Among those who don’t have their high blood pressure (hyperten­sion) under control, many simply don’t know they have hypertension or, if they do, aren’t getting treat­ment or taking any steps on their own to bring their blood pressure into a healthy range.

Then there are individuals who have a condition known as treat­ment-resistant hypertension. Research suggests that about 20 per­cent of people with high blood pres­sure have treatment-resistant hyper­tension, which means their blood pressure is higher than normal even though they are taking at least three different antihypertensive medica­tions (taken at the maximum recom­mended doses), one of which is a diuretic. Other commonly pre­scribed blood pressure-lowering drugs that may be used include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and cal­cium channel blockers. Another class of medications, known as aldos­terone antagonists—typically spironolactone (Adactone) or eplerenone (Inspire)—are also often among medications used to treat resistant hypertension.

In March 2024, the Food and Drug Administration (FDA) approved aprocitentan (Tryvio), the first endothelial-receptor agonist specifically meant for people with treatment-resistant hypertension. “It’s a completely new class of drug, so it offers us an opportunity that we haven’t had until very recently,” says Randy Zusman, MD, director of the Division of Hypertension at Massa­chusetts General Hospital.

He adds that the options for physi­cians and their patients with treat­ment-resistant hypertension continue to grow. In 2023, the FDA approved a procedure called renal denervation for treatment-resistant hypertension. The procedure involves the use of radiofrequency (heat) energy or ultra­sound to destroy certain nerves in the kidneys that affect the function of the renal arteries, which deliver blood to the kidneys. The reduced nerve activ­ity can help lower blood pressure.

Dr. Zusman adds that an experi­mental antihypertensive drug that is injected once or twice a year is show­ing promise, though much more research is needed to determine who would be best served by the drug and how to deal with safety concerns, such as a sudden drop in blood pressure.

Medication Management

While it’s certainly helpful to have additional options to help people get their high blood pressure under con­trol, Dr. Zusman notes that managing treatment-resistant hypertension is much more than finding the right mix of meds. He says that a big prob­lem is non-compliance—individuals who don’t take their medications as recommended or stop taking their medications because they finally got a good blood pressure reading or they don’t like the side effects. Of course, stopping the medications that helped lower your blood pressure—without first consulting your health­care provider—means your blood pressure is likely to rise again.

For others who have been diag­nosed with treatment-resistant hypertension, the problem may be that they aren’t yet taking the right combination of medications at the right doses and at the right times during the day.

He also explains that many indi­viduals, especially older adults, may have other health conditions that make it more difficult to get their blood pressure under control. For example, they may take other medi­cations that drive up blood pressure. Over-the-counter drugs, such as cer­tain cold medications and nons­teroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), may interfere with antihypertensive medications.

You may find that taking an alter­native painkiller or cold medicine, for example, will provide symptom relief without interfering with your antihypertensive regimen. It’s impor­tant to talk with your health-care provider about all the medications you take—over-the-counter and pre­scription drugs—as well as any sup­plements. Don’t assume that dietary or herbal supplements labeled “natu­ral” are necessarily harmless or even especially helpful.

Diet, Exercise, and Much More Even the most effective medication management can only go so far. Dr. Zusman explains that obesity, a high­salt diet, a sedentary lifestyle, smoking, and other unhealthy behaviors can conspire to keep your blood pressure elevated along with your risk for stroke, cardiovascular disease, and other health problems.

“Controlling treatment-resistant hypertension involves lifestyle mod­ifications and medications,” Dr. Zusman says, acknowledging that breaking long-held eating habits can be difficult for some people. Like­wise, getting up and moving more can be a challenge for individuals who have settled into a fairly seden­tary lifestyle.

Research suggests that even small changes can make a big difference. The AHA recommends 150 minutes a week of moderate-intensity aero­bic activity, such as brisk walking, swimming, cycling, or tennis. That works out to about 30 to 40 minutes a day, most days of the week. You can even break those daily workouts into shorter bursts of exercise if that helps.

The AHA also suggests that losing just 10 pounds can lead to notice­able improvements in your blood pressure. Some studies have found that some people may see a drop of 1 millimeter of mercury (mm Hg) in their systolic blood pressure (the top number in a blood pressure reading) for every two pounds of lost weight.

What You Can Do

Dr. Zusman recommends getting reliable blood pressure checks peri­odically to know whether your treat­ment is working and to spot con­cerning changes in your blood pres­sure as early as possible. “This is especially important for people with a family history of hypertension or cardiovascular disease,” he says.

Talk with your doctor about using a home blood pressure monitor. The

more proactive you can be and con­sistently follow your doctor’s advice about medications and lifestyle changes, the more likely you may be to move from treatment-resistant hypertension to well-managed hypertension.

The post What Does It Take to Effectively Manage Treatment-Resistant Hypertension? appeared first on University Health News.

The study compared selfreported dietary intake information and health records from over 159,000 U.S. women and over 47,000 U.S. men. The researchers calculated what they called a “Planetary Health Diet Index” to see how closely the participants’ usual dietary intake resembled the EAT-Lancet diet. The participants were free from cancer, diabetes, and major cardiovascular diseases when data collection began.

During more than 30 years of followup, 31,300 women and 23,206 men died. Compared to diets that least resembled the EAT-Lancet diet, those that were closest to the planet-friendly recommendations were associated with lower risk of death from cardiovascular disease, cancer, respiratory diseases, and neurodegenerative disease.

Doing what is best for our health can also benefit the earth. The Planetary Health Diet recommended by the EAT-Lancet Commission is a flexible, plant-forward dietary pattern in which meat and dairy make up a significantly smaller proportion of food intake than whole grains, vegetables, fruits, nuts, and legumes (see page 4 for a discussion of “plant-forward” dietary patterns).

Reducing Sodium Intake Lowers High Blood Pressure–You Can Do It!

If you have high blood pressure, you’ve probably been told to decrease your intake of sodium (the major source of which is salt). Some people’s blood pressure levels respond to sodium reduction more than others.

Researchers set out to find a way to easily identify these “salt sensitive” individuals. While their potential identification test was not successful, their randomized controlled trial did reinforce the idea that individuals can lower their blood pressure by making dietary changes.

Seventy-two participants with high blood pressure were randomized to either receive advice on how to lower sodium intake or not receive any dietary advice. At the start of the study, participants provided blood samples, 24-hour blood pressure measurement, and 24-hour urine collection (which provides more accurate data on sodium consumption than self-reported food intake information). The same measurements were taken after four weeks.

Blood pressure and urinary sodium excretion decreased in the intervention group compared to the control group.

The vast majority of the sodium we consume comes from salt in food purchased in a supermarket or prepared outside the home. If you have high blood pressure, reduce sodium intake by cooking at home more often. Try using flavorful ingredients, herbs, and spices to replace some of the salt you’d normally add to foods. Limit your intake of packaged foods as much as possible. When you do buy packaged foods, look for low- and reducedsodium varieties and check Nutrition Facts labels on packages to find foods with the lowest sodium levels. The individuals in this study were successful, and you can be, too.

Whole Grains Associated with Lower Risk for Type 2 Diabetes

A review and analysis of available research concluded that eating whole grains may help reduce the risk of developing type 2 diabetes. The researchers looked at 10 prospective cohort studies and 37 randomized trials. The prospective studies (which compare what people said they ate in the past with their current health) found an association between whole grain intake and lower risk of type 2 diabetes. The randomized controlled trials found that consuming whole grains in place of refined grains reduced fasting blood glucose, HbA1c, and insulin resistance.

To achieve these effects, the data suggests dietary patterns containing 150 grams or more of whole grains a day. This is about nine servings of whole grains. The Dietary Guidelines for Americans recommend six servings of grain foods a day, at least three of which should be whole grain. This is sufficient to stay within the calorie needs of most adults and is associated with health benefits.

If you’re not a big consumer of whole grains (like brown rice, barley, quinoa, buckwheat, wheat berries, and bulgur) or whole grain foods (like whole grain bread or pasta, oatmeal, or popcorn), slowly start replacing some of your refined grain foods with these tasty, healthy options.

The post Newsbites: Sodium reduction and blood pressure; whole grains and type 2 diabetes appeared first on University Health News.

Blood pressure is related to two forces: your heart pumping blood through your arteries, and the force of your arteries resisting this blood flow. With each heartbeat, blood pressure rises, and in between beats it falls. This is reflected in your blood pressure measurement: the top figure (systolic) is the pressure when your heart beats, and the lower (diastolic) is the pressure when your heart is at rest between beats. In older adults, lowering systolic blood pressure to 120 appears to decrease mortality. However, most people need to take two or three drugs to achieve this, and they may develop drug-related side effects. As such, most guidelines recommend you aim for a systolic blood pressure that is less than or equal to 140.

Other cardiovascular risk factors— including high cholesterol, triglycerides, and blood sugar—also are associated with potentially serious health outcomes like stroke and diabetes. Your doctor should be keeping tabs on these risk factors at your routine annual health check, but what target measurements should you be aiming for? Here’s a quick rundown:

• Cholesterol Too much LDL (also known as “bad” cholesterol) can cause plaque deposits to build up in your arteries, narrowing the channel through which blood flows. Your cholesterol levels are checked in a routine blood test called a lipid panel. If you do not have cardiovascular disease, your total level should be under 200 milligrams per deciliter (mg/dL), with LDL less than 100 mg/dL, and HDL (“good” cholesterol) 40 mg/dL or greater.

• Triglycerides These are fats that circulate in the blood, and—like LDL—they can contribute to plaque deposits in your arteries. Most experts recommend keeping fasting triglyceride levels (the level after you have fasted overnight) below 200 mg/dL.

• Blood sugar High blood sugar raises your risk for diabetes. If you already have diabetes, you’ll be familiar with the hemoglobin A1C test, which measures your average blood sugar control in the previous three months. While the American Diabetes Association recommends an A1C level of 7 percent for people with diabetes, 7.5 to 8 percent is considered a more reasonable goal for older adults.

The post Know Your Numbers appeared first on University Health News.

Diagnosing Kidney Disease

Diabetes is the top cause of kidney failure, causing nearly half of new cases. High blood pressure is the second most common cause of kidney failure, causing 28 percent of new cases; one in five adults with high blood pressure may have kidney disease.

Kidney disease is not reversible, but it is treatable. It’s important for your annual physical exam to include a blood test to evaluate kidney function, especially if you are older than age 60 and have high blood pressure, diabetes, a family history of kidney disease, an autoimmune disease, or a history of pre-eclampsia, which are all risk factors for kidney disease.

“Early detection is the key to effective long-term management,” says Line Malha, MD, Assistant Professor of Medicine, Division of Nephrology & Hypertension, Weill Cornell Medicine. Blood tests check how well kidneys are working by analyzing the glomerular filtration rate (GFR). Current guidelines say that a GFR below 60 for three months indicates chronic kidney disease (CKD). “We all lose kidney function as part of natural aging, but in people with kidney disease, the kidney function decline is faster,” says Dr. Malha.

Keeping Your Kidneys Healthy

Kidneys have several important jobs: They clean your blood, help control your blood pressure, help make red blood cells, and keep your bones healthy.

Focusing on these things can help keep your kidneys in tip-top shape:

Check your blood pressure. If it’s too high, that can put stress on your kidneys.

Watch your A1C. Keep your blood sugar levels in check. If they’re not under control, that can cause problems for your kidneys over time.

Drink water. Drinking water is a great way to keep your kidneys healthy. A word of caution, however: Drinking too much water can lead to low blood sodium levels, which can cause confusion, disorientation, nausea, and vomiting. If your urine is pale yellow or clear, it’s fine. If it’s dark yellow, you probably need more water.

Don’t Overdo NSAIDs. Prolonged use of NSAIDs can potentially damage the kidneys. NSAIDs, which include common medications like ibuprofen and naproxen, can reduce blood flow to the kidneys and may cause changes in fluid and electrolyte balance, leading to kidney dysfunction or damage over time.

Drug Treatment Options

Several types of medications are used to treat kidney disease. Since diabetes and hypertension are the two top causes of kidney disease, many medications used to treat kidney disease also treat these conditions. For example, hypertension drugs also used for kidney disease include:

• ACE inhibitors, such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), and enalapril (Vasotec)
• Angiotensin II receptor blockers (ARBs), such as telmisartan (Micardia) and losartan (Cozaar).

Medications originally formulated for diabetes, called SGLT2 inhibitors, including dapagliflozin (Farxiga) and empagliflozin (Jardiance), have also been approved by the FDA to help delay the worsening of CKD, and these drugs have the added benefit of lowering blood pressure. One of the newest medications approved for CKD is finerenone (Kerendia). This drug is used for treating CKD associated with type 2 diabetes. “These medications have all been shown to halt the progression of declining kidney function over time,” says Dr. Malha.

Maintaining Kidney Function

Kidney disease can often be prevented, and the progression to kidney failure can often be slowed or stopped. To maintain kidney health, follow up with your doctor and control your blood pressure and blood sugar levels,” says Dr. Malha.

The post To Maintain Kidney Health, Keep BP and Blood Sugar in Check appeared first on University Health News.

“Athero” What?

Athero comes from a Greek word for porridge or gruel. This colorful term refers to the plaque made up of cholesterol and other material that builds up inside your arteries (the blood vessels that carry oxygenated blood throughout your body).

As plaque builds up over time, the arteries get narrower, reducing the supply of blood to all parts of your body. The arteries also get stiffer. Sclerosis means “hardening.” Atherosclerosis is a type of arteriosclerosis which translates to “hardening of the arteries.”

The prevalence of atherosclerosis increases as we get older. In some cases, there is a genetic component. While we can’t do anything about age or genes, we do have some control over other risk factors that affect atherosclerotic plaque build-up, including blood levels of LDL (low-density lipoprotein) cholesterol, high blood pressure, type 2 diabetes, excess body weight, tobacco product use, physical inactivity, inadequate sleep, high levels of stress, and excessive alcohol intake.

Health Effects.

The health effects of atherosclerosis depend on where the plaque forms. For example, atherosclerosis in the arteries that supply blood to heart muscle can result in angina (chest pain, usually during exertion) and, eventually, heart attack.

Atherosclerosis that reduces blood supply to the kidney is known as renal artery stenosis. This condition can lead to reduced kidney function over time, cause high blood pressure, and, in severe cases, result in kidney failure.

Plaque buildup in the arteries that supply blood to your legs and arms is known as peripheral artery disease (PAD). PAD increases the risk of developing infections, sores, and death of tissue in the legs and arms, with extreme cases leading to loss of limbs. The most common symptom of PAD is pain in your arms and, more often, legs due to inadequate oxygen getting to the muscles. The pain typically starts with walking or exercise and goes away with rest. Symptoms aren’t usually obvious until an artery is over 60 percent blocked by plaque, so it’s important to address risk factors like high LDL cholesterol and high blood pressure well before the problem is obvious.

Atherosclerotic plaque build-up anywhere in the body can rupture and trigger the formation of a blood clot, known as a thrombus, which can block blood flow, and therefore delivery of oxygen and nutrients to tissues. Blood clots that block blood flow in the arteries that nourish the heart cause a heart attack, and those in the brain cause a stroke. Blood clots that block the arms or legs are called deep vein thrombosis and can cause complications,including inflammation of the vein (phlebitis), leg ulcers, and blood clots that travel to the lungs (pulmonary embolism).

Atherosclerosis is also a contributor to high blood pressure. As plaque builds up in arteries they stiffen. They are less able to stretch when the heart pushes blood into them with each heartbeat. This increases blood pressure.

For more information, see Conditions Related to Atherosclerosis.

Impact of Dietary Intake.

A healthy dietary pattern can help prevent, manage, and even reverse high blood levels of LDL cholesterol, high blood pressure, and other diet-related risk factors for atherosclerosis, like type 2 diabetes and excess body weight.

“The main component of arterial plaque is the cholesterol that comes from low-density lipoprotein (LDL),” says Alice H. Lichtenstein, DSc, senior scientist and director of the Cardiovascular Nutrition Team at the Human Nutrition Research Center on Aging and editor-in-chief of this newsletter. “Achieving and maintaining blood LDL cholesterol levels in the healthy range (with diet or, when necessary, medication) is essential.” To reduce LDL cholesterol levels, the major focus should be on replacing saturated fats from foods like red meats (beef, lamb, pork, venison); processed meats (deli meats, bacon, sausage, jerky, hot dogs); and butter and full fat dairy products with healthy unsaturated fats from plant sources like nuts, seeds, plant oils (such as soybean, olive, canola, corn, and sunflower), and avocados and increasing dietary fiber from fruits, vegetables, beans, and whole grains.

If you have high blood pressure, decrease the amount of salt (sodium) you consume and ensure you’re getting enough potassium by including plenty of fruits and vegetables in your diet. In general, choose unprocessed or minimally processed fruits, vegetables, legumes, nuts/seeds, whole grains, low-fat and fat free dairy, seafood, poultry, lean cuts of red meat, and liquid plant oils, and minimize ultraprocessed foods, salt/sodium, added sugars, and alcohol.

Shifting to a more plant-based diet can help reach LDL cholesterol and blood pressure goals. If plant-based meals are new to you, start with one vegetarian or vegan dinner a week, and build up a collection of favorite recipes. Look for recipes that feature beans, lentils, or tofu, plenty of vegetables, and whole grains rather than using ultraprocessed plantbased meat substitutes. Avoid recipes with lots of cheese or cream.

Beyond diet quality, avoid tobacco, meet physical activity guidelines of 150 minutes of weekly moderate-intensity activity, work to reduce excess body weight, get adequate sleep (seven to nine hours a night), and manage stress (building in time for things you enjoy such as reading, meditation, dancing, deep breathing, or other relaxing pursuits can help).

Since atherosclerosis is the main cause of cardiovascular disease (CVD), the American Heart Association (AHA) has published evidence-based dietary guidance to improve cardiovascular health. (Lichtenstein was co-lead author of this statement.) These recommendations can help control many of the risk factors that cause atherosclerosis (See 10 Diet Tips to Improve Cardiovascular Health).

“Even for someone at elevated risk of developing atherosclerosis due to genetic factors, adopting a healthy lifestyle is associated with lower risk of having a cardiovascular event,” says Lichtenstein, “and it is never too late to start!”

The post Understanding Atherosclerosis 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.

A: Because aspects of working memory and short-term memory overlap, they are sometimes used interchangeably. But, generally, they are thought of as two distinct types of memory. Short-term memory is, as the term implies, information that is held on to for a very brief amount of time. Some sci­entists suggest that information stored in short-term memory may last for 30 seconds or less. You might overhear a bit of conver­sation in a crowded restaurant, but unless what is said is of particular interest, the information will soon be gone from your memory. Information in working memory tends to last a little longer—perhaps several minutes or more. But the main distinction is that information in your working memory is there to be applied or manipulated, such as the instructions to complete a task. Short­term memory usually just refers to the brief storage of small amounts of information not meant for further use.

Q: Is masked hypertension the opposite of white-coat hypertension, and are they equally dangerous?

A: Both conditions can raise the risk of stroke, heart disease, and injury to the brain and other organs. In simple terms, masked hypertension is high blood pressure that is not apparent during a doctor’s appointment, though you may have high blood pressure at other times. White-coat hypertension is high blood pressure that can be measured at the doctor’s office, but does not register with home or ambulatory monitoring. Research suggests that masked hypertension carries the same risk as sustained (“unmasked”) high blood pressure, whether or not you are being treated for hypertension. However, white-coat hypertension is more of a risk factor for people who are untreated compared with those are being treated for high blood pressure. White-coat hypertension is often attributed to increased stress that accompanies a doctor appointment. The likely causes of masked hypertension aren’t as well understood.

Q: My mother died nearly two years ago, and my 81-year-old father has been sad and grieving ever since. I’ve also noticed his memory and judgment seem to be changing. Could that be depression, early demen­tia, both?

A: There is no typical timeline for grieving or for how much it might impact a person’s mood and cognition. While grief often lasts a few months before a person can start to move on, it’s not unusual for a widower or widow to experience prolonged grief. How­ever, long-term grief can lead to depression, especially in older adults. People experience depression differently, which means that symptoms can differ somewhat from one person to another. Persistent sadness is cer­tainly a common characteristic of depres­sion, but depression can also trigger problems with memory, decision-making, and other thinking skills—especially among older adults. As to your question, it’s impor­tant to understand that, among older adults, symptoms of depression and dementia can overlap. This sometimes makes it more chal­lenging to arrive at a precise diagnosis. If your father hasn’t seen a mental health pro­fessional yet, consider accompanying him to grief counseling or to see a therapist who specializes in helping older adults. If the memory changes are especially concerning, and perhaps affecting his daily functioning, you may want to talk with your father’s pri­mary care physician about cognitive testing or see a neurologist or neuropsychologist for a more comprehensive screening.

The post Ask the Doctor January 2024 appeared first on University Health News.

Triggering Factors

There are many reasons why these heart events may occur during the holidays. Key contributors include:

Overindulgence: From cookies and cakes to creamy string bean casseroles and eggnog, holiday feasts abound in fatty options. Overconsuming these items can lead to increased blood pressure, a leading risk factor for stroke. While a little indulgence isn’t health harming, it can be difficult to be disciplined around the holidays. You can thwart this process by choosing smaller portions and not going to festivities hungry. If you have high blood pressure, be sure to take blood pressure medications as prescribed, and monitor your blood pressure as advised by your doctor.

Increased Alcohol Consumption: Many people toast to the holidays with alcohol. It’s not usually a problem if you have one or two. But one consequence overimbibing is that it can trigger atrial fibrillation, increasing the risk for stroke. Alcohol can also negatively interact with medications and raise blood pressure. According to guidelines from Centers for Disease Control and Prevention (CDC), men should not have more than two drinks per day and women no more than one drink per day. Obviously, that can be difficult during the holidays. Try alternating alcoholic beverages with nonalcoholic choices. Also, avoid drinking on an empty stomach because you’ll feel the effects faster, which can lower inhibitions and hence your ability to manage your drinking.

Physical Inactivity: Colder weather and holiday activities might mean that some people are less active. Physical activity is crucial for maintaining cardiovascular health and reducing stroke risk. If you don’t yet have an exercise buddy, establish one. Exercise buddies can keep each other accountable, even if they are not together during the holidays. A daily motivational text exchange can be helpful. If you are traveling, there are many streaming options available on demand online that can help you stay on track. From dancing and marching in place to doing some yoga, several short 10-minute bursts of activity throughout the day count toward the minimum recommendation to exercise 30 minutes per day, five days per week.

Snow and Cold: In colder regions the drop in temperature can lead to vasoconstriction (narrowing of blood vessels), which raises blood pressure. Moreover, cold weather can lead to more significant strain on the heart, especially in those who are not accustomed to heavy physical activity, such as shoveling snow. If you are shoveling, it’s best to push the snow to the side rather than lift it, whenever possible. If you are lifting, don’t lift a full shovel, keep it light, bend at your knees to limit stress on your back, and avoid twisting motions.

Contrasting Emotions

As we age, life’s challenges, from the loss of loved ones to health concerns, can make the holidays an especially vulnerable time. Anxiety and depression can escalate due to grief, challenging interpersonal relationships, and financial strains. “Anxiety and depression may stem from various causes, but ultimately they can increase stroke risk,” says Dr. Shahid. “Sometimes when patients are depressed, they don’t take their medications, including those medications that may prevent a stroke. Anxiety and stress also can elevate cortisol levels, which is also linked to increased stroke risk.”

Whether you are a guest or a host, remember that the true spirit of the season is to enjoy each other’s company. Not everything has to be perfect or expensive. And it is OK to say no to an invitation or leave a party early if you are feeling overwhelmed. If certain topics or discussions tend to create conflict, especially in family gatherings, try to steer clear of them or approach them with a plan in mind. For example, some hosts ask that race, religion, and politics not be discussed at the table.

Be Aware of TIAs

TIA is an acronym for transient ischemic attack. It means that someone has had a stroke, but it was brief and has resolved. “A TIA is sometimes referred to as a “mini stroke” since it does not cause permanent damage,” says Dr. Shahid. However, it is critical to go to the hospital if you or a loved one suspects you have had a TIA. This is because a TIA is a warning sign. If a TIA is not managed immediately, it could be followed by a major stroke within hours or days. About 50% of patients who have a TIA will have a stroke within the next year, and there are many things we can do to prevent this from happening.”

The symptoms of a TIA are like those found early in a stroke and can include a sudden experience of:

• Weakness, numbness or paralysis in the face, arm, or leg, typically on one side of the body.

• Slurred or garbled speech or difficulty understanding others.

• Blindness in one or both eyes or double vision.

“As soon as you notice symptoms, you should call 911 because as time passes more brain cells are being damaged,” explains Dr. Shahid. “There are certain therapies we can only offer if a patient comes to the hospital within a certain time. When in doubt, call 911 and ask for help.”

© erhui1979 | Getty Images
If you suspect a stroke, call 911 immediately.

Time Is Brain

Some people may hesitate to seek medical care during the holidays due to disruptions in their routine, not wanting to disturb the festivities, or because of potential holiday closures of local clinics. But know that delays in treatment can be detrimental for conditions like stroke, where timely intervention is crucial. The phrase “time is brain” emphasizes the urgent need to diagnose and treat strokes, as the longer brain tissue goes without oxygen, the more damage occurs.

The basic idea is that with each passing minute during an acute ischemic stroke (where blood flow to a part of the brain is blocked), an estimated 1.9 million brain cells (neurons) are lost. This can lead to permanent brain damage, disability, or even death. Quick intervention, often with clot-busting drugs or endovascular procedures, can restore blood flow to the brain and prevent or minimize this damage.

Treatment and Prevention

Once the immediate crisis has passed, the focus shifts to preventing another stroke. This might include blood pressure medications, cholesterol drugs, anticoagulants, or antiplatelet agents; lifestyle changes such as a heart-healthy diet, regular exercise, not smoking, limiting alcohol, and managing underlying conditions like diabetes.

While many factors can increase stroke risk around the holidays, it’s essential to remember that risk factors for stroke are present year-round. According to the CDC every 40 seconds, someone in the United States has a stroke. Every 3 minutes and 14 seconds, someone dies of stroke. As dire as these statistics are research also shows that about 80% of strokes are preventable.

Your daily actions accumulate, and they matter. Maintaining a healthy lifestyle, managing stress, adhering to prescribed medications, and having regular check-ups can reduce your stroke risk and help mitigate other diseases as well.

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Metabolic Syndrome.

Metabolic syndrome is not a disease or condition of its own, but a cluster of factors that indicate you are at increased risk for type 2 diabetes, heart disease, heart attack, stroke, and a circulation problem called peripheral vascular disease. “Metabolic syndrome is defined by some basic clinical factors your healthcare provider can measure at a regular checkup,” says Richard D. Siegel, MD, co-director of the Diabetes and Lipid Center at Tufts Medical Center. “These are blood pressure, waist circumference, and blood concentrations of fasting triglycerides, glucose, and HDL cholesterol. If any three of these five criteria are outside the desired range, you have metabolic syndrome. The more factors you have, the higher your risk for disease. Treating the conditions that make up metabolic syndrome with lifestyle changes and medications (as necessary) can help you avoid serious outcomes.”

Metabolic syndrome is increasingly referred to as insulin resistance syndrome. Insulin is a hormone produced by the pancreas that causes glucose (sugar) to move from the blood into cells where it is used for energy or stored. Sometimes the cells become resistant to insulin’s signals. “People with metabolic syndrome tend to have higher levels of insulin in their blood than people who don’t have the syndrome,” says Siegel, “even if their glucose levels are relatively normal.” This indicates insulin resistance, which is a step on the way to type 2 diabetes.

The Factors.

Having any three of the five factors described in this section indicates you have metabolic syndrome and are at increased risk for type 2 diabetes, heart disease, heart attack, stroke, and peripheral artery disease. Let’s take a closer look:

1 A large waistline

Cutoff: Women—waist circumference over 35 inches. Men—waist circumference over 40 inches. “These measurements are best applied to people of European descent,” says Siegel. “People of other backgrounds, such as those of Asian heritage, may have lower cutoffs.”

Why it’s a factor: Most of our body fat is padding under the surface of our skin. Extra fat in your stomach area, however, is often an indicator of visceral fat, fat that wraps around the organs, including the liver. “Visceral fat and insulin resistance tend to go together,” says Siegel.

Research has found amount of visceral fat is correlated with the amount of fat in the liver. The liver plays an important role in regulating blood sugar levels, and fat in the liver (nonalcoholic fatty liver disease, or NAFLD) has been associated with increased risk for insulin resistance. (For more information on NAFLD, see our May 2023 issue.) Extra body fat (particularly belly fat) contributes to an increase in systemic inflammation, a factor also related to elevated risk for type 2 diabetes, heart disease, heart attack, stroke, and peripheral vascular disease.

Extra fat in your mid-section, therefore, is a bigger risk factor for heart disease and type 2 diabetes than extra fat in other parts of your body.

Diagnosis: This measure is not currently a typical part of health check-ups, but that may be changing. You can easily measure your waist circumference at home with a flexible tape measure. Place the tape measure midway between the top of your hip bone and the bottom of your ribs, in line with your belly button.

2 High blood pressure (hypertension)

Cutoff: Higher number over 130 mm Hg or lower number over 80.

Why it’s a factor: High blood pressure can damage the lining of your blood vessels, paving the way for the development of plaque, a cholesterol-rich substance that narrows and stiffens your arteries (a condition called atherosclerosis). Plaque buildup in arteries leading to the heart can cause angina (chest pain). Plaque in the arteries leading to the brain contributes to the development of dementia. When enough builds up, plaque can eventually block blood flow, causing a heart attack or stroke.

Diagnosis: A healthcare provider can take your blood pressure. Monitors are available for home use, but not all models are good choices. Ask your healthcare provider or pharmacist for advice or go to validatebp.org to find the best options.

Healthy individuals 18 to 39 years old should have their blood pressure checked at least every 3 to 5 years. Those 40 or older should be checked at least annually. If you have high blood pressure, follow the recommendation of your healthcare provider. (See September 2023 issues for more information.)

3 High blood sugar levels

Cutoff: Fasting blood glucose over 100 mg/dl. (This level is the start of the “prediabetes” range.)

Why it’s a factor: High blood sugar is directly related to insulin resistance. If cells become less responsive to insulin, the pancreas churns out more in an effort to get glucose into the cells that need it for energy. If there comes a time when the pancreas can’t keep up or the cells become too unresponsive, glucose builds up in the blood, leading to high blood sugar and, eventually, type 2 diabetes if the condition is not addressed with lifestyle changes.

Diabetes has a strong correlation with cardiovascular disease. Both type 1 and type 2 are known to increase risk for atherosclerosis and speed up its progression through a variety of mechanisms.

Diagnosis: Your fasting blood sugar levels should be checked regularly (once every year or two, depending on your age and other risk factors) using a blood test (this means you will need to abstain from eating or drinking anything but water for eight to 12 hours before your blood is drawn). Another measure typically tested at the same time is hemoglobin A1c (Hb A1c). This gives you and your healthcare provider an idea of your blood sugar levels over the past three months. Healthy people should have this blood test every three years or so. Those diagnosed with prediabetes should be tested at least yearly. If you have type 2 diabetes, follow the recommendations of your healthcare provider.

4 High blood triglyceride levels

Cutoff: Fasting triglyceride level of 150 mg/dL or higher.

Why it’s a factor: Triglycerides are a type of fat. They are in the foods we eat, but our body also makes triglicerides from excess calories and stores them as body fat. Refined carbohydrates particularly increase blood triglyceride levels. A high blood triglyceride level contributes to the development of atherosclerosis.

Diagnosis: Blood concentrations of triglyceride are measured as part the standard fasting blood test called a lipid panel which also measure total, LDL, and HDL cholesterol levels. Younger adults should have this blood test done every five years; men aged 45 to 65 and women aged 55 to 65 every one to two years; and adults over 65, annually.

5 Low HDL (“good”) cholesterol levels

Cutoff: Males, under 40 mg/dL. Females, under 50 mg/dL.

Why it’s a factor: Whereas “bad” low density lipoproteins (LDL) deliver cholesterol to your blood vessels, high density lipoproteins (HDL), known as “good” cholesterol, remove cholesterol from your blood vessels. Higher concentrations of HDL cholesterol in the blood are considered protective against atherosclerosis and cardiovascular disease.

Diagnosis: Like triglyceride, HDL levels are measured with a lipid panel. (See the section on triglyceride above for recommended frequency of testing.)

These conditions are all connected to each other, so when you have one, you are more likely to have or develop the others. “Having three of the five conditions counts as metabolic syndrome,” says Siegel, “but if you have two and have other risk factors, you need to consider that you may be at increased risk for cardiovascular disease and type 2 diabetes. Fat in the liver and elevations in blood levels of uric acid, leptin, or a clotting factor called PAI-1 are all minor criteria your healthcare provider may consider when evaluating your risk.”

It’s interesting to note that body mass index (BMI) is not part of metabolic syndrome. “BMI tends to track with total fat,” says Siegel, “but it may not be the best measure of risk for future disease.”

What to Do.

Working on improving your diet quality, increasing physical activity, and losing excess fat can lower your chances of developing all of the factors that make up metabolic syndrome, and therefore type 2 diabetes and cardiovascular disease. These same changes can also improve each of these factors if you already have them. For ways to take action, see the Take Charge! box.

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“The majority of patients with diabetes, about 70%, will die from heart disease rather than diabetes itself,” explains cardiologist Marwah Shahid, MD, UCLA Division of Cardiology. “People with diabetes are more likely to have high blood pressure, high cholesterol levels, and heart failure. This is why if you have diabetes, you should ask your doctor to screen you for heart disease as well.”

Diabetes and Heart Disease Connections

The connection between the two conditions stems from various factors, including:

Elevated blood sugar levels: In diabetes, the body either doesn’t produce enough insulin or cannot effectively use the insulin it produces. This leads to high blood sugar levels. Over time, elevated blood sugar levels can damage blood vessels and the lining of the arteries, promoting the development of atherosclerosis (hardening and narrowing of the arteries). Atherosclerosis is a primary cause of heart disease.

Increased risk factors: Diabetes is often accompanied by other risk factors for heart disease, such as high blood pressure, high cholesterol levels (especially elevated levels of LDL cholesterol, often referred to as “bad” cholesterol), and obesity. These factors contribute to the progression of atherosclerosis and the increased likelihood of heart disease.

Diabetic complications: Diabetes can lead to several complications that impact the cardiovascular system. For instance, peripheral artery disease (PAD) can occur, which involves the narrowing of blood vessels supplying the legs and feet. Additionally, diabetic neuropathy (nerve damage) can affect the nerves controlling the heart and blood vessels, impairing their function.

Inflammation and oxidative stress: Chronic inflammation and oxidative stress, both of which are associated with diabetes, can further damage blood vessels and promote the development of atherosclerosis. Inflammatory markers and free radicals contribute to the initiation and progression of cardiovascular disease.

Poorly controlled diabetes: If diabetes is poorly managed, with consistently high blood sugar levels, the risk of heart disease increases even further. It highlights the importance of proper diabetes management, including lifestyle modifications, medication adherence, and regular monitoring.

Treatments for Both Conditions

If you have diabetes or are at a heightened risk, it is crucial to take proactive measures to prevent heart disease due to the strong connections between the two conditions. “Improving your lifestyle has immeasurable benefits and will help improve your diabetes control and your heart,” says Dr. Shahid. “The majority of lifestyle interventions, including quitting smoking, engaging in moderate exercise at least three times a week, and focusing on a diabetic and heart-healthy diet, are fundamental for anyone with either diabetes or heart disease, and critical for those people with both.”

There also are medications that can treat both conditions. You may have seen television commercials advertising these claims.

“We have incredibly powerful medications that can help us manage and even reverse our diabetes and heart disease,” says Dr. Shahid. “Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) can help with both conditions. This class of medications, which includes Jardiance, works at the kidneys and blocks the reabsorption of sodium and glucose back into the body. This helps lower blood sugar levels for patients with diabetes and prevents the accumulation of sodium, a key component of heart failure management.”

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In addition to lifestyle changes, there are medications that treat both diabetes and heart disease. However, they may not be right for everyone.

Dr. Shahid further explains that some people only with heart failure or diabetes may be on these types of medications because they work so well. However, these medications do not treat all types of heart disease. There are several different types of heart disease that are linked to diabetes, and you may need additional medication to help treat and manage those other types (e.g., statins to lower cholesterol).

“The ideal patient for an SGLT2 inhibitor is generally younger than age 65, has normal kidney function, and may be overweight, have high blood pressure and heart failure,” Dr. Shahid explains.” We tend to avoid giving these medications to patient with type 1 diabetes or those who have type 2 diabetes with poor blood sugar control. We also avoid these medications in patients who have poor kidney function, since the medications work at the level of the kidney, as well as those who are at risk of frequent urinary tract or perineal infections.”

In addition, she says that glucagon-like peptide 1 (a.k.a. GLP-1) class medications (e.g., Trulicity, Ozempic) are typically for people with diabetes when the primary goal is weight loss,

as well as in people with risk factors for coronary artery disease. There has been more hype in the media about “off-label” use of GLP-1s for weight loss. These medications are not FDA approved for weight loss only and should not be used in those without diabetes. Furthermore, these medications are avoided in those who have reduced kidney function and a history of gastric surgery, gastroparesis, pancreatitis, or certain types of familial cancers.

If you have diabetes, it’s wise to see your doctor regularly, especially when starting any new medications. Periodic checkups allow health-care providers to assess the effectiveness of the prescribed medications, adjust dosages if necessary, and address any potential side effects or interactions with other medications.

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