AHA re-defines high BP in its new guidelines: “130 is the new high”

AHA re-defines high BP in its new guidelines: “130 is the new high”

New guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) for detection, prevention, management and treatment of high blood pressure have redefined high blood pressure for first time in 14 years. The guidelines were presented November 13, 2017 at AHA’s 2017 Scientific Sessions conference in Anaheim

In a change from the older definition of 140/90 and higher, high BP is now defined as systolic BP 130 mm Hg and higher, or diastolic BP 80 and higher. By lowering the definition of high BP, the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension. The importance of using proper technique to measure BP has been emphasized. Blood pressure levels should be based on an average of two to three readings on at least two different occasions.

The new guidelines have eliminated the category of prehypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).

Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines.

High blood pressure should be treated earlier with lifestyle changes and in some patients with medication at 130/80 mm Hg rather than 140/90.

Medication for Stage I hypertension should be prescribed if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk.

Blood pressure categories in the new guideline are: ·         Normal: Less than 120/80 mm Hg; ·         Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80; ·         Stage 1: Systolic between 130-139 or diastolic between 80-89; ·         Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg; ·         Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

(Source: AHA News Release, November 13, 2017)

AHA guidance on improving employee health and engagement

AHA guidance on improving employee health and engagement

Dr KK Aggarwal

The American Heart Association (AHA) has released an evidence review report titled “Resilience in the Workplace: An Evidence Review and Implications for Practice”, with practical actionable guidance for employers looking to implement resilience training programs. According to the report, resilience is an emerging, innovative strategy to improve employee health and productivity, and organizational performance.

The CEO Roundtable is the AHA’s leadership collaborative with 30-plus member CEOs who represent some of the nation’s largest employers who are committed to applying evidence-based approaches to improve their employees’ overall health.

Studies suggest resilience training may be a useful primary prevention strategy for employers to improve employee health and engagement. Although there is no consensus on how to define resilience, the report says that “resilience can be considered, in general, the ability to withstand, recover and grow in the face of stressors and changing demands”.

Resilience training aims to develop or strengthen a person’s ability to withstand, recover and bounce back from adversity and may improve the ability to cope with, and recover from negative workplace stressors.

In an online employee of 1,001 working adults within the US, which has also been included in the report, 73% said that their participation in resilience training programs improved their health a great deal or fair amount; specifically, they reported having more energy (51%), exercising regularly (45%), and improved quality of life (41%).

(Source: AHA News Release, October 11, 2017)

AHA statement on management of poststroke fatigue

AHA statement on management of poststroke fatigue Fatigue is a debilitating sequelae of stroke, both ischemic and hemorrhagic. About half of all patients who survive an episode of stroke often report fatigue, which may be mild and occurring occasionally to that which is severe and constant. Unlike the typical tiredness, post-stroke fatigue may or may not be related to a recent activity and does not improve with rest. It adversely affects daily activities of life and limits participation of the patients in rehabilitation programs, which in turn hampers recovery. This makes post stroke fatigue an issue that is of concern not only to the affected patient and the caregivers, but also to the clinician taking care of the patient. The American Heart Association (AHA) has published a scientific statement for healthcare professionals on the management of fatigue in patients who have had a stroke. Published May 25, 2017 in the journal Stroke, the statement recognizes the multidimensional nature of poststroke fatigue and lists factors such as old age; female gender; physical impairment and functional deficits; comorbidities such as hypertension, diabetes, kidney disease, heart diseases; medications such as sedatives, antidepressants, and hypnotics and pain as factors that contribute to the fatigue. Patients should be evaluated at the time of discharge from acute care followed by regular follow-up post-discharge at 3 months, 6 months, and 1 year and then yearly. The Fatigue Severity Scale is recommended. These patients should also be evaluated for depression. The statement elucidates the evidence related to the use of tirilazad mesylate, a neuroprotective agent and Modafinil, a drug originally used for patients with hypersomnia or narcolepsy to promote wakefulness, as agents that have shown some efficacy in relieving poststroke fatigue. Vitamin B12, vitamin B1, and idebenone, a synthetic coenzyme Q10 analog may also have a role. Nonpharmacological interventions include aerobic exercise and education of the patients and their caregivers about the condition and the need for exercising, establishing good sleep patterns and avoiding sedating drugs and excessive alcohol The statement also touches upon the impact of fatigue on the caregivers and states that “caregivers can be taught to help the stroke survivor space activities out throughout the day to conserve energy if this is found to be an effective intervention”. (Source: Stroke. 2017;48:e000-e000) Dr KK Aggarwal National President IMA & HCFI

Avoid weight gain at younger age to stay healthy in your old age

Avoid weight gain at younger age to stay healthy in your old age
Results of the Chicago Healthy Aging study presented at the recent American Heart Association's (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Health 2017 Scientific Sessions in Portland, Oregon show that significant weight gain over time as well as obesity and overweight in younger age result in poor physical performance in older age.
Researchers from Northwestern University in Chicago, Illinois evaluated 1,325 men and women who were initially examined in 1967-73 and then re-examined in 2007-10 in the Chicago Healthy Aging study. The mean age at baseline was 33 years and at follow-up was 71 years, when muscle strength (hand grip) and performance (4m gait speed and Short Physical Performance Battery [SPPB]) were measured.
The short physical performance battery (SPPB) measures static balance, gait speed, and getting in and out of a chair and has been used to monitor function in older people. The scores range from 0 (worst performance) to 12 (best performance).
At follow-up, subjects who were initially overweight and had gained the most weight (> 20lbs) were more likely to have a low SPPB score, slow walking speed (gait speed <0.8 m/s), or sex-specific handgrip strength (ORs: 4.55, 4.58, and 1.86, respectively) vs those study participants who had normal weight at baseline with minimal weight change (-10lbs to 20lbs), independent of other risk factors for cardiovascular disease.
Results of this study highlights the fact that prevention is better than cure. And preventive efforts of lifestyle diseases such as heart disease, obesity, type 2 diabetes and osteoporosis should start at a young age.
Normal weight obesity is the new epidemic of the society. A person can be obese even if the body weight is within the normal range. An extra inch of fat around the abdomen can increase the chances of heart disease by 1.5 times. A waist circumference of more than 90 cm in men and 80 cm in women increases the risk of future heart attacks. Normal weight obesity is also associated with the same health risks as does somebody who is overweight and obese.
Any weight gain after puberty is invariably due to fat. Though the overall weight can be in the acceptable normal range but any weight gain within that range will be abnormal for that person. Therefore, any individual who gains weight of more than 5 kg after the age of 18 years in girls and 20 years in boys is obese and overweight. Any weight gain at this age should be avoided. After the age of 50, the weight should reduce and not increase.
To live more than 80 years without lifestyle diseases, keep your abdominal circumference, lower blood pressure, LDL (bad) cholesterol, pulse rate and fasting sugar all lower than 80. Dr KK Aggarwal National President IMA and HCFI

Timing and meal planning affect heart health, says AHA

Timing and meal planning affect heart health, says AHA A new scientific statement from the American Heart Association (AHA) has highlighted the role of meal timing and frequency in prevention of cardiovascular diseases. According to it, planning when to eat meals and snacks and not skipping breakfast are patterns associated with healthier diets, which could reduce risk of cardiovascular disease. The statement reviews the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency and timing of eating occasions. It recommends that “intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management”. As clinicians, we stress upon eating a healthy diet, one that is rich in fruits, vegetables, whole grains, low-fat dairy products, poultry and fish and limiting red meat, salt and foods high in added sugars. Now, we should also educate our patients that “when and how often a person eats” are also important in promoting heart health - a more intentional approach to eating. Irregular patterns of eating have adverse impact on cardiometabolic health such as obesity, high blood pressure, cholesterol, blood glucose levels, insulin resistance. The statement titled “Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention” is published online January 30, 2017 in the journal Circulation. (Source: AHA News Release, Circulation) Dr KK Aggarwal National President IMA & HCFI

Top 10 Advances in Cardiology (AHA)

Top 10 Advances in Cardiology (AHA)

1.     In selective high-risk groups, additional therapies help prevent a second stroke: Previous research has shown that to prevent a second stroke, “aggressive medical management” — treating and controlling high cholesterol, high blood pressure and blood sugar, as well as lifestyle behaviors such as smoking cessation and exercise — is better than stenting. But a study, SAMMPRIS, published in JAMA identified a subgroup of patients at higher risk for a recurrent stroke despite this medical management – and who need stenting. Investigators found that high-risk patients included those who had an old stroke in the area of the blockage, a new stroke or were not on a statin at the time they joined the study.

2.     New possibilities for treating women with heart attacks: The study, in the American Heart Association’s journal, Circulation: Cardiovascular Imaging, found that women had a type of plaque thought to be vulnerable throughout the blood vessels, while in men, they were mostly found in the earliest part of the artery. The way plaques “broke” often was different as well. Men had larger size plaques even though the women in the study had more cardiovascular risk factors.

3.     More options for valve replacements in the elderly: In high risk patients with aortic valve stenosis, treatment means either open-heart surgery or transcatheter aortic valve replacement. This study, which focused on older patients, compared surgery and TAVR by looking at the survival and stroke rates of intermediate-risk patients. The research, published in the New England Journal of Medicine, showed the rates were similar and that use of either procedure would produce similar outcomes.

4.     Long-term study validates less-selective invasive treatment for narrowed neck arteries: In the past, the typical treatment for carotid arteries narrowing was carotid endarterectomy. And now, research, CREST study published in the NEJM and based on a 10-year follow-up, gives stenting more validation as an accepted alternative.

5.     Better together: Managing blood pressure and cholesterol at same time helps lower heart risk: This research, called HOPE 3, is a combination of three articles published simultaneously in the New England Journal of Medicine that, taken together, conclude that reducing both blood pressure and cholesterol is better than doing either alone. It also provide further evidence supporting the benefits of statins in Asian and Hispanic populations.

6.     Evidence we might be able to outsmart our genes: A study in NEJM found that among participants at high genetic risk for cardiovascular disease, a favorable lifestyle was associated with a nearly 50% lower relative risk than those with an unfavorable lifestyle that included smoking, obesity, lack of exercise and poor diet.

7.     Disparity in counseling women and minorities with heart failure: Implantable cardioverter defibrillator (ICD) can be lifesaving by preventing sudden death in people with severe heart failure. But, according to this study of 21,000 patients published in Circulation, women and minority patients eligible for the device far too often aren’t counseled about it. The findings show as many as four out of five hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients.

8.     Fainting could be a sign of pulmonary embolism in some patients: NEJM: In the past, fainting had not been considered high on the list of signs and symptoms pointing to PE. But researchers in the PESIT study used a diagnostic workup to assess the presence of the embolism and found it was present in about one out of six, or 18 percent, of the patients.

9.     Advancing the treatment of severe strokes: This meta-analysis of patient data from five landmark trials shows the benefits of stent retrievers that snare large clots from the brain. The research published in The Lancet consolidates work that means providing timely treatment for these patients could have a global impact.

10.  Two studies move the needle toward better prevention of heart disease:

·         Lowering blood pressure to below 120/90, compared with 140/90, led to significantly lower rates of death and “cardiovascular events” among adults age 75 and older. The study, published in the Journal of the American Medical Association, extends the results of the recent SPRINT trial and could help clear up inconsistencies in how doctors set blood pressure targets for geriatric populations.

·         Also this year, investigators in a separate project identified a gene variant that determines whether a carrier may have a lower risk of coronary heart disease than those without the gene variation (NEJM). This gene, called ANGPTL4, governs the action of lipoprotein lipase, or LPL, which plays a critical role in breaking down a type of fat in the blood produced by the liver, called triglycerides. High triglyceride levels are a contributor to heart disease risk. In this study, people with a specific genetic variation in the ANGPTL4 gene had lower triglyceride levels, higher “good” HDL cholesterol levels, and lower coronary artery disease risk than those who did not have the mutation.

Commonly used medications and nutritional supplements may cause or worsen heart failure - American Heart Association

Commonly used medications and nutritional supplements may cause or worsen heart failure - American Heart Association The American Heart Association (AHA) has cautioned that commonly used medications and nutritional supplements may cause or worsen heart failure in its first scientific statement, which provides guidance on avoiding drug-drug or drug-condition interactions for people with heart failure. The statement provides comprehensive information about specific drugs and “natural” remedies that may have serious unintended consequences for heart failure patients. In addition to prescription medications, over the counter drugs may also have unintended consequences for heart failure patients. • For example, non-steroidal anti-inflammatory drugs (NSAIDs), including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium and fluid retention and making diuretic medications less effective. • Over-the counter heartburn medications and cold remedies may also contain significant amounts of sodium, which is usually restricted in patients with heart failure. Heart failure patients have, on average 5 or more separate medical conditions and they take 7 or more prescription medications daily, often prescribed by different healthcare providers. And, according to the statement, medications can cause problems in several ways: being toxic to heart muscle cells or changing how the heart muscle contracts; interacting with medications used to treat heart failure so that some of their benefits are lost; and containing more sodium than advised for patients with heart failure. Robert L. Page II, Pharm.D., M.S.P.H., chair of the writing committee for the new scientific statement said that healthcare providers should talk to patients with heart failure at every visit about all prescription and over the counter medications they may be taking, as well as nutritional supplements and herbs. The statement suggests that patients should show each of their healthcare providers a complete list of their medications, including over-the-counter drugs and natural supplements. They should consult with a health professional before starting or stopping any medication. (Source: AHA)