High Blood Pressure Still Slipping Past Doctors

(HealthDay News) -- The dangers of high blood pressure are well-known, but a new study finds a lack of routine blood pressure screening in doctor's offices and a low percentage of hypertension patients actually meeting their blood pressure goals after diagnosis.

The Stanford University School of Medicine study, published in the May issue of Hypertension, found that in the offices of private U.S. physicians:

Blood pressure was taken in only 56 percent of all patient visits, and in 93 percent of visits by patients diagnosed with hypertension.
Only 39 percent of patients being treated for hypertension were at the recommended blood pressure levels.
Only 20 percent of hypertensive patients who also have diabetes or kidney disease had their blood pressure controlled.
"Doctors should be screening more routinely during all office visits," study co-author Dr. Randall Stafford, an associate professor of medicine at the Stanford Prevention Research Center, said in a prepared statement. "Dual medication treatment should be seen as standard therapy, and intensive lifestyle changes should be encouraged."

The study analyzed data from a federal 2003-04 survey of services performed in offices of private U.S. physicians. It noted such details as whether the blood pressure cuff was brought out, whether appropriate medications were prescribed, and whether treatment achieved its goal.

High blood pressure affects more than 65 million people in the United States and is one of the most important and preventable risk factors for cardiovascular disease, strokes and kidney disease. High blood pressure, often called "the silent killer," can damage one's body for years before actual symptoms develop.

This lack of symptoms may be a major reason for poor quality of care, researchers said.

"This is a problem that spans much of preventive medicine," Stafford said. "The treatment itself doesn't make patients feel better. If somebody has asthma, they know that if they stop taking medication, they're going to start wheezing. With blood pressure medicines, patients don't feel any different."

Without this noticeable change, many patients stop following the doctor's orders or fail to return for follow-up care.

"We know many patients don't take the medications they were prescribed for the doses that were prescribed nor for the duration that was prescribed," lead author Dr. Jun Ma, an associate staff scientist at the Palo Alto Medical Foundation Research Institute, said in a prepared statement.

Increasing routine blood pressure screenings, even in specialists' offices, could be the first step to improving care, Stafford said.

"Many physicians in specialized practice appear to feel they don't need to measure blood pressure," he said. The thinking goes, "'I'm a dermatologist, so I don't need to screen for high blood pressure.' But because there's a high likelihood of high blood pressure getting missed, we need to take advantage of all opportunities for screening."

Once a doctor diagnoses someone with high blood pressure, the physician must clearly explain the necessary treatments and strongly encourage lifestyle changes.

"Physicians may need to tell patients that it's likely to take two or more medications to get blood pressure under control," Stafford said. "They also need to use a comprehensive strategy to attack high blood pressure that includes recommended changes in lifestyle: weight loss, reduction in sodium, a plant-based diet, increases in physical activity. Both patients and physicians need to take advantage of all available strategies."

More information The American Heart Association has more about high blood pressure.

Atherosclerosis May Also Harm Vital Organs

(HealthDay News) -- New research indicates that the fatty plaques that harden arteries may also harm vital organs.

"Atherosclerosis is usually associated with plaque formation in arteries," said study author Rita K. Upmacis, an associate research professor in pathology and laboratory medicine at Weill Medical College of Cornell University in New York City. "But using a mouse model of atherosclerosis, we have demonstrated that the effects of this disease are more widespread, affecting . . . the heart, liver and lungs."

The finding, scheduled to be presented this week at the American Chemical Society annual meeting, in New Orleans, centers around the availability of nitric oxide (NO), an important gas within the body that relaxes blood vessel walls and helps prevent atherosclerosis. Certain substances in plaque remove NO and create a toxic substance known as peroxynitrite, which hampers the function of enzymes necessary to the health of blood vessel walls.

In the latest study, researchers found that in mice that were fed a high-fat diet and who developed atherosclerosis, peroxynitrite, nitrotyrosine and other substances that interfered with NO were common not only in the blood vessels, but also in the hearts, lungs and liver.

"During many disease states, reactive oxygen species such as superoxide are formed," explained Upmacis. "The problem here is that nitric oxide, which is beneficial to the body, reacts with superoxide, and forms something called peroxynitrite, which is a powerful oxidant that can cause all sorts of damage and wreak havoc. These reactions are predicted to lead to the vascular dysfunction encountered in atherosclerosis."

It is possible drugs could be developed to increase NO production and prevent organ damage from atherosclerosis. However, there could be unwanted side effects, such as an increased risk of infection, so it would be difficult to create a drug targeted specifically to atherosclerosis, Upmacis said.

Since nitrotyrosine levels can be detected in the blood, it may also be possible to one day develop a test that could both detect and track the development of atherosclerosis, the researchers added.

What about using statins to prevent organ damage?

Dr. John C. LaRosa, president of the State University of New York Downstate Medical Center, New York City, said it's a possibility.

"Statins improve flow rates in the kidney and may delay or prevent deterioration of kidney function in older adults," he said. "Statins also improve retinal [eye] blood flow in diabetics and may deter diabetic eye disease. These effects are currently under investigation, however, and are not current indications for statin use."

Dr. Alan Kadish, associate director of the Northwestern Cardiovascular Institute in Chicago, said when it comes to atherosclerosis, prevention is the best cure.

"At the present time, the best thing patients can do is understand that atherosclerosis can have bad effects, even some that are still being identified, and adhere to exercise, diet and lifestyle modifications that will decrease their risk of developing atherosclerosis," he said.

More information
For more on atherosclerosis, go to American Heart Association.

A Month of Exercise Helps Ease Heart Failure

(HealthDay News) -- Just four weeks of moderate exercise is enough to boost the cardiac performance and breathing capacity of patients with heart failure, a new study finds.

This slightly more strenuous exercise program -- in standard use in Europe for people with heart failure -- works at least as well as the less intense American regimen, the researchers noted. They presented the findings Tuesday at the Experimental Biology conference in San Diego.

In heart failure, the heart progressively loses the ability to pump blood. In the United States, doctors typically recommend three-times-a-week exercise sessions for eight to 12 weeks to help ease the condition, noted study author Stephen F. Crouse, a professor of kinesiology and internal medicine at Texas A&M University, in College Station.

His team looked at data from an Austrian rehabilitation center where 366 heart failure patients (average age 63) exercised 14 to 22 minutes on stationery bicycles six times a week. Participants also did a brisk 45-minute walk each day.

Four weeks of that regimen were enough to produce a significant increase in the participants' breathing capacity, Crouse said.

"This is something that we can recommend continuing for the rest of their lives," he added.

The benefits of exercise for people with heart failure are well-established, Crouse acknowledged. "There are some data from U.S. studies showing that the European regimen has at least equal benefits," he said.

The study used such standard measures of heart function as VO2max, which measures oxygen consumed; resting heart rate; and blood pressure. But of greater interest was the measurement of blood levels of the protein NT-proBNP, which is secreted when heart muscle cells are stressed, Crouse said.

"We have this biomarker in the blood that can be followed very well and that correlates with [cardiac] performance," he said.

Levels of NT-proBNP went down as standard measures of heart performance went up, Crouse said. Blood levels of the protein dropped by 33 percent in the study group after four weeks of the exercise regimen.

Measuring NT-proBNP "is something we would suggest could become a routine clinical test, of treatment and performance," Crouse said. A blood test for the protein is not expensive and is a better alternative for more costly tests such as echocardiography, he said.

The longer-term effects of a continued exercise program for heart failure will be assessed by the Texas A&M team, Crouse said. "We need data to follow them out," he said.

The results were not surprising and will not affect advice on exercise now given to people with heart failure, said Dr. William E. Kraus, research director at the Duke University Center for Living. His center is currently leading a major trial of long-term exercise training for people with heart failure, with results expected later this year.

Use of NT-proBNP as a measure of performance is "a new wrinkle, but not so much of one that it makes me want to change practice," Kraus added.

More information

Guidelines for exercise in heart failure are provided by the Cleveland Clinic.

One-Third of Dementia Cases Laid to Small Blood Vessel Damage

(HealthDay News) -- Small blood vessel damage caused by hypertension and diabetes may be among the leading causes of dementia, according to new research.

The findings provide an additional reason to control these common conditions, according to Dr. Thomas Montine of the University of Washington, who was to present the study Sunday at Experimental Biology 2008 in San Diego.

The autopsied brains of a third of men and women with dementia or cognitive decline showed evidence of small vessel damage -- a cumulative injury that can result from multiple small strokes caused by hypertension and diabetes. The strokes are often so small that the person notices nothing until the cumulative effect reaches critical mass, the researchers said.

Meanwhile, 45 percent of the risk for dementia was associated with pathologic changes of Alzheimer's disease. Another 10 percent risk was linked to Lewy bodies, which are neocortical structural changes that indicate a degenerative brain disease known as Lewy Body Dementia, a possible variant of Alzheimer's and/or Parkinson's disease, the study found.

The finding about small vessel disease challenges conventional wisdom and conclusions from most autopsy studies of brain aging and dementia, Montine said in a prepared statement.

The broader population sample on which the autopsy study was based may be reason for the differing results, he said. Most previous research had focused on participants in Alzheimer's disease center studies, or was limited to one gender, ethnic or professional group. The individuals in the new study were part of a large managed care program and representative of the Seattle urban and suburban area they came from: white, Asian, African-American and Hispanic, with a range of educational and professional levels.

In the study, which ran from 1994 to 2006, some participants suffered cognitive impairment and dementia, while others did not. Roughly a third of all 3,400 participants died, and autopsies were performed on the 221 who had given permission for this to be done.

More information
The American Heart Association has more about controlling high blood pressure.