Here is a picture of my family and me having afternoon tea at the Ritz in London last month:

Today we look at a prospective study of nearly half a million participants in the UK Biobank cohort. Researchers published the study online in the Annals of Internal Medicine.

Tea, health, and longevity

Before we get into the recent tea study, let’s set some definitions. In a recent Medium piece, I talked about lifespan, health span, and longevity.

• Lifespan. The duration of an individual’s existence.
• Healthspan. Healthspan is the period of life spent in good health, free from the chronic diseases and disabilities of aging. Healthspan is a length of chronological time beginning at birth and ending when an individual is no longer in good health or is suffering from diseases or disabilities of aging.
• Longevity. Longevity is a balance of lifespan (living longer) and health span (living better).

British researchers examined nearly 500,000 adults with an average age of 57 years.

Approximately 85 percent of the subjects reported drinking tea, 90 percent reported consuming black tea, and most drank at least two cups daily; most drank two to three cups (29 percent), four to five cups (26 percent), or six to seven cups (12 percent) per day.

Let’s get to the results after a median follow-up of 11.2 years:

Those who drank at least two cups of tea daily had a lower all-cause mortality risk. Adding milk or sugar did not take away the benefit, and the tea’s temperature did not influence the results.

Compared to those with no tea intake, one cup per day tea drinkers had a five percent lower risk of death, a 12 to 13 percent lower risk for those drinking two or seven cups, and about a 10 percent lower risk for those drinking eight or more cups each day.

In addition to lower all-cause mortality risk, tea drinkers also had a lower risk of suffering cardiovascular death, ischemic heart disease, and stroke (compared with individuals who did not drink tea).

Why is tea associated with better health?

We do not know why people who drink tea may live longer. The large study I presented does not prove a causal relationship between tea drinking and better health.

With that important caveat in mind, study author Maki Inoue-Choi, an epidemiologist at the National Cancer Institute, offers that tea is “very rich in bioactive compounds” that reduce stress and inflammation, including polyphenols and flavonoids.

In support of these observations, a 2020 study using the UK Biobank database discovered an association between higher consumption of green and black tea and biomarkers related to cardiometabolic health, including lower cholesterol levels. Tea is also associated with very small decreases in blood pressure.

Should you double up on your tea habit? While the research findings are encouraging, the British study is observational — the evidence is not from an experiment, and the researchers infer results. Perhaps we tea drinkers do better because we put aside soft drinks. I would love to see a randomized trial comparing tea drinking versus no tea drinking.

In addition, the gains associated with tea consumption appear small in magnitude. I am reassured that my tea habit may have health upsides, even though the study offers nothing to make me drink more than I currently do.

Tea — Frequently asked questions (FAQs)

Let’s turn to some frequently asked questions about tea.

1. Do all teas come from the same plant? Many define tea as the infusion of the plant camelia sinensis in water. So, in this sense, tea all comes from the same plant.
2. How many tea types are there? There are six general groups of tea, including 1) Black tea (red tea in Chinese), a fully oxidized tea. 2) Green tea, a form that is barely oxidized. Green tea undergoes a process to remove excess water. 3) White tea is the least processed type; simply dry the leaves. 4) ) Oolong (blue) tea refers to partially oxidized teas. 5) Yellow tea; and 6) Dark (black in Chinese) tea, ones that are post-fermented (they have good mold growing on them).

年茶 三年药 七年宝 (one-year tea, three years medicine, seven years treasure). Thank you for joining me today. Do you drink tea?

The post Step Aside, Coffee — The Health Benefits of Tea appeared first on Medika Life.

Do you eat chocolate? I avoid commercial milk chocolate with its milk, sugar, cocoa butter, and small volumes of cacao. My preferred chocolate form, dark chocolate, has much more cacao and less sugar than its milk chocolate counterpart.

Let’s explore some of the potential cardiovascular upsides of consuming dark chocolate. We’ll look at some nutritional information and how much dark chocolate you should eat (and no, the answer is not all of it).

Chocolate and blood pressure

Regular consumption of dark chocolate may lower your chances of suffering from cardiovascular disease. For example, regularly eating dark chocolate can lower your blood pressure.

How does dark chocolate work its magic to lower blood pressure? Dark chocolate contains flavonoids, a substance that can stimulate nitric oxide production in your body.

The upside of this nitric oxide production? Nitric oxide results in widening blood vessels, which translates to better blood flow and lower blood pressure.

Here are the results of a small study from Iran looking at the effects of eating dark chocolate on 60 subjects with high blood pressure and type 2 diabetes.

Those who consumed 25 grams of dark chocolate daily for eight weeks had significantly lower blood pressure than individuals who ate the same amount of white chocolate.

Chocolate and cholesterol

“Your hand and your mouth agreed many years ago that, as far as chocolate is concerned, there is no need to involve your brain.”
― Dave Barry

Other compounds in dark chocolate target cholesterol; polyphenols and theobromine can lower “bad” low-density lipoprotein (LDL) cholesterol levels and increase “good” high-density lipoprotein (HDL) cholesterol.

Here’s some evidence: A 2017 clinical trial discovered that adding almonds, cocoa, and dark chocolate to the usual American diet (taking care not to exceed recommended daily calorie totals) improves lipid profiles.

The study authors volunteer that putting almonds, dark chocolate, and cocoa into your diet (without exceeding energy needs) may drop your heart disease risk. Together, almonds and dark chocolate lowered the number of small LDL particles.

Thank you for joining me today.

The post Three Heart Benefits of Dark Chocolate appeared first on Medika Life.

Let’s look at a myth about strokes before turning to the risk factors. We’ll end with some strategies to drop your risk of suffering from a stroke.

Myth: We can’t reduce stroke risk

This one hits close to home for me as my dad died of a heart attack and stroke in his 86th year. Friend to both Dr. Martin Luther King and Malcolm X and mentor to hundreds, his passing was a significant loss to many.

But there is this turn of events: Three weeks before his death, my father expressed that he had a full and wonderful life, that his grandchildren were on a path to success, and that he would die in three weeks. He died naturally, to the day.

Now, back to stroke risk-reduction. Here are the most common risk factors for stroke, according to Johns Hopkins Medicine (USA):

Stroke: Potentially modifiable risks

• High blood pressure (hypertension). A blood pressure of 140/90 or higher can damage blood vessels (arteries)providing your brain’s blood supply.
• Heart disease. Heart disease is the number two risk factor for stroke and the primary cause of death for stroke survivors. Stroke and heart disease share many risk factors.
• Diabetes
• Smoking
• Oral contraceptives (birth control pills)
• High blood cholesterol and lipids. High cholesterol levels can lead to thickening or hardening of the arteries (atherosclerosis) caused by plaque buildup. This buildup can decrease the amount of blood flow to the brain. A stroke occurs if there is a blockage of blood supply to the brain.
• Obesity
• Lack of exercise
• Excessive alcohol use. Consumption of more than two alcohol-containing drinks daily raises blood pressure. Binge drinking can lead to stroke.
• Illegal drugs. Intravenous drug abuse is associated with a high risk of stroke from blood clots. Cocaine and other drugs increase the risk of heart attacks, strokes, and many other cardiovascular problems.
• High red blood cell count. Blood thickening makes clots more likely. This thickening raises stroke risk.
• Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke. Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.
• Heart abnormalities. Damaged heart valves (valvular heart disease) can cause long-term heart damage. Over time, this can raise your risk for stroke.
• Mini-strokes (transient ischemic attacks or TIAs) have symptoms the same as with a stroke, but with a TIA, the symptoms are temporary. Here’s the problem: TIAs make it nearly 10-times more likely to have a stroke than someone of the same sex and age who has not experienced a TIA.

After a transient ischemic attack, the risk of stroke is somewhere between two and 17 percent within the first 90 days. Among patients with a transient ischemic attack, one in five will have a subsequent stroke, a heart attack, or die within one year.

There are many risk-reduction strategies for those who have suffered a TIA.

Stroke: Fixed risks

The risk of a stroke more than doubles for each decade after age 55. African-Americans have a significantly higher risk of stroke than whites, partly because African-Americans are more likely to suffer from high blood pressure.

While stroke occurs more commonly in men, more women than men die from the disease in the USA.

A history of a prior stroke increases the chances of having another one. Those with a family history of the condition have a higher risk, too. In the USA, strokes are more common in the country’s southeastern part.

Strokes occur more frequently during temperature extremes.

Stroke risk-reduction

I focus on modifiable risk factors. I avoid high blood pressure, tobacco, and work to tamp down my slightly high triglycerides. I am okay weight-wise and do not suffer from diabetes.

Physical activity and a healthy diet can go a long way to reducing these risk factors. Finally, I try to minimize stress. Hopefully, these lifestyle maneuvers will help me escape any genetics from my dad.

Get help FAST

FAST is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to get help fast. FAST stands for:

F — Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

A — Arm weakness. One arm is weak or numb. When the person lifts both arms simultaneously, one arm may drift downward.

S — Speech difficulty. You may see slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly when asked.

T — Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make a note of the time the symptoms first appeared.

The post A Big Stroke Myth You Should Know appeared first on Medika Life.

Today we explore a study suggesting that as blood pressure rises above 90 mm, we risk damaging our heart’s blood vessels (coronary arteries). Today we look at that recent discovery before turning to more practical issues about blood pressure measurement:

• How often should you check your blood pressure?
• What time of day is best?
• Should you immediately repeat the measurement?
• What substances should you avoid for 30 minutes before checking you?

First of all, thank you for joining me today and caring about your health.

Blood pressure basics

I recently bought a blood pressure measuring tool. Do you know what the medical term is for the device? Kudos if you know this remarkably long name: Sphygmomanometer.

When I measure my blood pressure, the machine gives me two numbers, systolic and diastolic blood pressure. The former refers to systole, when my heart pumps blood into the main blood vessels, the aorta.

Diastolic points to diastole, the resting time when blood refills the heart. My heartbeats and the blood pressure rises to the systolic level. In-between beats, it drops to the diastolic level.

I have long thought that I had ideal blood pressure, with a systolic blood pressure of 110 to 118. The American Heart Association agrees with my assessment, offering these observations about blood pressure:

• Normal: Systolic less than 120 and diastolic less than 80
• Elevated: Systolic 120 to 129 and diastolic less than 80
• High blood pressure, stage 1: Systolic 130 to 139 or diastolic 80 to 89
• High blood pressure, stage 2: Systolic 140 or higher or diastolic over 90
• High blood pressure crisis (contact a doctor immediately): Systolic 180 or higher or diastolic over 120

A medical professional must confirm a high blood pressure diagnosis. If you have shallow blood pressure, you should connect with a medical professional.

Blood pressure: A new normal?

Am I right in thinking I am perfect for my blood pressure? Now comes a study that calls our historical definitions of blood pressure into question.

The study title gets right to the point: “Intensive Blood Pressure Control Lowers Cardiovascular Risk.”

Let’s get a bit more granular: When systolic blood pressure rose above 90 mm, the risk of coronary artery damage rose with it. The study suggests that we have made significant improvements in modifying heart disease risk factors (such as tobacco cessation), but we have more work to do. Cardiovascular disease remains the leading cause of death in the USA.

For every 10 mm increase in systolic blood pressure, the risk of calcium deposits and cardiovascular events rose accordingly. Compared with people with systolic pressures of 90 to 99 mm, those with pressures of 120 to 129 mm were 4.58 times more likely to have experienced a cardiovascular event.

We in the USA (and elsewhere) have work to do. As we put on more and more pounds, we increase our risk of two risk factors for heart disease — type 2 diabetes and high blood pressure.

Yes, we have pills for treatment, but they can come with side effects. You probably know what I am going to say: Use lifestyle, including my five pillars of health:

• Move (walking is my go-to)
• Get adequate sleep
• Eat well (and watch your cholesterol and blood sugar levels)
• Mindfulness
• Community engagement

It goes without saying to avoid tobacco and to dodge excess alcohol. Now back to blood pressure. As positive encouragement, I offer this: Individuals in traditional non-industrial societies typically maintain systolic blood pressure in the low 90s throughout life.

Measuring your blood pressure

The Mayo Clinic offers guidance on performing accurate blood pressure monitoring at home:

• Check your blood pressure device’s accuracy. Check it against your healthcare provider’s office model before you start using a monitor. Your provider can also make sure you are using it correctly.
• Measure your blood pressure twice daily. Check in the morning before eating or taking medications, and check again in the evening. Aim for the same times each day.
• Don’t measure blood pressure immediately after you awaken. If you exercise in the morning, check before exercising.
• Avoid caffeine, alcohol, and tobacco use in the 30 minutes before measuring, and go to the toilet first (a full bladder may increase your blood pressure).
• Sit quietly during monitoring and always use the same arm. Get your arm to the level of your heart when measuring. Put the cuff on bare skin, not over clothing.
• Repeat the measurement one to three minutes after the first measurement. Write down the results.

Be kind to your heart, brain, and kidneys. Watch your blood pressure. Most of us, myself included, can do better. Thoughts?

The post Rethinking Blood Pressure appeared first on Medika Life.

“By 2050, Alzheimer’s disease and dementia prevalence will rise to nearly 13 million. To bring this back to a more understandable level, The Alzheimer’s Association offers this sobering statistic:

One in 3 seniors dies with Alzheimer’s or another dementia (such as dementia with Lewy bodies).

Let’s be clear: There is no proven cure or highly effective treatment for Alzheimer’s. Nevertheless, a growing body of research strongly suggests that combining healthy lifestyle habits can reduce your risk of cognitive decline.”

Dementia — risk factors

An update to the 2017 Lancet Commission report is our focus. Initially, the group reported nine potentially modifiable risk factors for dementia:

• less education
• high blood pressure (hypertension)
• hearing impairment
• smoking
• obesity
• depression
• physical inactivity
• diabetes
• low social contact

We can now add three more: Excessive alcohol consumption, traumatic brain injury, and air pollution.

Dementia — What can we do to reduce risk?

There is some good news: Given the 12 modifiable risk factors are responsible for approximately two in five cases of dementia worldwide, we have the opportunity to change the natural history of the disease for 40 percent of us.

The Lancet Commission report authors categorize risk reduction strategies as 1) reducing pathologic damage (inflammatory, blood vessel, or amyloid/tau plaque-related); and 2) maintaining or improving cognitive reserve.

I plan to stay active cognitively, socially, and physically. We have little evidence for any single activity protecting against Alzheimer’s and other forms of dementia. Still, sustained physical activity in midlife (and perhaps in later life, too) drops dementia risk. This improvement in odds may be secondary to the associated decreases in obesity, diabetes, and cardiovascular risk factors.

If my hearing diminishes, I will not be too proud to decline hearing aids. And you? How are you reducing your risk of suffering from memory loss? Oh, one more thing — Watch the sugary beverages:Drinking This Twice Daily May Increase Your Dementia RiskWHAT TYPES OF BEVERAGES do you enjoy? I enjoy a single cup of espresso each morning, a mid-morning cup of tea, and…medium.com.

The post Top 13 Ways to Cut Dementia appeared first on Medika Life.

 How so?

The COVID pandemic has changed the way we evaluate health technologies in four important and distinct ways.

1. Practicality replaces glitz.  The “Wow factor” is what mattered in the past.  “Look how cool this laser is that can identify your heart rhythm from 300 feet away!” “This headset lets me see how food travels through my body in real time!”   Technology can still be cool, but now the question is how will I use it?  Wearables that measure important variables like blood pressure will get more attention than new imaging tools that simply provide a clearer picture.
2. Prevention takes precedence over therapeutics.  COVID has demonstrated to us the importance of our personal health.  For too long, we made our jobs and other commitments our top priority.  Going forward, one’s personal health will become a major focus, especially as it relates to prevention.  How will a particular technology let me take control of my own health?  Nowadays, I am now more interested in a toilet that can monitor my urine for signs of diabetes or my stool for colorectal cancer than a device that creates holograms.  Once one gets pass the “icky” factor of some tools,  we will evolve to truly personalized preventive medicine.
3. Rigorous outcomes rule the day.  Everything now will be measured by how did it change patient outcomes.  Sure, it a device might show a new way to measure blood glucose – but what impact does it have on quality of life, co-morbidities, and life expectancy?
4. Consumer centricity rather than physician centricity.  In the past, technology has been focused on the health system and doctors.  It’s been a B-B approach.  That won’t go away, but more and more tech innovations will put the health consumer in charge.  For instance, I won’t be wearing a device that sends all the information to my doctor, but rather there will be more interpretation of all the data from wearables with direct communication to the patient.  This may require changes in regulation by the US Food and Drug Administration with a more practical definition of what constitutes a “medical device.” 

The real future of  digital health is when tech tools  continuously collect health data points and help interpret the information and provide preliminary diagnoses to patients.   The doctor isn’t going to be left out of this equation, but the difference will be that the patient will no longer be left out.  It’s the patient who will be at the center of how these technologies function from start to finish.

I’m sure I still going to be wow-ed this year and be entertained by the advancements we have made, especially during the last two years. But I’m also going to ask tougher questions on innovation, especially as relates to the purpose and impact.

The post Four Ways COVID has Changed Health Tech appeared first on Medika Life.

At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant and her blood pressure returns to normal within 12 weeks after delivery.

This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus. Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth. Some women who have gestational hypertension later develop preeclampsia.

Preeclampsia is similar to gestational hypertension because it also involves high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine. 

The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy). If it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.

A serious complication of hypertensive disorders in pregnancy is HELLP syndrome, a situation in which a pregnant woman with preeclampsia or eclampsia suffers damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:

• H – Hemolysis, in which oxygen-carrying red blood cells break down
• EL – Elevated Liver enzymes, showing damage to the liver
• LP – Low Platelet count, meaning that the cells responsible for stopping bleeding are low

Postpartum preeclampsia describes preeclampsia that develops after the baby is delivered, usually between 48 hours and 6 weeks after delivery. Symptoms can include high blood pressure, severe headache, visual changes, upper abdominal pain, and nausea or vomiting. Postpartum preeclampsia can occur regardless of whether a woman had high blood pressure or preeclampsia during pregnancy.

Postpartum eclampsia refers to seizures that occur between 48 and 72 hours after delivery. Symptoms also include high blood pressure and difficulty breathing. About one-third of eclampsia cases occur after delivery, and nearly half of those are more than 48 hours after the birth.

Postpartum preeclampsia and eclampsia can be serious and, if not treated quickly, may result in death.

How common is Preeclampsia

According to research referenced in the AHA Journals, with the greatest morbidity and mortality, preeclampsia affects 5% to 7% of all pregnant women but is responsible for over 70 000 maternal deaths and 500 000 fetal deaths worldwide every year. In the United States, it is a leading cause of maternal death, severe maternal morbidity, maternal intensive care admissions, cesarean section, and prematurity.

Risk factors for the development of preeclampsia have been studied extensively and major risk factors include;

• a history of preeclampsia,
• chronic hypertension,
• pregestational diabetes mellitus,
• antiphospholipid syndrome, and
• obesity, among others. 

Other risk factors include advanced maternal age, nulliparity, history of chronic kidney disease, and use of assisted reproductive technologies. Relatively rare risk factors are a family history of preeclampsia and mothers carrying a trisomy 13 fetus.

Does Preeclampsia target ethnic groups

According to an article published in the US National Library of Medicine entitled Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women, researchers found the following.

“In general, our results are consistent with findings from prior studies, which likewise showed that non-Hispanic blacks have a higher risk of pregnancy-induced hypertension and Asians/Pacific Islanders a lower risk of preeclampsia compared with non-Hispanic white women”

Warning Signs of Preeclampsia

Early signs and symptoms

Initially, pre-eclampsia causes:

• high blood pressure (hypertension)
• protein in urine (proteinuria)

You probably won’t notice any symptoms of either of these, but your doctor should pick them up during your routine antenatal appointments.

High blood pressure affects 10 to 15% of all pregnant women, so this alone doesn’t suggest pre-eclampsia, but if protein in the urine is found at the same time as high blood pressure, it’s a good indicator of the condition.

Further symptoms

As pre-eclampsia progresses, it may cause:

• severe headaches
• vision problems, such as blurring or seeing flashing lights
• severe heartburn
• pain just below the ribs
• nausea or vomiting
• excessive weight gain caused by fluid retention
• feeling very unwell
• sudden increase in oedema – swelling of the feet, ankles, face and hands

Without immediate treatment, pre-eclampsia may lead to a number of rare, but serious complications, including:

• convulsions (eclampsia)
• HELLP syndrome (a combined liver and blood clotting disorder)
• stroke

Signs in the unborn baby

The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby. The growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intra-uterine or foetal growth restriction.

If your baby is growing more slowly than usual, this will normally be picked up by your healthcare provider during your antenatal appointments.

Treating Preclampsia

Pre-eclampsia can only be cured by delivering your baby. If you have pre-eclampsia, you’ll be closely monitored until it’s possible to deliver the baby.

Once diagnosed, you’ll be referred to a hospital specialist for further assessment and any necessary treatment. If you only have high blood pressure without any signs of pre-eclampsia, you can usually return home afterwards and attend regular (possibly daily) follow-up appointments.

If pre-eclampsia is confirmed, you’ll usually need to stay in hospital until your baby can be delivered.

Monitoring in hospital

While you’re in hospital, you and your baby will be monitored by:

• having regular blood pressure checks to identify any abnormal increases
• having regular urine samples taken to measure protein levels
• having various blood tests – for example, to check your kidney and liver health
• having ultrasound scans to check blood flow through the placenta, measure the growth of the baby, and observe the baby’s breathing and movements
• electronically monitoring the baby’s heart rate using a process called cardiotocography, which can detect any stress or distress in the baby

Medication for high blood pressure

Medication is recommended to help lower your blood pressure. These medications reduce the likelihood of serious complications, such as stroke and have proven track records of safety. This means the medications have undergone clinical trials that have found them to be safe and effective for this purpose. An extensive list of these can be found below in the section labeled “For Healthcare Professionals”.

Other drugs may be considered by your doctor that have known benefits and can be used “off-label” (outside their licence) if it’s felt the benefits of treatment are likely to outweigh the risks of harm to you or your baby.

If your doctors recommend treatment with one of these medications, you should be made aware that the medication is unlicensed in pregnancy and any risks should be explained before you agree to treatment, unless immediate treatment is needed in an emergency.

Other medications

In clinical practice, therapies involving antiplatelet agents such as low aspirin doses (ACOG, 2018) and calcium supplementation in women with low calcium diets (Hofmeyr et al., 2014) have proven to bring small to moderate benefit to women with high risk pregnancies.

Anticonvulsant medication may be prescribed to prevent fits if you have severe pre-eclampsia and your baby is due within 24 hours, or if you have had convulsions (fits).

They can also be used to treat fits if they occur.

Delivering your baby

In most cases of pre-eclampsia, having your baby at about the 37th to 38th week of pregnancy is recommended. This may mean that labor needs to be started artificially (known as induced labor) or you may need to have a caesarean section.

This is recommended because research suggests there’s no benefit in waiting for labour to start by itself after this point. Delivering the baby early can also reduce the risk of complications from pre-eclampsia.

If your condition becomes more severe before 37 weeks and there are serious concerns about the health of you or your baby, earlier delivery may be necessary. Deliveries before 37 weeks are known as premature births and babies born before this point may not be fully developed.

You should be given information about the risks of both premature birth and pre-eclampsia so the best decision can be made about your treatment.

After the delivery

Although pre-eclampsia usually improves soon after your baby is born, complications can sometimes develop a few days later.You may need to stay in hospital after the delivery so you can be monitored.

Your baby may also need to be monitored and stay in a hospital neonatal intensive care unit if they’re born prematurely. These units have facilities that can replicate the functions of the womb and allow your baby to develop fully.

Once it’s safe to do so, you’ll be able to take your baby home.

You’ll usually need to have your blood pressure checked regularly after leaving hospital, and you may need to continue taking medication to lower your blood pressure for several weeks.

You should be offered a postnatal appointment 6 to 8 weeks after your baby is born to check your progress and decide if any treatment needs to continue. This appointment will usually be with your doctor.

For Healthcare Professionals

Treatment of hypertension in pregnant and postpartum women
Author:Phyllis August, MD, MPH
Section Editors:Charles J Lockwood, MD, MHCMGeorge L Bakris, MD
Deputy Editor:Vanessa A Barss, MD, FACOG

Please refer to the Full Article above for references and further reading

OVERVIEW OF ANTIHYPERTENSIVE DRUG OPTIONS

Overall safety — All antihypertensive drugs cross the placenta. There are no data from large well-designed randomized trials on which to base a strong recommendation for use of one drug over another. Data regarding both comparative efficacy in improving pregnancy outcome and fetal safety are inadequate for almost all antihypertensive drugs. Although adverse fetal and neonatal outcomes have been reported in women exposed to antihypertensive medications during pregnancy, clear conclusions about the impact of these drugs on pregnancy and the fetus are not possible given the significant methodologic weaknesses and lack of statistical power of available studies.

Adding to the confusion in this area are data suggesting that offspring of women with chronic hypertension, either treated or untreated, are at increased risk for congenital malformations, particularly cardiac malformations, compared with offspring of normotensive women. Although it is possible that hypertension increases the risk for congenital heart disease (CHD) and that antihypertensive drugs further increase this risk, it is also possible that hypertension and CHD share similar risk factors.

●In a meta-analysis that evaluated the risk of CHD in offspring of women with hypertension during pregnancy compared with offspring of women without hypertension, the risk of CHD was approximately 80 percent higher in women with hypertension (relative risk [RR] 1.8, 95% CI 1.5-2.2).

When the effect of treatment was analyzed, the risk of CHD was 100 percent higher in treated hypertensive women (RR 2.0, 95% CI 1.5-2.7) and 40 percent higher in untreated hypertensive women (RR 1.4, 95% CI 1.2-1.7).

The magnitude of effect was generally similar across subtypes of CHD and across the range of antihypertensive therapies; however, data were insufficient to exclude modest differences. Although a positive association was noted in 14 of 15 studies, these results should be interpreted with caution as neither a dose-response relationship between maternal antihypertensive medication and CHD nor some potentially important characteristics of the population (eg, severity of hypertension) could be ascertained.

Drug options — The following drugs are effective antihypertensive agents with an acceptable safety profile in pregnancy. The choice of drug depends on the acuity and severity of hypertension and whether parenteral or oral therapy is appropriate; these factors are discussed below. Response to antihypertensive medication is variable, and generalizations about comparative efficacy in overall or specific hypertensive populations are difficult to make. The most widely used medications (labetalol, methyldopa, hydralazine, nifedipine) have not been examined in comparative effectiveness trials.

Methyldopa — Methyldopa has been widely used in pregnant women and its long-term safety for the fetus has been demonstrated, but it is only a mild antihypertensive agent and has a slow onset of action (three to six hours). Many women will not achieve blood pressure goals on this oral agent or are bothered by its sedative effect at high doses.

Although methyldopa is not widely used outside of pregnancy, it remains useful in this setting, particularly in women who develop adverse effects or are intolerant of other, more widely used medications.

Methyldopa has been used for several decades, and its safety has been more extensively documented than other antihypertensive agents. Clinical trials (eg, Control of Hypertension in Pregnancy Study [CHIPS] ) utilized this agent and demonstrated that women treated with methyldopa may have had better outcomes compared with those treated with labetalol, although these data may be biased by residual confounding.

Beta blockers — Beta blockers are widely used in pregnancy. Asthma is a common contraindication as bronchospasm may occur.

●Choice of beta blocker

•Labetalol has both alpha- and beta-adrenergic blocking activity. It is the preferred drug in this class because early studies in experimental models suggested that it may preserve uteroplacental blood flow to a greater extent than traditional beta blockers. Labetalol has been associated with maternal hepatotoxicity, which, although rare, is important to recognize as it may be confused with the elevated liver chemistries of HELLP syndrome. Most cases are reversible, but fatalities have been reported.

•Although less well studied in pregnant women, metoprolol and pindolol are acceptable alternative agents.

Beta-adrenergic blockers that lack alpha blocking properties (eg, atenolol) have been associated with slightly lower placental and fetal weight at delivery when used early in pregnancy and are generally avoided if an effective drug with a better safety profile is available. In addition, myometrial relaxation of the gravid uterus is a beta-2-receptor-mediated process, and nonselective beta-adrenergic blockers (such as propranolol) may counteract the effect of beta-2 stimulation.

●Evidence of the safety of beta blockers –Despite the widespread use of labetalol in pregnancy, the safety of beta blockers remains somewhat controversial due to inconsistent reports of preterm birth, fetal growth restriction/small for gestational age infant, perinatal mortality, and neonatal apnea, bradycardia, and hypoglycemia, as well as inconsistent reports of an increased risk for congenital malformations. Further research is required given the limitations of available data, including inability to analyze data by type of beta blocker; variability in timing of exposure within the first trimester; and the fact that most studies did not address differences in indications for beta blocker therapy (eg, hypertension versus control of heart rate) or recall, recording, publication, and survivor biases.

•In a meta-analysis of 13 population-based case-control or cohort studies examining the risk of congenital malformations associated with first-trimester oral beta blocker exposure compared with no exposure, there was no overall increase in major congenital malformations (odds ratio [OR] 0.90, 95% CI 0.91-1.10). Associations with some organ-specific malformations were observed: cardiovascular defects (OR 2.01, 95% CI 1.18-3.42, four studies), cleft lip/palate (OR 3.11, 95% CI 1.79-5.43, two studies), and neural tube defects (OR 3.56, 95% CI 1.19-10.67, two studies).

•In a systematic review specifically examining the risk for congenital heart defects associated with treated and untreated maternal hypertension, beta blocker therapy was associated with an increased risk compared with no treatment (RR 2.1, 95% CI 1.6-2.7).

•Subsequent studies have reported conflicting results but overall have generally been reassuring that there is no large relative or absolute increase in the risk for overall malformations or cardiac malformations that is independent of measured confounders (eg, hypertension, obesity, diabetes). Most recently, the InPreSS consortium pooled data from large cohorts drawn from six countries and reported that beta blocker use was not associated with large increases in the relative and absolute risks for major malformations overall (RR 1.07, 95% CI 0.89-1.30; risk difference per 1000 persons exposed 3.0, 95% CI -6.6 to 12.6) or cardiac malformations (RR 1.12, 95% CI 0.83-1.51; risk difference per 1000 persons exposed 2.1, 95% CI -4.3 to 8.4), the most common class of birth defects. Strengths of this study were that medication use was defined on the basis of exposure during the first trimester, the major period of organogenesis; exposure was based on filled prescriptions, which avoided recall bias but did confirm actual intake of the medication; and the analysis was restricted to women with hypertension, addressing the issue of confounding by this common indication for beta blockers.

Calcium channel blockers

●Choice of calcium channel blocker

•Nifedipine is the most widely used drug in this class in pregnancy. It is available in immediate-release rapid-acting, intermediate-acting, and extended-release formulations. We generally prefer to use an intermediate- or extended-release formula. (See ‘Nifedipine’ below.)

•Although amlodipine is widely used in nonpregnant individuals with hypertension, there are sparse data on its use in pregnancy. The largest report of documented birth outcomes was among 231 Japanese women, of whom 48 had first-trimester exposure to amlodipine, 54 were exposed to other antihypertensives, and 129 had hypertension but were not exposed to any drug. The rate of fetal morphologic abnormalities was similar in the three groups (range 4.2 to 5.6 percent), suggesting that amlodipine may not be associated with an increased risk of malformations.

•Nondihydropyridine calcium antagonists, such as verapamil and diltiazem, have been used as well, although most reports in the literature included only a small number of women.

●Evidence of safety of calcium channel blockers – Calcium channel blockers have been widely used for tocolysis and acute blood pressure reduction in the second half of pregnancy, but minimal information is available on fetal effects in early pregnancy.

Although a meta-analysis of in utero exposure to antihypertensive medication found evidence of increased risks of stillbirth (OR 3.0, 95% CI 1.0-8.7), preterm birth (OR 4.6, 95% CI 2.9-7.3), and CHD (OR 1.4, 95% CI 1.2-1.7) in pregnancies exposed to calcium channel blockers, the ORs were based on single studies, and the studies did not evaluate the effect of treated versus untreated hypertension and did not specify the type of hypertensive disorder being treated.

Hydralazine — Intravenous hydralazine has been widely used for many years for treatment of acute severe hypertension in pregnancy and is an acceptable antihypertensive drug in this setting. However, the hypotensive response to intravenous hydralazine is less predictable than that seen with labetalol. Although hydralazine can be taken orally, it causes reflex tachycardia and fluid retention, which limit its usefulness in pregnancy.

A meta-analysis demonstrated a slightly increased rate of adverse events with hydralazine compared with labetalol, but the evidence was not sufficient to make a definitive recommendation for one drug over the other.

Thiazide diuretics — Diuretics are generally not used in pregnancy except for treatment of pulmonary edema. The role of thiazide diuretics has been a source of controversy for decades, although some guidelines suggest that these agents can be continued in women with chronic hypertension who were taking them prior to pregnancy. Significant volume depletion is not likely in this setting since most of the fluid loss occurs within the first two weeks of use, assuming that drug dose and dietary sodium intake are relatively constant.

Clonidine — Clonidine has a similar mechanism of action as methyldopa and can be an effective drug for treatment of nonsevere hypertension in pregnancy. However, it has bothersome side effects and the possibility of rebound hypertension if it is stopped suddenly, so other agents are preferred.

The author has prescribed clonidine for rare patients in whom methyldopa, labetalol, and nifedipine could not be used. Because clonidine is available as a transdermal patch, it is particularly useful for patients who cannot take an oral antihypertensive drug.

The post Preeclampsia and Eclampsia in Pregnancy appeared first on Medika Life.

I had a cut in my visual field in 2015. A magnetic resonance imaging (MRI) study revealed a large tumor in my pituitary gland region. Fortunately, surgery showed it to be benign, but I still needed three surgeries to reduce the tumor’s total gross removal.

The pituitary gland greatly influences our blood levels of the hormone testosterone. As the tumor had compromised my pituitary function, I no longer made much testosterone. My care team recommended testosterone supplementation. While it fixed the blood levels of this so-called male hormone, my blood pressure rose from a baseline of 90/60 mm Hg to 140/95.

I cannot overemphasize the role lifestyle played in getting my blood pressure down. For many (but not all) of us, turning to more healthy habits may be sufficient to bring blood pressure down to a safer level. Even if you need medications to help control your blood pressure, you should still optimize your healthy habits.

First, I continue to avoid tobacco-containing products. You probably already know that there is no safe level of the substance. Nicotine raises blood pressure and pulse. It also narrows your arteries and hardens their walls, making it more likely for you to have a clot. Smoking stresses your heart, raising your risk of a stroke or heart attack.

Drinking too much alcohol can lift blood pressure to unhealthy levels. Having more than three drinks in one sitting raises your blood pressure temporarily, but repeated binge drinking can lead to long-term increases.

For my patients, I ask them to consume no more than one drink daily if they are female and two if they are male. Still, there does not appear to be any safe level when it comes to cancer risk.

Second, I improved my diet. For me, the DASH diet formed the foundation for my approach to eating. DASH stands for Dietary Approaches to Stop Hypertension and aims to lower blood pressure. This method includes lots of fruits and vegetables, whole grains, and several servings daily of low-fat dairy products, some fish, poultry, nuts, dried beans, nuts, and seeds. There should be minimal consumption of sweets, red meat, and sugary beverages.

Do DASH diets work? Absolutely. One study showed that following the DASH diet for eight weeks allowed participants with high blood pressure to drop their blood pressure by 11.4 mm Hg in systolic (the top number) blood pressure and 5.5 mm Hg in diastolic (the bottom number) blood pressure.

I used a particular DASH diet, one with a high level of proteins. This approach appears to be better than a high-carbohydrate DASH-like diet. The high-protein diet dropped systolic blood pressure 3.5 points more than the high-carb diet in people with hypertension, for a total 16.5 point reduction.

A bonus? The high-protein approach also dropped LDL (“bad”) cholesterol three points more than the high-carb diet. Both approaches lowered HDL “good” cholesterol slightly. I had to turn to healthier snacks than my preferred pretzels. You may wish to substitute carrot sticks for potato chips or crackers. Air-popped popcorn (without butter) is sometimes a go-to snack for me. Finally, I upped my unsalted nut intake.

These DASH diet results are comparable to the effects of some drugs. Because those with borderline high blood pressure had improvements, the DASH diet may prevent hypertension from developing.

Honestly, I have not always been good about added salt to my diet. I worked to cut my sodium intake to no more than 1,000 milligrams per day. I had read that the American Heart Association suggests no more than 1,500 milligrams per day for most adults), especially if you are at higher risk.

Salt sensitivity appears to be most prevalent among those of us who are middle-aged or elderly, overweight, or African-American. Salt sensitivity also tends to become more prevalent as we age. I also raised my dietary intake of potassium, striving for 3,500 to 5,000 milligrams daily.

I dropped my weight from 165 pounds to 143 pounds. Weight loss may lower blood pressure by 5 to 20 mm Hg per 10 kg of weight loss in a patient with more than 10 percent of ideal body weight. Not surprisingly, the amount of blood pressure-lowering varies significantly among individuals.

I aimed to get a minimum of thirty minutes of moderate aerobic exercise on virtually all days of the week. Regular physical activity can reduce blood pressure by 5 to 7 mm Hg for those who already have high blood pressure. This drop can translate to a reduction of cardiovascular risk by 20 to 30 percent or nearly one-third.

Besides blood pressure improvement, modest amounts of exercise can also improve cholesterol, reduce plaque buildup in your arteries, and lower the chances of unwanted clots. You may strengthen your muscles and bones and see benefits in mood and mental functioning. Of course, if you have heart disease or other health problems, please check in with your doctor before initiating an exercise program.

Finally, I reduced my stress levels. I began walking for 45 minutes daily. I also started box breathing and, for a while, did Vinyasa flow yoga. Alas, the last no longer appeals to me. While the association between stress and high blood pressure remains unclear, stress is known to contribute to risk factors such as a poor diet and excessive alcohol consumption.

So, you may wonder how well I did with my aggressive and multifaceted approach to health improvement. Remember that 140/95 mmHg blood pressure that served as a wake-up call for me? I give you today:

A healthy lifestyle — including avoiding tobacco, minimizing my alcohol intake, eating nutritious foods, watching my salt intake, exercising almost every day, and lowering my stress levels — led to a remarkable improvement in my blood pressure and cholesterol levels.

The post How I Dropped My Blood Pressure (and You May Too) appeared first on Medika Life.

• Systolic blood pressure 120 (the first number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.
• Diastolic blood pressure 80 (the second number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

An easy way to to remember this is that up (or the top number) is when the pressure is up, and the bottom or down number is when the pressure is down. The measurement unit, mm Hg, simply means millimeters of mercury. Mercury was used in the first accurate pressure gauges and is still used in medicine today as the standard unit of measurement for pressure.

Which Number is more important?

Typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.

However, either an elevated systolic or an elevated diastolic blood pressure reading may be used to make a diagnosis of high blood pressure. According to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.

What readings are considered normal?

If your blood pressure falls within the following ranges then it’s considered normal, From 90-120/60-80 mm Hg. These numbers can also be adjusted for age. This chart will help you better understand the numbers

Your Heart Beat (Pulse Rate) and Blood Pressure

While your blood pressure is the force of your blood moving through your blood vessels, your heart rate is the number of times your heart beats per minute.

• They are two separate measurements and indicators of health.
• For people with high blood pressure (HBP or hypertension), there’s no substitute for measuring blood pressure.

A rising heart rate does not cause your blood pressure to increase at the same rate. Even though your heart is beating more times a minute, healthy blood vessels dilate (get larger) to allow more blood to flow through more easily. When you exercise, your heart speeds up so more blood can reach your muscles. It may be possible for your heart rate to double safely, while your blood pressure may respond by only increasing a modest amount.

Can other factors affect my Blood Pressure?

Yes. Each patient needs to be monitored and carefully assessed on an individual basis There are factors that can lead to a temporary elevation of your Blood pressure. You doctor will consider these factors if your blood pressure is unusually high and you can mention these to your Healthcare Provider.

1. White Coat Hypertension

Some people experience white coat hypertension, when blood pressure is elevated in the doctor’s office but not in other settings. These patients need to monitor their blood pressure at home or wear an ambulatory blood pressure monitor that takes your blood pressure every 30 minutes for 24 hours.

While white coat hypertension was formerly considered simple nervousness, recent research suggests otherwise.

A study published in the journal Hypertension found that people with white coat hypertension are at a significantly greater risk for developing sustained high blood pressure than people who have normal blood pressure. One possible explanation is that people with white coat hypertension have a harder time managing stress and anxiety.

2. Stress

Emotional stress and anxiety can temporarily increase blood pressure. Over time, excess stress can take a toll on your cardiovascular system and might lead to permanent blood pressure problems. 

3. Medication

Both over-the-counter and prescription medications can impact your blood pressure. Some medications, like diuretics and blood pressure pills, are designed to lower your blood pressure numbers. Others, like cold and allergy medications, can increase your blood pressure. Be sure to discuss any medication you may be taking with your doctor if you’re assessed with high blood pressure.

4. Activity

Exercise, talking, laughter, and even sex can cause blood pressure fluctuations. These increases are generally small and short lived. If you’ve been running to get your doctors appointment, resting a few minutes before you have your blood pressure taken will negate the effects and allow for a “normal” reading.

5. Food and Drink

What you eat or drink might impact your blood pressure reading. Foods high in tyramine, a substance found in aged foods, can increase blood pressure. This includes foods that are:

• fermented
• pickled
• brined
• cured

Drinks with caffeine can boost blood pressure numbers temporarily, too.

6. Adrenal Issues

Your adrenal system is responsible for hormone production. Adrenal fatigue occurs when your hormone production is low. Your blood pressure may fall as a result. An overactive adrenal system can cause sudden spikes in blood pressure and hypertension.

7. Pheochromocytoma

This rare tumor develops in the adrenal glands and impacts hormone production. It can cause sudden bursts of irregular blood pressure readings with normal spans in between.

Additional Risk Factors

These factors may put you at greater risk for experiencing fluctuating blood pressure:

• high levels of stress
• anxiety
• taking blood pressure pills that aren’t effective or don’t last until your next dose
• tobacco use
• excessive alcohol consumption
• night-shift work

Certain conditions can also increase your risk for developing an abnormal blood pressure. These include:

• diabetes
• pregnancy
• dehydration
• cardiovascular disease
• obstructive sleep apnea
• kidney disease
• thyroid problems
• nervous system problems

Further Resources

1. The American Heart Association
2. Center for Disease Control: Heart Health

The post Understanding Your Blood Pressure appeared first on Medika Life.