Can breathing exercises lower high blood pressure?
PULMONARY VASCULAR RESPONSE TO INCREASING CARDIAC INDEX FOLLOWING SYSTEMIC HYPOTENSION IS MODIFIED BY PENTOBARBITAL ANESTHESIA
We examined the effect of sodium pentobarbital (PB) anesthesia on the pulmonary vascular response to increasing cardiac index (CI) following systemic hypotension (H). The pulmonary vascular pressure gradient (pulmonary arterial-pulmonary capillary wedge pressure:AP) was measured at multiple levels of CI (ml/min/kg) during stepwise inflation and deflation of an inferior vena cava (IVC) occluder in 10 conscious dogs, and again during PB anesthesia (30 mg/kg, iv). Maximum IVC constriction decreased (p<0.01) CI (131 ± 9 to 46 ± 4 vs 120 ± 8 to 39 ± 4) and systemic arterial pressure (113 ± 2 to 51 ± 2 mmHg vs 94 ± 4 to 47 ± 2 mmHg) in conscious and PB dogs, respectively. Following 15 rain of H, CI was gradually increased by deflation of the IVC occluder. Compared to values obtained during inflation of the IVC occluder, AP was not significantly changed at any level of CI following H in conscious dogs. For example, δP was 6.0 ± 0.5 mmHg before and 6.0 ± 0.6 mmHg after H at CI = 60, and 11.7 ± 0.7 mmHg before and 11.8 ± 0.8 mmHg after H at CI - 120. In contrast, pulmonary vasoconstriction was observed following H during PB, i.E. ΔP was increased (p<0.01) 24 ± 5% from 6.1 ± 0.4 mmHg at CI - 60, and 30 ± 7% from 10.5 ± 0.6 mmHg at CI = 120. Thus, pulmonary vascular regulation following H is altered by PB anesthesia.
How To Lose Weight: Part 3Medical Views
By Drs. Nirmal and Renu Joshi
The first two parts of this series focused on general principles of weight loss and diet changes. What about medications for weight loss? When added to lifestyle modification, medications can lower body weight by 5-20% (10-40 lbs. For a 200 lb. Individual). A few important general principles before you consider these options:
One, not every drug works for everyone; individual responses can be quite different.
Second, after an initial response, generally no further weight loss occurs. This does not mean the drug is not working. It simply means this is the extent to which the drug will work.
Lastly, when drug treatment is stopped, weight regain can be expected.
Dr. Nirmal Joshi is president of the Joshi Health Clinic an a practicing physician in Central Pennsylvania.
As physicians, we like that a plethora of options have more recently become available. Regardless of how weight loss is accomplished, even small degrees of weight loss can substantially reduce the incidence of diabetes, blood pressure, as well as cardiac and stroke risk.
As a reminder, you are an appropriate candidate for medication therapy if your BMI (Body Mass Index) is over 30, or if your BMI is 27-30 and you have weight related diseases such as diabetes or blood pressure and you have not been able to reduce weight with lifestyle changes.
Dr. Renu Joshi is an endocrinologist with Mt. Nittany Health in State College, Pa.
A good way to look at weight-loss medications is whether you have diabetes. If you do not have diabetes, approved oral medication options include Phentermine-Topiramate combination (common brand name: Qsymia) and Bupropion-natrexone combination (Contrave). Phentermine-Topiramate is an option for women after menopause or for men, who do not have high blood pressure or known heart disease and can reduce weight up to 8-10% (15-20 lbs. In a 200 lb. Person).
The phentermine component can increase blood pressure and heart rate and the topiramate component can cause birth defects (hence not recommended in women of child bearing age).
Bupropion-naltrexone combination can reduce weight up to 5% (10 lbs. In a 200 lb. Person) and can also cause transient increases in blood pressure and heart rate. Both medications can be associated with nuisance side effects such as nausea and dry mouth and may have medication interactions. Hence the critical importance of physician supervision.
In their brand form, either drug may set you back by $200-500 per month or more. However, the individual components are available in a generic form and with appropriate physician supervision, you will be able to get the cost down to less than fifty or a hundred dollars without any change in efficacy.
One of the most significant recent advances in the treatment of weight loss has been the development of GLP-1 agonists (Glucagon-like peptide). These include Semaglutide (Wegovy) and Liraglutide (Saxenda), both administered by an injection under the skin. '
Used once a week by injection, Semaglutide can reduce body weight significantly, up to 15% (30 lbs. In a 200 lb. Person). In addition to lowering blood sugar, they work for weight loss by suppressing the hunger centers and also slow the rate of stomach emptying causing one to feel full and less hungry. Importantly, there is increasing evidence that these medications can be protective to the heart, lowering the risk of heart attacks and strokes.
Although cost continues to be a major limiting factor for their use (often coming with a price tag of over $1000 a month and often not covered by insurance), they are the medical drugs of choice if cost constraints can be overcome.
An exciting new development has been the recent release of data from the makers of Wegovy demonstrating a significant lowering of heart attack and stroke risk by up to 20%. This may pave the way for insurers to begin paying for such medications.
If you have diabetes, additional options are available. Metformin, an oral, time-tested "work-horse" for the treatment of diabetes, comes with a "side effect" of reducing weight somewhat.
Semaglutide (Ozempic), as a weekly injection, is highly effective, with all the benefits noted above; the pill form, Rybelsus is somewhat less effective. Another new medication, and also a weekly injection, Tirzepatide (Mounjaro) is a combination of a GLP-1 agonist and a GIP (gastric inhibitory polypeptide) receptor agonist, and may be even more effective than Ozempic.
We have seen reports of non-medically supervised acquisition of Ozempic-like medications from compounding pharmacies. This disturbing practice can be potentially life-threatening. Their side-effect profile is just beginning to emerge. Rare but sobering reports of pancreatitis, anesthetic complications related to slowing of stomach emptying and other side effects are being noted.
While there is tremendous interest and optimism around their remarkably positive effects in reducing the incidence of heart attacks and strokes, more time is needed to truly allow their longer-term safety profile to emerge.
Do not venture into using without medical consultation and close expert supervision.
Dr. Nirmal Joshi is president of the Joshi Health Foundation and a practicing physician in Mechanicsburg, Pa.
Renu Joshi is an endocrinologist at Mt. Nittany Health System in State College, Pa.
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Cardiac Screening Of Bronny James Several Months Ago Was Normal, Says Source Familiar With The Matter
CNN —
Bronny James, who on Monday suffered a cardiac arrest and was hospitalized, had a cardiac screening several months ago as part of a program for prospective NBA players, according to a source familiar with the matter.
The screening included a transthoracic echocardiogram – which looks at blood flow through the heart and heart valves – and an EKG, which is a recording of the heart's electrical activity, the source said. Both screenings came back with normal results.
The normal results of those tests are a good sign and likely mean the episode wasn't caused by an anatomical preexisting problem.
But the 18-year-old will still likely have his heart rhythm monitored for a longer period in the hospital – since an EKG only captures a snapshot in time – so medical professionals can determine whether there are any unusual spikes of electrical activity.
If those readings are normal as well, doctors may also look at other possibilities of what could have caused this, including significant dehydration or intense practicing.
Bronny is NBA superstar LeBron James' older son.
The 6-foot-3 combo guard, who is an incoming freshman for the University of Southern California's basketball team, was rated a four-star recruit and shined in the McDonald's All-American Game in March featuring some of the country's top high school basketball players.
He suffered the cardiac arrest during basketball practice at USC, a family spokesperson said in a statement Tuesday.
"Medical staff was able to treat Bronny and take him to the hospital. He is now in stable condition and no longer in ICU," the family statement said.
"LeBron and Savannah wish to publicly send their deepest thanks and appreciation to the USC medical and athletic staff for their incredible work and dedication to the safety of their athletes."
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