Acute vs. Chronic.

Under acute stress, you may feel a jolt of energy and notice your visual focus and thinking sharpen and your motivation increase. You are faster and stronger, and even your immune system is primed for action. When this moment of acute stress passes, your vital signs (and everything else) return to normal.

Chronic stress is different. If you’re under continuous stress for long stretches of time, such as from a high stress job, financial insecurity, living in fear of violence, or caring for a chronically ill loved one without adequate support, your body never gets the chance to return to baseline.

Health Impacts.

Long-term exposure to stress affects your whole body. It may increase your risk for health problems including high blood pressure, heart attack, stroke, type 2 diabetes, and mental health issues like depression, anxiety, and addiction. See “Possible Health Effects of Chronic Stress” for more information.

Day-to-day symptoms of chronic stress, such as trouble concentrating, crankiness, changes in appetite, fatigue, insomnia, and turning to mind-altering substances for relief, can interfere with productivity and relationships and add to the negative health impacts of chronic stress.

Managing Stress.

If you are feeling stressed a lot of the time, it’s important to identify the source and find healthy ways to reduce or relieve that stress (and avoid unhealthy ways, such as overeating, smoking, illicit drug use, or excessive alcohol consumption). If you can directly address the source of your stress (by discussing job responsibilities with management, for example), do so. If this is not possible, take steps to manage the stress in your life with the tips in the “Take Charge!” box. Your whole body will thank you!

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On the Increase

A study presented at the 2024 Annual Meeting of the American Academy of Orthopedic Surgeons in February pointed to a significant rise in sports-related injuries over the two-decade follow-up period, with the injury rate increasing from 55,684 in 2012 to 93,221 in 2021. The data also suggested that cycling increased in popularity between 2012 and 2021. Another recent study (BMC Geriatrics, May 27) looked at data collected from 1,109 older adults who sustained a fracture and visited a trauma center between June 2020 and July 2023. Among the participants, 144 had suffered a fracture while engaged in sports. The analysis showed that the average age of people who suffered a sports-related fracture was 74. “Sports-related fractures were most likely to happen outdoors, with men particularly susceptible,” Dr. Bloom says. “This fits with previous studies indicating that older men are more likely to participate in sports compared with older women.”

Specific Sports More Risky

In the BMC Geriatrics study, the sports most likely to be associated with fractures were outdoor walking intended as exercise (as opposed to more leisurely walking to get from one place to another), cycling, and mountain hiking, all of

which were linked with lower-extremity fractures. Having an underlying disease, such as diabetes, high blood pressure, or a heart condition, did not increase the risk of injuries. “Suffering a stroke lowered the risk,” Dr. Bloom observes. “The lower risk may reflect the fact that stroke often is followed by a decrease in muscle strength. This may limit a person’s ability to participate in sports.”

Many Benefits

Dr. Bloom says it is wonderful that more older people are getting involved in sports, since there is much trial evidence underlining the benefits of vigorous physical activity. It boosts cardiovascular health, slows age-related loss of muscle mass and bone density, can reduce your risk of falls by improving your balance, eases stress, helps you sleep better, and limits weight gain. Research also has linked high levels of physical activity with better brain function in older age. “Another great thing about sports is that many of them are sociable activities: You can walk, cycle, and play pickleball or other racket sports with friends,” Dr. Bloom adds. “It’s vital to maintain those social connections as you get older, since studies have suggested that social interaction may confer protection against cognitive impairment.”

But these data also highlight the risks associated with sports—and Dr. Bloom cautions that they also likely underestimate injury rates. “Many people who sustain sprains, strains, and lacerations while playing sports often seek medical care from their primary-care doctor or a local walk-in clinic instead of attending emergency departments and trauma centers,” she says. The data also suggest that older adults are participating in a wider variety of sports and/or participating in sports that are more likely to result in injury, especially if they require a level of strength, agility and balance that you don’t have. “It would be interesting to see data that includes an assessment of the participants’ degree of mobility and individual skill level along with other factors that may contribute to injury, such as weather conditions and whether someone was wearing suitable shoes and protective clothing,” Dr. Bloom says.

Pace Yourself

Staying safe while engaged in sports starts with managing your expectations when it comes to how much you can still do. The heart and lungs work less efficiently in older age, so less oxygen is transferred to the blood. Appetite decreases, meaning that most older adults eat less than they should. As a result of these changes, endurance, muscle mass and strength decline as you age. Your balance also may be affected by age, particularly if you have vision or hearing issues or take certain medications (including some blood pressure drugs). These factors don’t mean that you cannot or should not continue to enjoy the sports you’ve always loved, but you may have to slow down slightly to conserve your energy and avoid fatigue. One thing you might want to try is alternating between vigorous sports, such as pickleball or tennis one day and more leisurely options, such as golf, the next.

Starting from Sedentary

If you’ve been leading a sedentary life and/or have chronic underlying health issues, it’s particularly important to objectively assess your fitness level before taking up a sport. “If you need help doing this, ask your doctor to refer you to a physical therapist who can work out a safe sports regimen for you,” Dr. Bloom says. “You also might want to consult a personal trainer who works with older adults—your local gym or senior center may be able to recommend one.” Be patient—instead of launching yourself into your chosen sport, you may need to gradually build up your strength and cardiovascular fitness levels, perhaps by starting a walking program and pushing yourself farther and faster over time.

If you want to try a new sport, find out about it. “You’ll need background information about whether it’s important to wear special types of footwear, a helmet, and/or safety goggles, about the level of endurance and/or agility the sport requires, whether it’s a sport that involves rapid acceleration and deceleration and relies on you having good balance,” Dr. Bloom says. “Even if you’re very fit and want to challenge yourself, you don’t want to risk injuries that might have been highly preventable with a bit of preparation.” See What You Can Do for other strategies that will help you stay safe while playing sports.

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This isn’t the first study to point to links between stroke and dementia—in fact, up to 60 percent of stroke survivors develop some degree of post-stroke cognitive impairment, according to the ASA. Laura K. Stein, MD, MPH, associate professor of neurology at Mount Sinai, says the link underlines the importance of monitoring stroke survivors for cognitive decline and educating people about strategies that may confer protection against stroke and dementia.

First-Year Risk Greatest

For the study, a Canadian research team matched 180,940 people who had suffered a recent ischemic stroke (caused by a blood clot) or an intracerebral hemorrhage (caused by bleeding within the brain) with two control groups, one including people from the general population who had not had a heart attack or stroke, and the other including people who had suffered a heart attack but not a stroke. The researchers evaluated the rate of new cases of dementia starting at 90 days after a stroke, over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after a stroke and over time, up to 20 years.

The analysis showed that the risk of dementia was greatest in the first year after a stroke, with a nearly threefold

increased risk. The risk halved by the five-year mark but remained elevated 20 years later. Dementia occurred in nearly 19 percent of stroke survivors over an average follow-up of 5.5 years. After accounting for dementia risk factors such as high blood pressure, diabetes, and high cholesterol, the risk of dementia was 80 percent greater in stroke survivors compared with people who had not experienced a heart attack or stroke. A similar increase in risk was seen in stroke survivors compared with people who had experienced a heart attack. The risk of dementia in people who had suffered an intracerebral hemorrhage (bleeding in the brain) was nearly one-and-a-half times greater than those in the general population.

Small-Vessel Disease Implicated

While there still is much we don’t undertand about the connection between stroke and dementia, Dr. Stein says we are learning more about the association between vascular health and brain health. “Researchers have recently identified the importance of the ‘neurovasculome’—a fancy term for the brain’s blood vessels, cells, and lymphatic system—to overall brain health and optimal cognition,” she says. “We know there is an association between dementia and damage to the small blood vessels of the brain, and there is evidence that cognitive outcomes may be better in people whose blood pressure is more aggressively treated.” She adds that damage from a stroke can damage brain structures and the connections between them, as well as the neurovasculome, and notes that this damage is especially likely in a brain with pre-existing susceptibility due to small-vessel disease and lower reserve (essentially the brain’s capacity to withstand harm). “In people with these vulnerabilities, a smaller stroke may have a greater impact than a larger stroke would in someone with greater baseline brain reserve,” she explains.

Post-Stroke Cognitive Screening Is Vital

While people with mild post-stroke cognitive impairment may recover fully, an improvement in cognitive impairment without a return to pre-stroke levels is more likely. Persistent impairment may be too mild to warrant a diagnosis of dementia, but still can affect your independence and quality of life after a stroke. This means it is important for stroke survivors to be evaluated for cognitive decline—indeed, a 2023 American Heart Association scientific statement recommends post-stroke cognitive screenings. If you are a stroke survivor and have not been screened for cognitive impairment, Dr. Stein recommends you discuss screening with your doctor. “Screening is especially important if someone is not meeting expected post-stroke milestones and may identify potentially reversible contributors to cognitive impairment,” she says. Possible contributing factors include depression, abnormal electrolytes (minerals that affect numerous body functions), thyroid disorders, low levels of vitamin B₁₂, and medication side effects. “Even if a reversible cause of cognitive impairment following stroke is not identified, a thorough cognitive evaluation can help an individual understand their cognitive strengths and weaknesses, identify areas for lifestyle modification and targeted cognitive therapy, and plan for the future,” Dr. Stein adds.

Safeguard Yourself Against Stroke

There is evidence to support that more severe and recurrent strokes are more strongly associated with post-stroke dementia. “This means that one of the most important things we can all do for our brain health is to identify and aggressively treat risk factors for stroke,” Dr. Stein emphasizes. These include high blood pressure, high cholesterol levels, the abnormal heart rhythm atrial fibrillation, diabetes, obesity, and smoking. Research suggests that having three or more cardiovascular risk factors may increase the risk of post-stroke dementia in older adults and has indicated that diabetes and atrial fibrillation may be particularly influential. See this month’s From the Editor for strategies to manage these risk factors.

Also be aware of symptoms that may indicate a stroke, including sudden problems with your balance and/or coordination, blurred vision or loss of vision, drooping on one side of the face, numbness/weakness in one arm, and slurred or incoherent speech. “Time is brain, and you should immediately call 911 if you think you or someone you know could be experiencing a stroke,” Dr. Stein concludes.

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The Centers for Disease Control and Prevention (CDC) recommend that all Americans over the age of six months get an updated COVID-19 vaccine when these become available this fall. By now, nearly all Americans have had a COVID infection, gotten a COVID vaccine, or both, but the updated vaccines offer a timely boost as immunity wanes and the virus continues to mutate. While mutations are thought to help COVID variants evade immune defenses and spread faster, there is no evidence they cause more severe illness. Even so, people ages 65 and older remain at great risk of COVID-related complications—they account for two-thirds of COVID hospitalizations and 82 percent of in-hospital deaths, according to the CDC. Only about 40 percent of Americans in that age group were immunized with the COVID vaccines that were offered last fall. You can visit the CDC’s dedicated COVID vaccine website for more information (http://tiny.cc/CDCCovid).

Plant-Based Meats May Reduce Cardiovascular Disease Risk

Plant-based meat alternatives often are marketed as being low in harmful saturated fat compared with “real” meat—however, up to now it hasn’t been clear if the products reduce the risk of cardiovascular disease. A recent review from researchers at the University of British Columbia, in Vancouver, suggests that they do even though they are classified as ultra-processed foods. The review (Canadian Journal of Cardiology, June 25) looked at studies published from 1970 to 2023, and found that cardiovascular risk factors like total cholesterol, LDL (“bad”) cholesterol, and body weight all improved when people substituted plant-based meat alternatives for real meat in their diets. Compared with real meat, plant-based meat products tend to be higher in sodium, which contributes to high blood pressure. However, the review did not find that the meat substitutes raised blood pressure.

Ultra-Processed Food Harms

A recent study underlines the mortality risks associated with diets that are high in ultra-processed foods. The National Cancer Institute study looked at data from more than 540,000 people who provided information about their eating habits and health in the mid-1990s, when they were ages 50 to 71. Over half of the participants have since died. The researchers analyzed overall rates of death among those who were in the 90th percentile for consumption of ultra-processed foods at the start of the study versus those in the 10th percentile. Processed foods were defined according to a standard classification system, and included deli meats, snacks, ready meals, fast foods, and soft drinks. People who ate the greatest amounts of ultra-processed foods over the median 23-year follow-up were 10 percent more likely to die early than those who ate the least. The study was presented at the annual meeting of the American Society for Nutrition in June.

Stroke Mortality Worse for Black People

Overall rates of long-term survival following stroke are getting better—but not for Black people, according to a new University of Cincinnati study (Neurology, July 15). Researchers identified 8,428 cases of ischemic stroke (the type caused by a blood clot) and 1,501 cases of intracerebral hemorrhage (a less common and more severe type of stroke caused by bleeding in the brain). Among participants with ischemic stroke, five-year survival decreased from 53 percent in 1993-94 to 48 percent in 2015. There were no changes in five-year survival following an intracerebral hemorrhage. While the overall numbers improved, Black study participants were found to be 20 percent more likely to die within five years after an ischemic stroke than white people. Long-term social, economic and environmental inequities likely contribute to the disparity. See this month’s From the Editor for stroke-prevention advice.

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You may not be able to eradicate all of your individual stroke risk factors, but you likely can mitigate some of them enough to significantly reduce your chance of suffering a stroke. Along with any medications you may be prescribed to lower your blood pressure, cholesterol, and blood sugar, a healthy diet and plenty of exercise are cornerstones of stroke prevention. Eat plenty of fruits, vegetables, and whole grains, and substitute fish and poultry for red meat. Cut back on your salt intake, since too much salt raises blood pressure. Get at least 30 minutes of physical activity each day (you can break this up into smaller segments). If you’ve already had a stroke, eating more healthfully can help prevent another, and exercise can help you regain your cardiovascular fitness and cognitive function, as well as combat the depression that often follows stroke. Stroke rehabilitation programs focus closely on diet and exercise, so ask your doctor to refer you to one of these programs if he or she has not already done so.

Another crucial element of stroke protection is knowing the symptoms that can red-flag a stroke. The American Stroke Association recommends learning the “BE FAST” rubric:

• B for Balance. Do you have a sudden loss of balance or coordination? To check, walk in a straight line or touch your finger to your nose.

• E for Eyes. Are you noticing sudden vision changes, such as double vision, or loss of vision in one eye?

• F for Face drooping. Is there drooping or numbness on one side of your face? Is your smile uneven?

• A for Arm weakness. Look for weakness in one arm (raise both arms and see if one arm drifts downward).

• S for Speech difficulty. Is your speech slurred or otherwise hard to understand?

• T for Time to call 911. If you have any of the above symptoms, call 911.

Keep in mind that women may experience additional stroke symptoms, including confusion and disorientation, nausea and vomiting, and fatigue.

As our article emphasizes, time is brain. Recognizing possible stroke symptoms and seeking medical help immediately can make a huge difference to post-stroke function, since treatment with a clot-busting drug is most effective within 4.5 hours of symptom onset if your stroke is caused by a blood clot.

The post Address Your Stroke Risk appeared first on University Health News.

Dry Mouth

Dry mouth is not a normal part of aging, but it is a common concern for many older adults. Saliva is an unsung hero of digestion—it coats food particles with enzymes that initiate the breakdown of carbohydrates into smaller food molecules and moistens and softens food so that it is easier to swallow. Chewing stimulates saliva secretion from the salivary glands in the mouth, but your production of saliva can decrease in older age due to medications, including some drugs that treat high blood pressure and urinary incontinence; certain diseases, such as diabetes, Parkinson’s disease, and the autoimmune condition Sjogren’s syndrome (you are at greater risk for this if you have rheumatoid arthritis); and having had treatments for cancer, including radiation therapy. Environmental conditions, like dry heat, also can cause dry mouth.

Dry mouth is uncomfortable, and not having enough saliva to moisten food can make it more difficult to swallow. Dry mouth also increases the risk of tooth decay and other oral infections because another one of saliva’s primary jobs is to kill bacteria. For this reason, it is important to see your doctor or dentist to determine what might be causing dry mouth. Self-help measures include sucking on sugar-free lozenges or chewing sugarless gum to stimulate saliva production—you also may want to try Salivart, an “artificial saliva,” that is available over the counter at pharmacies. Avoid mouthwashes that contain alcohol, as these can worsen dryness.

Coughing While Eating

Coughing during a meal is a sign that you’re having to clear your throat while you eat or drink. You’re doing this to avoid aspirating food or fluids into your lungs.

Eating and breathing share space in the back of the throat, or pharynx (see image, right). Food enters the esophagus (the muscular tube that leads to the stomach) through the pharynx while air is diverted into the trachea (windpipe) and lungs. The epiglottis—a small flap of cartilage attached to the larynx—plays a key role in this process of diversion by staying open during breathing and closing during swallowing. You need intact neuromuscular reflexes for the epiglottis to function correctly, but with aging, some of these reflexes become less effective. They also may be impacted by esophageal dysphagia (difficulty swallowing food due to inflammation or narrowing of the esophagus), stroke, dementia, and Parkinson’s disease. The result is that it becomes easier for food and drinks to “go down the wrong pipe.” The coughing and sputtering that accompanies this is uncomfortable and embarrassing if it occurs when you are eating out. But aspiration also can cause inflammation of the lungs (pneumonitis), pneumonia, and choking, so it is important to get evaluated by an ear, nose and throat specialist if you think you may be aspirating food. Interventions that may help include exercises, dietary modifications, or adopting different eating positions.

Difficulty Taking Medication

Pill esophagitis, which is when a drug gets stuck in the esophagus, occurs more often in older adults and can cause inflammation, injury, and pain. You may be able to prevent it by taking medications with plenty of water, while sitting up—also avoid lying down for about 30 minutes afterward. If you’re still having trouble it may be possible to split pills in half, but check with your doctor or pharmacist, since some tablets should not be split. If you get the go-ahead, use a proper pill-splitter (you can purchase them at most pharmacies). If your medication comes

in capsule form only, or tablets cannot be safely split, ask your doctor or pharmacist if a liquid version of the drug is available. If none of these approaches help, you may need to see a specialist who can check that your esophagus is functioning correctly.

Can’t Go, Won’t Go

The frequency of bowel movements considered normal ranges from three times a day to three times a week. In general, bowel transit time—the time it takes for food to move through the digestive tract—is about three days. But if you have chronic constipation, transit time can increase to four to nine days, and, if you are bedridden, up to two weeks. This increase in transit time is common in older adults due to a decline in peristalsis (involuntary muscle contractions that propel food through the intestines). If peristalsis is sluggish, stool moves too slowly through the colon. Slow passage means that more water is absorbed from food, and this results in hard, dry stools that contribue to constipation.

If you frequently suffer from constipation, eating more fiber and drinking plenty of fluids will help your colon make bulkier stools that are easier to pass. Also get plenty of exercise, since this can help food move through the gastrointestinal tract. Whenever you have the urge to move your bowels, go to the bathroom. Ignoring the urge allows stool to remain in the colon for longer and this means that more water will be absorbed from it, resulting in hard stools that are more difficult to expel. Also try to have a bowel movement after you’ve eaten a meal. After you eat, your stomach stretches, triggering what is known as the gastrocolic reflex. This reflex increases the movement of ingested food toward the rectum, increasing rectal pressure and stimulating a bowel movement.

If these measures don’t bring relief, ask your doctor if an undiagnosed health condition (for example, untreated thyroid disease—see last month’s issue for more on thyroid disease) might be contributing to your constipation. He or she also will be able to check if you take any medications that raise the risk of constipation (opioids are known to worsen constipation, and laxatives should always be prescribed when opioids are prescribed). Your doctor may suggest using a laxative and can advise on which option will suit you best.

Burning Fluid at the Back of the Throat

If you get this often, you likely have gastroesophageal reflux disease (GERD), a condition in which stomach acid refluxes (flows backward) from the stomach into the esophagus. The lower esophageal sphincter (LES), a muscular valve that separates the esophagus from the stomach, should prevent reflux, but if it has decreased resting pressure, it may not close properly between meals. LES pressure naturally decreases with age and may be affected by excess weight and a range of medications often taken by older adults, including some blood pressure drugs, statins, antidepressants, and bisphosphonates (used to treat osteoporosis).

GERD typically causes heartburn (a burning sensation in the chest), but older adults may not experience this because the older esophagus is less able to feel pain. Instead, they taste stomach acid at the back of their throat. Other GERD symptoms often reported by older adults include difficulty keeping food down after meals, a dry cough at night, a persistent sore throat, and a repeated need to clear their throat when they get up in the morning.

GERD is associated with potentially serious complications, so if you think you may have the condition, tell your doctor. He or she may prescribe drugs to ease the symptoms and should review your regular medications to ensure they aren’t contributing to the problem. Self-help strategies include eating smaller, more frequent meals instead of fewer large ones, avoiding foods that may trigger symptoms (such as fatty and spicy foods, citrus fruits, garlic, chocolate, and peppermint), limiting your alcohol intake, and not eating in the two to three hours prior to bedtime. Minimize pressure on your stomach by wearing loose-fitting clothing and avoiding tightly belted outfits. If you are overweight, losing weight may help, since excess belly fat places pressure on the stomach.

Gas and Stool Leakage

The tone and strength of the internal anal sphincter (a ring of muscle that prevents stools from leaking through the anus) decline in older age. The pelvic floor (a group of muscles that support the bowel and bladder) also may weaken, particularly in women who have experienced pregnancy and childbirth. These factors make flatulence and stool leakage more likely.

You may be able to reduce your production of gas by cutting back on certain gas-producing foods, such as onions, broccoli, cabbage, and beans. As to stool leakage, the more completely you empty your bowels the less there will be to leak, so be sure to take sufficient time on the toilet. Raising your feet eight to 12 inches (rest them on a pile of books or a box) while going to the bathroom may help you empty more completely.

Kegel exercises, which can help prevent urinary incontinence, also may help with stool leakage, since they strengthen the pelvic floor muscles. Your pelvic floor muscles are the same ones you may have been using to keep you from passing gas. To exercise them, slowly pull them up (imagine they are an elevator stopping on every floor of an apartment block), hold for three seconds, and then release them equally slowly. Work up to a set of 10 contractions and repeat each batch of 10 three times a day. Also reduce your intake of caffeine, lactose, and artificial sweeteners, as these can loosen stools. If these strategies don’t work, mention the problem to your doctor (try not to be embarrassed— we really have heard it all before!).

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The post First Drug for Resistant Hypertension Approved appeared first on University Health News.

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.

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“Oxygen is carried to the heart muscle in blood through the coronary arteries,” says Samuel Stone, MD, cardiology fellow at Tufts Medical Center. “When the flow of blood and oxygen is limited, damage to the heart muscle occurs. If oxygen is unable to reach the heart muscle for significant periods of time, muscle cells die.”

Atherosclerosis (the buildup of cholesterol- laden plaque lining the walls of arteries) is the main culprit behind heart attacks. “If plaque ruptures, it can cause a clot to form,” says Stone. “If this happens in a coronary artery, it cuts off oxygen from a portion of the heart muscle, leading to a myocardial infarction (heart attack).” If the clot is in an artery in the brain, the resulting death of brain cells is called a stroke.

Risk Factors.

“There are two categories of risk factors for a heart attack,” says Stone, “non-modifiable and modifiable. Non-modifiable risk factors are things we cannot control, such as age, sex, and family history. For example, men over the age of 45 and women over the age of 55 are more likely than younger men and women to have heart disease. Having close relatives who had heart attacks at a young age is also a risk factor.” Black and Mexican Americans, American Indians, native Hawaiians, and some Asian Americans are at higher risk, although this may be due at least in part to modifiable societal disparities that impact their overall health, rather than genetics.

“Modifiable risk factors are things that individuals can control or that can be treated,” Stone explains, “including tobacco use, high blood pressure, high cholesterol, diabetes, obesity, metabolic syndrome, poor diet, lack of exercise, and chronic stress.” Additionally, you may be at increased risk if you have chronic kidney disease, blood triglyceride levels of 175 mg/dL or higher, chronic inflammatory conditions like rheumatoid arthritis or psoriasis, or a history of preeclampsia or early menopause. Regularly getting less than seven hours of quality sleep a night and excessive alcohol use also play a role in the development of heart disease and can increase heart attack risk.

Prevention.

You can protect your heart by taking control of the modifiable risk factors mentioned above. A healthy dietary pattern is key. Replace most animal fats (especially red meats, full fat dairy products, and butter) with sources of unsaturated fatty acids (like fish and non-tropical plant oils); cut back on sweet or salty packaged (usually ultraprocessed) foods and beverages; lower sodium intake; and choose whole grain over refined grain products.

“Follow up routinely with primary care for blood pressure and cholesterol screening, as well as clinical evaluation for other risk factors and symptoms of heart disease,” says Stone. “This is particularly essential for those with family history or other risk factors for heart disease. For those with elevated blood pressure or high LDL cholesterol levels, we recommend treatment with lifestyle modifications and medication when needed.”

During…and After.

It’s important to know the warning signs of a heart attack and seek help immediately for yourself or someone else. Getting treatment quickly can save a life and may limit long-term damage. If you suspect you or someone around you is experiencing a heart attack, don’t wait to see if the symptoms improve—call 911. Not all heart attacks present as chest pain. See “Heart Attack Warning Signs” to learn what to look for.

About 25 percent of heart attacks in the U.S. occur in people who have suffered a previous attack. Individuals who have had a heart attack should follow their healthcare providers’ recommendations for medications, rehabilitation, and lifestyle changes to maximize their recovery and minimize their risk for another attack in the future. Whether you have had a heart attack or not, do what you can to protect your heart. “A healthy lifestyle, along with detection and treatment of modifiable risk factors, can greatly decrease your risk for heart disease and a heart attack,” says Stone.

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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.

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