Americans Not Controlling High Blood Pressure

 

Posted by Dennis Thompson, HealthDay Reporter

Nearly half of Americans with high blood pressure are not properly controlling their condition, increasing their risk of heart attack, stroke and heart disease, a new government report shows.

About 47 percent of people with high blood pressure have not brought their numbers to a normal range, through either lifestyle changes or medications, according to data published Nov. 12 from the U.S. Centers for Disease Control and Prevention.

That’s actually a huge improvement: Back in 1999, more than 68 percent did not have their blood pressure under control, the report found.

But it’s far short of the federal Healthy People 2020 goal, which calls for fewer than 40 percent of people with high blood pressure to have it uncontrolled by that date, according to the CDC researchers.

Experts agreed that the problem is still significant.

“I don’t think we have enough positive information to be cheering,” said Dr. Patrick O’Gara, executive medical director of the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital in Boston. “Although the trend is positive, the magnitude of the problem is self-evident. We have a lot of work to do.”

High blood pressure is defined as 140 or higher systolic pressure (the top number) and 90 or higher diastolic (the bottom number). Systolic is the pressure of blood in the vessels when the heart beats, and diastolic is the pressure between beats.

The overall rate of high blood pressure in the United States has remained constant, hovering between 28 percent and 29 percent, the new report found.

Two in three people over the age of 60 have high blood pressure, and one in three people between the ages of 40 and 59 have the condition.

What improvements there have been in controlling high blood pressure have not benefitted all groups in the United States.

Whites are most likely to have their blood pressure under control, close to 56 percent, the CDC report showed. Blacks (48 percent under control), Asians (43 percent) and Hispanics (47 percent) are all more likely to be living with uncontrolled high blood pressure.

A large part of the problem is getting people to start taking blood pressure medications, and then to stay up with them, said Dr. Richard Stein, director of the Urban Community Cardiology Program at the New York University School of Medicine.

“Patients don’t like to take drugs,” Stein said. “I don’t like to take drugs. Drugs that don’t have an obvious beneficial effect for me, it’s easier for me to forget to take them.”

High blood pressure is called the “silent killer” because people often have no immediate symptoms. Prescribing medication to a person who feels well can be difficult, Stein said.

“When you start on medication, you’re usually prescribed at least two different drugs,” he said. “Suddenly you’re going from nothing to two or more drugs, and now we’ve turned you from a person who was healthy and now you think you’re sick.”

Stein said doctors are going to need to figure out better ways of counseling patients to keep taking their medications, possibly by drawing attention to other members in their family who died of conditions related to high blood pressure.

“If you don’t do anything different than he did, you’re probably going to have the same problems that he did,” Stein said.

O’Gara said that doctors will need to rely on other health care professionals, including nurses and pharmacists, to keep up the pressure on patients to take their blood pressure medications.

“Can we expand the number of providers who would supervise the treatment of hypertension?” he said. “If I had 10 pharmacists who worked with me, I could reach 100 people more effectively. Primary care is shifting to where people go to buy their toiletries and toothpaste, out there in the community for these patients with chronic illnesses. It’s not coming to an academic medical center to have me take their blood pressure.”

However, it’s probably going to take a concerted effort to teach the next generation healthy habits before a big difference is seen in America’s blood pressure rates, O’Gara concluded.

“I think it may take a generational change, to alter our proclivity to overeat and use too much salt, to not exercise and spend too much time in front of a screen,” he said.

More information
For more information on blood pressure, visit the U.S. National Institutes of Health.

SOURCES: Patrick O’Gara, M.D., executive medical director, Carl J. and Ruth Shapiro Cardiovascular Center, Brigham and Women’s Hospital, Boston, Mass.; Richard Stein, M.D., director, Urban Community Cardiology Program, New York University School of Medicine, New York City; Nov. 12, 2015, brief report, U.S. National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

The Stroke Risk Factors All Women Should Know


Strokes aren’t just an old-person problem—and not recognizing seemingly-innocent symptoms (such as neck pain) may put you in danger!

It was 4 a.m. on morning in November 2014, and Merideth Gilmor, a publicist who represents athletes like Maria Sharapova, was looking forward to finally going to sleep. The day had started early, with her usual eight-mile run. Then she and her husband had gone to her best friend’s wedding, where they spent the night “partying like rock stars,” she says. By the time she got back to her hotel room, she was more than ready to fall into bed and conk out. But as she did just that, she felt something weird. “I’ll never forget it; it felt just like I’d snorted a huge dandelion up my nose. Then my vision went black,” she remembers. “I could hear, but I couldn’t communicate and I couldn’t move.”

Gilmor, then only 38 years old, had just had a massive stroke.

A Growing Problem
Gilmor’s far from alone. “Stroke prevalence in younger women has been on the rise,” says Philip B. Gorelick, M.D., the medical director at the Mercy Health Hauenstein Neuroscience Center in Grand Rapids, MI. Between 1988 to 1994 and 1999 to 2004, stroke prevalence in women aged 35 to 54 tripled; men experienced virtually no change, says Gorelick. While it’s one of the top five medical diagnoses young women don’t expect, overall, about 10 percent of strokes occur in people younger than 50. (Another shocking stat: Stroke kills two times as many women as breast cancer each year.)

“It’s hard to know if the prevalence is increasing, or if we’re just becoming better at recognizing strokes in younger adults,” says Caitlin Loomis, M.D., an assistant professor of neurology at the Yale School of Medicine, and a neurologist at Yale-New Haven Hospital. But Gorelick theorizes that strokes are becoming more common, in part because high blood pressure and high cholesterol levels, two risk factors for stroke, are affecting more women at younger ages. (Did you know there’s a link between insomnia and high blood pressure?)

While awareness of the problem is certainly growing, because strokes are so much more common in older adults, many people—doctors included—fail to recognize symptoms when they occur in younger women. About 13 percent of stroke sufferers are misdiagnosed, according to a recent study in the journal Diagnosis. But the researchers found that women are 33 percent more likely to be misdiagnosed, and people under age 45 are seven times more likely to be given a wrong diagnosis.

And that can be devastating: Every 15 minutes a stroke sufferer goes without getting treatment adds another month of disability to their recovery time, according to research in Stroke.

Luckily, Gilmor’s husband recognized her symptoms—partial paralysis in her face, confusion, slurred speech—as a stroke. “I heard him call 911, and I thought, I should get dressed. But I couldn’t move my limbs,” she says. At the hospital, the doctor’s confirmed what her husband feared: She’d had an ischemic stroke, which account for about 90 percent of all strokes and occur when something, usually a clot, obstructs a vessel supplying blood to the brain. (Hemorrhagic strokes, on the other hand, occur when a blood vessel tears or ruptures.)

Carolyn Roth wasn’t quite so fortunate. In 2010, she was just 28 when she developed her first warning sign: serious pain in her neck after a trip to the gym. She wrote it off as a pulled muscle. She also managed to explain away the diamond-like spots that clouded her vision as she drove home that night and the neck pain that kept her popping Tylenol the entire next day.

Finally, the next morning she was concerned enough to call her father, who took her to the hospital. She went in around 8 a.m., and a few hours later a doctor told her she’d had a stroke. “They knew right away, because my eyes weren’t responding to light,” she says. But she was floored. While she’d felt pain, nausea, confusion, and vision impairment, she hadn’t experienced some of the more “typical” symptoms, such as left-side paralysis. That may be because her stroke was caused by a dissection, or a tear in an artery, usually the result of some sort of trauma like a car accident or violent coughing fit. (Certain symptoms—like these top warning signs—you should never ignore.)

“When it comes to stroke recovery, time is of the essence,” says Loomis. “Certain medications are only useful when delivered within a three to 4.5-hour window, so it’s essential that stroke victims are brought to a hospital as soon as possible and evaluated quickly.”

The Aftermath
Stroke recovery looks different for every patient. “A lot depends on the size of the stroke and the location in the brain,” notes Loomis. And while it’s true that recovery can be a long, slow road, contrary to what many people believe, a stroke isn’t necessarily a sentence for a lifelong disability. That’s especially true for younger patients, who Loomis says tend to do better than older patients when it comes to physical therapy and rehab. (Some health issues also affect men and women differently.)

Both Gilmor and Roth say they were lucky to have flexible jobs that allowed them to get plenty of rest. “Sleep is so important in the beginning, since your brain is trying to fix itself. It takes a long time,” says Roth. After taking a few months off from the gym to recover, she slowly began exercising again. “I’ll do any exercise now—I even ran the New York City marathon in 2013!” she says. (Thining of running? Check out 17 Things to Expect When Running Your First Marathon.)

Gilmor also credits her support system—her doctors, who she calls her “Stroke Squad” (Loomis was one of them), family, clients, coworkers, and friends—with her recovery. “I tried to see humor in everything, which I think helped,” she says. In addition to physical therapy, Gilmor, who still experiences weakness in her left side, slowly started rock climbing with her son as a way to rebuild her strength.

But running was her real end goal. “My son said to me, ‘Mom, I think you’ll be better when you can run again.’ Of course that made me be like, ‘Okay—I gotta run!’” says Gilmor. She’s currently training for the 2015 New York City Marathon, and, in fact, just finished a 14-mile long run.

“It’s not easy, trying to run a marathon,” says Gilmor. “But you just take baby steps. My whole outlook now is this: You’ve got to get past your excuses. You might be scared, but you’ve got to be bigger than the fear.”

What You Can Do Now
There’s nothing you can do to guarantee that you’ll never have a stroke. But these seven strategies can help minimize your risk—and support present-day survivors.

1. Know all the signs: The acronym FAST is a good place to start. It stands for Face drooping, Arm weakness, Speech difficulty, and Time to call 911—which covers the main symptoms of most strokes. “But I would say the more important thing to remember is that if anyone changes suddenly in front of your eyes, get help,” says Dr. Loomis. In addition to FAST symptoms, suddenly developing vision problems, being unable to talk or stand upright, slurred speech, or otherwise just not seeming like one’s normal self can all be signs of a stroke.

2. Be wary of certain meds: Gilmor’s doctors believe her risk for having a stroke was elevated due to the type of birth control she took. “Any hormonal contraception that contains estrogen, including many birth control pills, patches, and vaginal rings, do increase your risk for forming a clot,” says Loomis. Usually, those clots wind up in a vein, not an artery. But if you have other risk factors, like high blood pressure, you may want to talk to your ob-gyn about switching birth control. (One writer shares why she’ll never take the Pill again.)

3. Never ignore neck pain: About 20 percent of ischemic strokes in adults under age 45—including Roth’s—are caused by cervical artery dissection, or a tear in the blood vessels leading to the brain, research in The Open Neurology Journal shows. Car crashes, coughing or vomiting fits, and sudden twisting or jerking motions can all cause these tears. Loomis says that doesn’t mean you should avoid yoga (after all, millions of people twist and jerk their heads around every day and nothing happens), but you should pay close attention to how you feel after doing anything that causes abrupt movements to the neck. If you feel extreme pain or nausea, or notice any vision problems after, get to a doctor stat.

4. Stretch it out: You’ve heard the warnings about making sure to stand up and stretch when you’re flying. Chances are, you’ve also ignored them—especially if you’ve been in a window seat. But flying can encourage blood to pool in your legs, increasing your risk of forming clots that could then move toward your brain, says Loomis. (Gilmor’s doctors think a recent plane ride, combined with her Pill use, is what triggered her stroke.) A good rule of thumb: Get up and stretch or walk the aisles at least once an hour.

5. Keep tabs on these numbers: Make sure to get your blood pressure and cholesterol taken regularly, and if the numbers start creeping up into the “higher than normal” zone, ask your doctor what you can do to get them back down, suggests Gorelick. High blood pressure damages blood vessels, and high cholesterol may increase your chances of developing a clot.

6. Stick to a heart-healthy diet: Loomis recommends the Mediterranean diet, which has been shown to reduce cardiovascular disease. “It’s high in fish, nuts, and vegetables, and low in red meats and fried things,” she says. Get started with these Mediterranean Diet recipes. Eating this kind of clean diet will also help you maintain a healthy weight, which Gorelick and Loomis agree is one of the easiest ways to reduce your risk of stroke.

7. Support survivors: If you haven’t personally been affected by stroke, you probably don’t have to look that far to find someone who has: Every 40 seconds, someone has one, and today there are 6.5 million stroke survivors living in the U.S. And as Loomis says, “A stroke is a life-changing event that can be hard to get through, physically, and emotionally. Having a network of support makes a huge difference.” To help support survivors, the National Stroke Association just launched their Come Back Strong movement. There are tons of ways to get involved: changing your profile picture to the Come Back Strong logo, donating money, or taking part in the Comeback Trail event on September 12—dedicate a local trail to a stroke survivor you know, and walk it in honor of his or her path to recovery on that day.

New Breakthrough in Hemorrhagic Stroke Treatment

 

When someone has a hemorrhagic stroke, blood from a burst blood vessel leaks out into the brain. The leaked blood is harmful to the surrounding brain tissue and needs to be removed. Conventional surgery is highly invasive and can result in losing some healthy brain tissue in order to remove all the leaked blood.

A new device called BrainPath is minimally invasive and allows neurosurgeons to be very precise in cleaning up the spill. To date, the BrainPath technology is in use in 50 U.S. hospitals.

Read about a stroke patient who benefitted from this procedure.  Dr. Shah says that this surgery should be performed within 8 hours of the stroke occurring.

Source: StrokeSmart

Stroke Deaths Drop in 2013


Stroke, the fourth leading cause of death in the United States in 2012, dropped to the fifth leading cause in 2013, according to recent data released by the Centers for Disease Control and Prevention.

2013 Findings

The findings are significant and indicate that prevention and intervention efforts are making a difference, an expert in neurology and epidemiology said.

“In this case, the wonderful take-home message is that the decline is real,” said Daniel T. Lackland, professor of epidemiology in the department of neurology at the Medical University of South Carolina. Programs of all kinds designed to decrease the impact of stroke are working, he said.

“These statistics are really providing us with some good information that we’re moving in the right direction. We’re not where we need to be, though,” he said.

The 10 leading causes of death in 2013—heart disease and cancer were the number one and two killers—were the same as in 2012, but two causes, stroke and “unintentional injuries,” switched places.

More than 130,500 people died from unintentional injuries in the U.S. in 2013; just under 129,000 people died from stroke, the data shows.

Possible Explanations

While it’s too early to know exactly why the stroke numbers went down, interventions like the clot-buster tPA likely are a factor, Lackland said.

“We know that management of blood pressure has a major impact here yet only 50 percent of people with high blood pressure have it under control,” he said.

According to Lackland, stroke deaths, stroke incidence, and recurrent strokes are all on the decline.

“It means the clinicians are doing a good job of keeping people alive so that they become stroke survivors,” he said.

Stroke Still At Large

However, research shows that people are having strokes at a younger age. A study published in Neurology, the medical journal of the American Academy of Neurology, found that the increase could be attributed to a rise in risk factors like diabetes, obesity, and high cholesterol. Lackland said high blood pressure is also a significant problem.

“We’re seeing higher blood pressure at younger ages,” he said.

Overall, though, the data shows good news when it comes to stroke. It’s evidence that education efforts and medical intervention are saving lives.

“We’ve seen a decline in stroke mortality for almost the past 100 years,” Lackland said. “What’s exciting about this data is that you see the decline is greater since we’ve had programs designed and implemented specifically to reduce stroke mortality.”

Source: StrokeSmart Magazine