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'Normal' Blood Pressure Risks
by JENNY HOPE, Daily Mail
People with 'normal' blood pressure should consider reducing it by exercise and cutting salt in their diet, according to controversial
new guidelines. The advice from U.S. Hypertension experts says that reaching the 120/80 level, which is generally regarded as normal, could mean a person is on the way to developing high blood pressure.
Doctors do not usually become concerned about a patient's blood pressure until it reaches 140/90.
But the new guidelines claim anything over 115/75 should be regarded as cause for concern.
Issued by the National Heart, Lung and Blood Institute and endorsed by the American Heart Association, they say patients need to start exercising and eating a healthier diet once blood pressure reaches 120/80, the level currently categorised as ' prehypertension'.
They do not need to take drugs, however, until the reading reaches 140/90.
"The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke and kidney disease," says the report published yesterday in the Journal of the American Medical Association.
British experts said last night they were worried about the move, claiming it would "medicalise" blood pressure levels that posed little extra health risk.
Professor Bryan Williams, president of the British Hypertension Society, said it was revising its own guidelines but would not be incorporating the U.S. Targets.
He said at present in the UK, only patients whose systolic number (the top one) was 160 or more needed to take drugs.
Those whose systolic blood pressure fell in the range 140 to 160 did not necessarily have to take drugs because lifestyle changes including a healthier diet and more exercise might be sufficient, he said.
People whose systolic number was between 120 and 130 should not be given the impression they had a medical condition, he added.
"Of course there is a continuum and higher blood pressure increases your risk. But the increase is very small at these levels.
"There is something wrong if we have to medicalise blood pressure levels that are really quite normal. More than 50 per cent of people aged over 65, for example, have blood pressure over 140.
"Classifying people as pre-hypertensive at much lower levels is not useful. Putting everyone on drugs would lower blood pressure but for a small gain.
"It is preferable to use medication where you get an appreciable benefit and that means using it effectively for people at the higher end."
The U.S. Experts recommend diuretics, cheap drugs that lower blood pressure by removing water from the blood, as they work better than later-generation drugs in preventing the complications of high blood pressure.
But for the first time the guidelines say patients with certain high-risk conditions should probably be started right away on angiotensin-converting enzyme or ACE inhibitors, angiotensinreceptor blockers, beta-blockers and calcium channel blockers.
Most will probably need two or more drugs, especially if their blood pressure is 160 and over.
Dr Aram Chobanian, a member of the guidelines committee and dean of the Boston University medical school, said even little changes in blood pressure were important.
"Let's do something early on that will prevent it, and that doesn't mean medication," he said.
The U.S. Experts said they recognised that people who suddenly found themselves falling into the pre-hypertension category were likely to feel a little disbelief and it might be difficult to persuade them to make changes.
{"status":"error","code":"499","payload":"Asset id not found: readcomments comments with assetId=181049, assetTypeId=1"}Cardiac Catheterization
Cardiac catheterization (also called cardiac cath, heart cath, or coronary angiogram) is a procedure that allows your doctor to see how well your blood vessels supply your heart. During the test, they put a long, narrow tube called a catheter into a blood vessel in your arm or leg and guide it to your heart with the aid of a special X-ray machine. Doctors use contrast dye that they inject into your blood vessel through the catheter to create X-ray videos of your valves, coronary arteries, and heart chambers.
Your doctor uses cardiac cath to:
Common uses of cardiac catheterization
Your doctor can use cardiac cath to both find and fix problems. Procedures that might be done during your cardiac cath include:
A cardiac cath is generally safe. But as with any procedure that involves going into your body, there are risks. Your doctor will discuss the risks with you and be careful to lessen the chances of having them.
Risks can include:
What happens before cardiac catheterization?
This procedure is usually done at a hospital. Most people will also need blood tests and an EKG. Some other things to keep in mind:
How long does a cardiac catheterization last?
A cardiac cath procedure usually takes about 30 minutes (and longer if you have an intervention), but the preparation and recovery time add several hours. Plan on being at the hospital all day.
What happens during a cardiac catheterization?
You'll put on a hospital gown. A nurse will put an intravenous (IV) needle in your arm in order to give you medications and fluids.
The cardiac cath room looks like an operating room. You'll lie on a special table. A large camera and several TV monitors will be above you. You can watch the pictures from your cardiac cath on the monitors.
The nurse will clean and possibly shave the site where they'll insert the catheter (in your arm or groin). Sterile cloths will cover the site and help prevent infection. Keep your arms and hands at your sides so you don't move the drapes.
The nurse will put electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an EKG machine that charts your heart's electrical activity.
Your doctor will give you a mild drug to help you relax, but you'll be awake during the procedure. Your doctor will use a medication called a local anesthetic to numb the area where the catheter goes in. This could be at your groin (they'll call this the femoral approach) or on your wrist (the radial approach).
Your doctor will make a small cut over the blood vessel. They'll insert a device called an introducer sheath and thread the catheter through it into the arteries of your heart. You might feel some pressure but shouldn't feel pain. If you feel any pain, tell your health care providers.
When the catheter is in place, they'll dim the lights and insert a small amount of dye (also called contrast material) through the catheters into your arteries and heart chambers. The contrast material outlines your vessels, valves, and chambers.
When the doctor injects the dye into your heart, you may feel hot or flushed. This is normal and will go away in a few seconds. Tell the doctor or nurses if you feel itching or tightness in your throat, nausea, chest discomfort, or any other symptoms.
The X-ray camera will take photographs of your arteries and heart chambers. Your doctor may ask you to take a deep breath, hold your breath, or cough during the procedure. You'll need to hold your breath while they're taking the X-rays. When all the photos are done, the team will remove the catheter and turn on the lights.
What happens after a cardiac catheterization?
If the catheter was put in your wrist, your doctor will remove it and the sheath. They'll close the cut and bandage it. You'll be able to walk around.
The doctor will watch you for a few hours to make sure you're feeling OK. Tell your nurse if you think you're bleeding or feel any numbness or tingling in your fingers. You might get medication to help with discomfort in your arm. You'll also get instructions about how to care for your arm after you go home.
If the catheter went into your groin, your doctor will remove the device and close the cut with stitches, a collagen seal, or pressure. A collagen seal is a protein material that works with your body's natural healing processes to form a clot in your artery. In some situations, your doctor might stitch the introducer sheath into place and take it out after the bleeding stops.
To help prevent infection, your wound will be covered with a sterile dressing. You'll need to lie flat and keep your leg straight for 2 to 6 hours to prevent bleeding. To avoid straining your abdomen and groin, you'll need to keep your head low (no more than two pillows high). You won't be able to sit up or stand during this time. The nurse will check your bandage regularly, but tell them if you think you're bleeding (have a wet, warm sensation) or if your toes tingle or feel numb. You might get medication to help with discomfort after the anesthetic wears off. Your nurse will help you out of bed when it's OK for you to get up.
Your doctor's orders will let you know when you can get out of bed to go to the bathroom. The nurse will help you sit up and dangle your legs on the side of the bed.
Drink plenty of liquids to clear the dye out of your body.
You may feel the need to pee more often than usual. This is normal. If you didn't get a urinary catheter during the procedure, you'll need to use a bedpan or urinal until you're able to get out of bed.
Your doctor will tell you if you can go home or will need to stay overnight.
Before you go home, your doctor will discuss treatment, including medications, dietary changes, exercise, and future procedures. They'll also talk about how you should care for the wound site, activity, and follow-up care.
Your doctor will tell you what they found during the procedure and whether they needed to do any other procedures, like an angioplasty or stent.
Once you get home, follow all of your doctor's instructions about your activity level and what medications to take. You might have a bruise at the wound site. Call your doctor if you have any other problems.
Tai Chi May Be More Effective Than Aerobic Exercise At Lowering Blood Pressure
Exercise is a critical component of a healthy lifestyle. It can aid in the management and prevention of high blood pressure. Research is ongoing about the most effective exercise options to manage specific conditions.
A new study published in JAMA Network Open compared the effects of tai chi and aerobic exercise on lowering blood pressure among participants with prehypertension.
After twelve months of four one-hour tai chi or aerobic exercise sessions a week, the tai chi group experienced a more significant reduction in blood pressure readings.
The results point to the potential benefits of tai chi to improve cardiovascular health.
Blood pressure is a good indicator of cardiovascular health. When it gets too high, it can increase the risk of stroke and heart disease. Medical professionals divide blood pressure readings into several categories to track how high someone's blood pressure is and what interventions may be most helpful to keep it in a healthy range.
A typically normal blood pressure reading is less than 120 mmHg systolic and less than 80 mmHg diastolic. An elevated reading is between 120-129 mmHg systolic and less than 80 mmHg diastolic. High blood pressure stage one is between 130-139 mmHg systolic or 80-89 mmHg diastolic. Then, high blood pressure stage 2 is 140 mmHg or higher systolic or 90 mmHg or higher diastolic.
A term that is not as typical anymore is prehypertension, which has to do with blood pressure that is higher than normal but not quite high enough to be considered high blood pressure stage two.
Dr. Rigved Tadwalkar, board certified consultant cardiologist at Providence Saint John's Health Center in Santa Monica, CA, who was not involved in the study, explained to Medical News Today:
"Prehypertension is defined as having a systolic blood pressure between 120 and 139 mmHg or a diastolic blood pressure between 80 and 89 mmHg. It is important to note that prehypertension is not the same as hypertension (persistently high blood pressure). However, people with prehypertension are at an increased risk of developing hypertension, as well as heart disease, stroke, and other cardiovascular problems."
People with blood pressure above normal levels can take several steps toward management. One of the main interventions is regular exercise. A variety of options for exercise exist, like walking and biking.
Tai chi is one form of exercise that continues to be an interesting area of study. It involves gentle movements and balance. It may help with several areas of health, like fall prevention and pain control.
Researchers of the current study wanted to see if tai chi helped lower blood pressure and how it compared to other exercises.
This study was a randomized clinical trial that included 342 adults. All participants had prehypertension, which researchers defined as "systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg."
The researchers excluded participants who had certain conditions like diabetes, coronary heart disease, or chronic kidney disease. The average age of participants was around 50 years.
The researchers divided participants into two intervention groups. One group did tai chi, and the other participated in aerobic exercise. Each group participated in four one-hour supervised sessions a week of their activity for one year. The tai chi group did a 24-form Yang-style tai chi, and the aerobic exercise group did activities like jogging, cycling, and brisk walking.
The primary outcome that researchers measured was systolic blood pressure after twelve months. They also looked at several secondary outcomes, like changes in systolic blood pressure after six months and average changes in diastolic blood pressure readings.
Overall, the group participating in tai chi saw the most improvement in blood pressure readings. After one year, the tai chi group saw an average decrease of 7.01 mmHg in systolic blood pressure. In contrast, the aerobic group saw an average decrease of 4.61 mmHg in systolic blood pressure.
In addition, more participants in the tai chi group experienced blood pressure readings in a normal range after twelve months. The researchers also found that 24-hour ambulatory systolic blood pressure readings were lowered more in the tai chi group than in the aerobic group.
The results add to the evidence of tai chi being a helpful intervention for cardiovascular health.
Dr. Cheng-Han Chen, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was also not involved in the study, noted to MNT:
"In this study, regular tai chi was found to improve blood pressure better than aerobic exercise in patients with prehypertension. This is a useful finding, as it gives us another avenue to be able to treat elevated blood pressure."
"Longer term studies should be considered to assess whether tai chi can prevent progression to clinical hypertension. In patients with elevated blood pressure, tai chi can provide a low impact form of exercise that can potentially improve blood pressure. It also has the added benefit of helping with balance and flexibility. However, clinical utility and uptake will depend on the availability of proper training in the technique," he added.
This research does have certain limitations. First, the study was conducted in a single country, and future research could include more diversity among participants. The researchers were unable to look at intervention effects among subgroups.
The researchers also acknowledge that the results of the secondary outcomes are exploratory. Future research can work on confirming these findings. A total of 17.3% of participants discontinued their participation, leaving only a certain number of participants to analyze.
Dr. Tadwalkar offered the following words of caution in interpreting the study's results:
"It's important to remember that this was a fairly small study, and more research is needed to confirm these findings and assess the long-term effects of Tai Chi on cardiovascular health. Additionally, the study didn't explore the mechanisms by which Tai Chi might exert its blood pressure-lowering effects. Understanding these mechanisms could provide valuable insights for future research and clinical practice."
However, as the authors of the study note, tai chi as an intervention could still be beneficial, as it's something many age groups can do in community settings. People interested in trying tai chi can seek appropriate guidance from professionals.
"Ultimately, tai chi may join forces with established methods to offer a personalized approach to blood pressure management and overall well-being. However, remember that consulting a physician remains crucial for an individualized treatment plan tailored to one's specific needs and health status," Dr. Tadwalkar noted.
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