obesity, high blood pressure, and high total and LDL cholesterol levels— the same risk factors that increase the chances of coronary artery disease.

Be Alert for Symptoms

PAD most commonly affects arteries in the legs. According to Dr. Feldman, symptoms include cramping in the lower extremities and/or pain or tiredness in the calf or hip muscles, particularly when walking or climbing stairs. In more advanced stages of PAD, symptoms include sores or wounds on the toes, feet or legs, a lower temperature in the extremity, color changes in the skin of the toes and/or feet, and poor nail growth or hair growth on the toes and legs, respectively.

“It’s important to know if you have PAD because the loss of circulation to the legs and feet can cause gangrene and loss of a limb,” says Dr. Feldman. PAD can be present without any symptoms, so people can have PAD and not know about it. PAD can also be present in the arteries that carry circulation to the brain, arms, kidneys, and stomach.

Diagnosing PAD

Dr. Feldman notes that PAD can be easily diagnosed with an evaluation that includes a thorough medical history, a physical exam, and diagnostic tests. The evaluation can be performed by the patient’s primary care physician, or by doctors who specialize in the diagnosis and treatment of PAD, such as cardiologists, vascular medicine specialists, surgeons, and podiatrists. An evaluation for PAD usually includes a simple, noninvasive, diagnostic test called an ankle-brachial index (ABI). This test compares the blood pressure readings in your ankles with the blood pressure in your arms; if the pressure in your ankles is significantly lower than in your arms, you probably have PAD. Dr. Feldman says that further tests, such as Doppler ultrasound of the arteries in the lower extremities, a magnetic resonance angiography, or a computerized tomography angiography, may be needed to identify the location and severity of the blockages.

Treatment Options

The goal of treating PAD is to improve quality of life, alleviate symptoms, and reduce the chances of heart attack, stroke, or amputation. Dr. Feldman explains that there are three main treatment approaches to PAD, which include:

• Medications and lifestyle changes (treatment of hypertension, diabetes, and/or cholesterol, eating a healthy diet, getting regular exercise, and weight loss and smoking cessation, if required)
• Minimally invasive endovascular procedures, including balloon angioplasty (this involves threading a catheter with a balloon on the tip to the narrowed or blocked artery and inflating the balloon, which increases blood flow) or stenting (a small, hollow mesh tube called a stent is threaded to the site of the blockage and placed there, holding the artery open)
• Bypass graft surgery, in which a blood vessel from another section of your body is attached to the artery on either side of the blockage, allowing the blood to flow around the area that is blocked.

“Many cases of PAD can be treated with lifestyle changes, an exercise program, and medications,” says Dr. Feldman. “If the blood flow in the extremities is severely reduced and causing severe symptoms, patients may benefit from procedures that include angioplasty with drug-coated balloons, stenting, atherectomy (removal of plaque from the artery), or a surgical intervention.”

The post Heart Arteries Aren’t the Only Ones That May Be Clogged appeared first on University Health News.

The only way to know if you have hypertension, is to know your blood pressure numbers and where they fit in on the blood pressure chart. Knowing your numbers is the key to controlling your blood pressure. [2] This is really important because on the new chart, almost half of American adults fall into one of the high blood pressure categories. [1]

Jump to Blood Pressure Chart

What Is Blood Pressure?

Your blood pressure is a measurement of the pressure inside your arteries, the blood vessels that carry blood away from your heart. High pressure on the walls of your arteries causes damage to the arteries and to other organs of your body. This damage usually occurs without any warning symptoms of hypertension. [3]

Blood pressure is measured in millimeters of mercury (mm Hg). There are two numbers measured during a blood pressure check, and they are both important:

• Systolic blood pressure is the pressure inside arteries when your heart beats, forcing more blood through your arteries.
• Diastolic blood pressure is the pressure inside arteries between heartbeats when your heart is relaxed.
• The risk of death from heart disease or stroke doubles for each 20 mm Hg elevation of systolic blood pressure and each 10 mm Hg of diastolic blood pressure in adults ages 40 to 89. [2]

Blood Pressure Chart and Categories

AHA now recognizes five blood pressure ranges and categories:

• If you are in the normal category, you do not need any treatment but you should stick to a heart-healthy diet and regular exercise routine.
• If you are in the elevated category, you are likely to develop higher blood pressure and you should start making lifestyle changes to prevent higher blood pressure now.
• Stage 1 hypertension always requires lifestyle changes and may require medication if you have other risk factors for heart attack or stroke.
• Stage 2 hypertension usually requires both lifestyle changes and medication.
• Hypertensive crisis always requires a call to your doctor and may require a 911 call if you have chest or back pain, difficulty breathing, numbness, weakness, or difficulty speaking. [2]

To diagnose one of these categories, your blood pressure should consistently fall in the range on the chart. Your doctor will take your blood pressure several times at three or more office visits and may have you take your own pressure at home. All these readings will be factored into a diagnosis of hypertension. [3]

Lifestyle Changes for Hypertension

Some people may need medications to control their blood pressure. There are many options depending on your overall health, blood pressure, and response to medication. Some people will need to take more than one type of medication. [3]

In many cases, lifestyle changes may be the only treatment you need. These lifestyle changes are important for everyone with hypertension:

• A heart-healthy diet
• Limiting salt
• Maintaining a healthy weight
• Increasing physical activity
• Limiting alcohol
• Not smoking
• Managing stress [3]

SOURCES

1. Harvard Health Publishing, The new blood pressure guidelines: Messages you may have missed
2. American Heart Association, Understanding Blood Pressure Readings
3. Mayo Clinic, High blood pressure (hypertension)

The post The New Blood Pressure Chart: Where Do Your Numbers Fit? appeared first on University Health News.

The Dangers of Energy Drinks

The answer to “Is Red Bull Bad for you?” is self-explanatory when you consider that energy drinks often contain the following:

• High levels of caffeine (about 4 cups of coffee)
• High levels of sugar
• Artificial colors and flavors
• Added stimulants and compounds

Putting all these factors together, energy drinks like Red Bull really are not good for your body. High levels of caffeine and sugar can be extremely dangerous to the body and have even been shown to stop the heart when consumed in excess.

The acidity of energy drinks is potentially harmful to bone, muscle, and brain health. Energy drinks are also extremely addictive, causing you to depend on them to boost your energy. They may also elevate blood pressure, as we discuss below.

 

After Drinking Just One Energy Drink, Blood Pressure May Elevate

A 2015 study found that after adults drank one 16-ounce can of an energy drink, the average systolic blood pressure of the participants increased by 6.2 percent after consumption, while the average diastolic blood pressure increased by 6.8 percent after consumption._[1]

Additionally, norepinephrine levels increased by 74 percent after drinking the energy drink; elevated norepineprhine can cause changes in blood pressure, heart rate, and heart function._[1] Researchers conclude that the changes in blood pressure and norepinephrine levels may increase one’s chances of cardiovascular problems.

Other studies have found similar effects—that energy drinks lead to significant increases in blood pressure readings, which can increase cardiovascular problems, as well as cause anxiety after consumption._[2]

Caffeine itself has blood-pressure-raising effects, which may partly explain why energy drinks are so dangerous when it comes to keeping blood pressure in the healthy range._[3] But studies show that energy drinks raise blood pressure by other mechanisms, too, different from caffeine alone._[4]

A study reported by the American Heart Association (AHA) found that energy drinks can increase blood pressure and cause changes in the heart’s electrical activity. Healthy young adults that drink 32 ounces of an energy drink had heart and blood pressure changes that were more than expected from the amount of caffeine. These dangers may be due to the addition of other stimulants added to caffeine. AHA recommends that anyone with a history of heart or blood pressure problems should avoid energy drinks.

So, How Can A Person Get Energy Without an Energy Drink?

If you want to avoid the negative health effects associated with energy drinks, and especially if you have high blood pressure and want to protect your heart, stay away from products like Red Bull and 5-Hour Energy. Instead, look to natural alternatives for boosting your energy levels.

For starters, try an energy-boosting food to keep you alert instead. You also may want to look to make improvements to your overall diet and use vitamins to increase your energy levels.

Here are some of the best foods for energy. Try these delicious, energy-sustaining combos!

The best foods for energy include combinations of protein and whole grains to keep you alert longer. Next time, try these combos instead of an energy drink.

Originally published in 2015, this post is regularly updated.

SOURCES

[1] JAMA. 2015 Nov 8:1-3. [Epub ahead of print]
[2] Circulation. 2015;132:A12689.
[3] Pediatrics. 2011 Mar;127(3):511-28.
[4] Physiol Rep. 2015 Feb 25;3(2). pii: e12290.
[5] Energy drinks may provide jolt to heart, blood pressure | American Heart Association

The post Is Red Bull Bad for You? Why You Should Steer Clear of Energy Drinks appeared first on University Health News.

Home monitoring may also help your doctor diagnose hypertension. Some people tend to have higher blood pressure readings in the doctor’s office due to anxiety, called “white coat” hypertension. Blood pressure readings can also  change throughout the day. Having a series of readings from home can help your doctor decide if you have hypertension and pick the best treatment. [1,2]

But just like in the doctor’s office, getting accurate blood pressure readings at home is the key; you must have good measuring techniques and strictly follow some specified procedures in order for your readings to be accurate. [1,2]

Get the Right Blood Pressure Monitor

Ask your doctor or pharmacist to help you pick an automatic, cuff-style, upper-arm blood pressure monitor. Monitors with a digital reading of your upper (systolic) and  lower (diastolic) numbers tend to be the most accurate. Finger or wrist monitors are not accurate enough, and are not recommended by AHA. [1,2]

Any monitor you chose needs to be validated. It is always a good idea to bring your new monitor to your doctors office and have the doctor or nurse watch you take your own pressure and check your reading against the office monitor. Your health care provider should make sure that the cuff fits your arm properly. Once your monitor and technique has been checked, you are ready to start monitoring at home. [1,2]

How to Get an Accurate Blood Pressure Reading at Home

1. Ask your doctor when to take blood pressure readings.

Checking blood pressure too often can cause you to experience more stress and possible short-term high readings. To get the best readings, take two or three readings. Wait about one minute between readings. If your monitor does not save the readings, make sure to write them down on a blood pressure monitor chart.

When you are just starting or if you have recently changed treatment, your doctor will probably have you check your blood pressure every morning and night, at about the same time. Once your pressure is stable, you may be able to measure less frequently.

2. Properly prepare for taking your blood pressure.

Do not take blood pressure right after getting out of bed. Take your blood pressure before breakfast. Avoid caffeine, tobacco, alcohol, and exercise for at least 30 minutes before a blood pressure check. Empty your bladder. Rest quietly for about 5 minutes before starting.

3. Follow proper form.

You should be sitting in a straight-backed chair, sitting up straight with your arm resting on a table at heart level. Place the cuff just above your elbow. Do not place the cuff over clothing, just on your bare arm. You can use either arm, but use the same arm each time. Do not cross your legs. Keep your feet flat on the ground. Now you are ready to take your blood pressure. [1,2]

Even at home blood pressure reading can be different each time you test. It’s the average that your doctor will want to see. If you are getting wildly different readings, let your doctor know and have your pressure checked at the office. A blood pressure reading of 180 over 120 should have you taking your blood pressure again. If it is still that high, contact your doctor right away. [1]

For pregnant women who have high blood pressure with pregnancy – called preeclampsia – your doctor may have you do blood pressure readings at home during pregnancy. If you have a heart rhythm abnormality, your doctor may prefer that you have your pressure checked in the office. These arrhythmias – like atrial fibrillation – may interfere with the accuracy of a home monitor. [1,2]

Many home blood pressure monitors will store your readings and you may be able to transfer the readings to your computer or phone. It is still a good idea to use a chart to keep track of the readings, times, and changes over time:

Track Your BP on a Home Blood Pressure Log

Our blood pressure chart reflects the standard classification system adopted by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and by the American Heart Association. [1]

Managing Your Blood Pressure

Monitoring is only one part of managing hypertension. Your doctor will use your results to help you come up with a treatment plan. Although there is no cure for hypertension, treatment can keep blood pressure low and avoid complications of hypertension like heart attack, stroke, kidney damage, loss of vision and sexual dysfunction. [1-3]

Treatment may start with lifestyle changes. These changes may reduce or delay high blood pressure. They include:

• A heart-healthy diet
• Limiting salt
• Getting exercise
• Avoiding stress
• Losing weight
• Not smoking
• Limiting or avoiding alcohol

If lifestyle changes are not enough, adding blood pressure medication may be necessary. [3]

SOURCES

1. American Heart Association, Monitoring Your Blood Pressure at Home
2. Mayo Clinic, Get the most out of home blood pressure monitoring
3. American Heart Association, Make changes that matter

The post Get Accurate Blood Pressure Readings at Home appeared first on University Health News.