Apr
21
2013

World Health Day 2013, Focus on Hypertension

In the US high blood pressure causes 348,000 American deaths per year, in the world its death toll amounted to 9.4 million every year. This is unfortunate as high blood pressure is an illness, which can both be effectively treated and prevented. Uncontrolled high blood pressure (hypertension) causes heart attacks and strokes, can cause kidney failure, heart failure and blindness. You control blood pressure with lifestyle changes and/or medication,  and these risks go away.

The age standardized death rate  (Ref. 1) for both sexes in the US for heart disease is 80.5 per 100,000 and for strokes 25.4. In Canada these rates are 66.2 and 22.9; in Germany 75.0 and 31.2; in Italy 51.7 and 34.9, in Japan 31.2 and 36.7. The death rates from cardiovascular disease per 100,000 people in the same countries is as follows: in the US 172.2, in Canada 130.7, in Germany 200.2, in Italy 153.5 and in Japan 107.1.

There are obviously significant differences in these countries, which I will discuss further below.

On the occasion of the World Health Day, which was celebrated on 7 April 2013 to commemorate the founding of the WHO in 1948, with the topic of high blood pressure the World Health Organization has edited a PDF publication of 155 pages entitled “Global Atlas on cardiovascular disease prevention and control” (Ref.1, be patient, loads slowly). In it prevention and treatment for high blood pressure are discussed in detail. This text points out that there has been a remarkable decline in death rates from heart attacks and strokes (collectively called “cardiovascular disease”) between 1981 and 2000 in the United Kingdom. A thorough analysis of this showed that 58% of this decline was due to risk factor reduction in the whole population (reduction of smoking and heavy alcohol consumption, reduced salt intake, combatting physical inactivity and reduction of saturated fat intake). The other 42% of the decline in cardiovascular disease is due to treatment by a physician. So, it is clear from this that the majority of mortality prevention comes from the patient, less than 50% comes from the treating physician. However, it is important that physicians will educate their patients to cut out risk factors themselves in order to prevent hypertension.

World Health Day 2013, Focus on Hypertension

World Health Day 2013, Focus on Hypertension

Risk Factors for High Blood Pressure

In the past it was thought that most cases of high blood pressure would be due to “essential hypertension”, a term saying “we don’t know what causes high blood pressure”. Many physicians still use this term. Only a small amount of cases were considered “secondary” hypertension where the causes were known (e.g. kidney disease, hormonal imbalance, pregnancy). But in the meantime research by Harvard University and other research institutions has shown that there are a number of specific causes that contribute to high blood pressure, either alone or in combination.

Here are the commonly known causes: too much salt in our diet; we tend to not eat enough vegetables and salads; we like to sit in cars, in front of the TV or in front of the computer (physical inactivity). Many people still smoke, although tobacco is known to cause high blood pressure and lung cancer. Too much alcohol is known to cause hypertension as well. So the following steps will prevent high blood pressure :

  1. consuming less salt
  2. eating a balanced diet (preferably the DASH diet)
  3. engaging in regular physical activity
  4. avoiding tobacco use
  5. avoiding harmful use of alcohol (more than 2 oz. or 60 Grams per day)

Diabetes is known to worsen the risk for heart attacks and strokes and increases the risk of high blood pressure as well. So, some hidden risk factors for high blood pressure related to diabetes are as follows: a high fasting blood sugar; obesity; food with too much fat, too much sugar and too many starches (not enough complex carbohydrates).

What Can Be Done To Reduce Death Rates From High Blood Pressure?

As Canada is one of the countries where the death rate from strokes and heart attacks is lower than in the US or Germany, I like to point out some of the reasons for this. I practiced medicine in Canada for many years. The “Canadian Hypertension Education Program” have been guidelines for practicing physicians to follow providing effective screening and treatment of high blood pressure. Cardiologists at various continuing education conferences have promoted this. At my office I had a hypertension recall program where my staff called every patient with high blood pressure into the office every 3 months. We would review the home-measured blood pressure readings from the patient (recorded in a little booklet). I also took the blood pressure of the patient and so did my staff on the patient’s arrival. We reviewed the blood pressure medication and reviewed the possible side effects. The patient was also told what to do, if the blood pressure would be higher than normal (possible adjustments of the medication at home). I also encouraged my patients with regard to the life style issues (the 5 points mentioned above). Over the years the number of patients who developed heart attacks or strokes declined, as one would expect.

A recent review in the Canadian Family Physician mentions that there is room for improvement regarding the Canadian statistics. As mentioned above Italy and Japan are doing better with regard to mortality from heart attacks and strokes compared to Canada. We have a health care system in Canada that is available to every Canadian resident and funded by provincial taxes. In this system patients do not have to pay for office visits (although they pay for it indirectly through taxes). For the patient with high blood pressure it means that there is a system in place, which helps prevent cardiovascular disease and treats high blood pressure effectively. In my opinion the home recording of self-measured blood pressure readings at least once per day with a home blood measure monitor is vital to encourage the patient to be engaged with regard to his/her blood pressure problem.

Newer Findings About High Blood Pressure

For years physicians did not know where high blood pressure came from. In the last few years research has shown that nitric oxide plays an important role in preventing high blood pressure. It is produced by the lining of your arteries (by the so-called “endothelial cells”) and is the natural artery relaxer.

Foods that produce nitric oxide in the body are spinach, kale, red beet, cabbage varieties and other vegetable greens. These foods, which are also contained in the DASH diet, and regular exercise will stimulate the lining of your arteries to produce nitric oxide, which prevents high blood pressure, heart attacks and strokes. If all these measures and the above recommendations to prevent high blood pressure do not help, it is time to treat it. As already indicated above it is important that the patient who has been identified as needing high blood pressure treatment with medication, takes the medicine regularly (called ”compliance”). By keeping the blood pressure reading below 120/80 you prevent your risk of getting a heart attack, a stroke, heart failure or blindness from broken retinal vessels. If the patient develops any side effect from the medication, it is important to see the physician about this right away. It may be that the medication has to be adjusted or altered.

Nitric oxide can be taken as a supplement (Neo40), which allows the endothelial lining to be regenerated as indicated in this interview with the inventor, Dr. Nathan Bryan from the University of Texas Health Center in Houston.

The older we are, the more likely it is that our blood pressure will be high. As this link shows, 2 out of 3 people above the age of 60 in the US have systolic hypertension (the upper value of the blood pressure is elevated). As we age, it appears that the lining of the arteries do no longer produce the required amount of NO (nitric oxide) to prevent high blood pressure and prevent hardening of the arteries. So, it would be wise to adopt the Mediterranean diet with lots of vegetables, spinach, kale, bok choy, Swiss chard and others to boost your NO production, but still measure your blood pressure regularly. If you do not have a home blood pressure monitor, go to a pharmacy that allows you to check your blood pressure for free. If it is above 120 over 80 seek the advice of a health professional. You can find more information in Ref. 1.

In essence, what World Health Day 2013 asks us to do is to pay attention to your blood pressure and make sure it is normal.

More on high blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

References:

Ref. 1)  http://www.nethealthbook.com/articles/cardiovasculardisease_hypertension.php

Last edited Nov. 6, 2014

Apr
01
2008

Eat Your Veggies To Protect Your Eyes

A study at Brigham and Women’s Hospital in Boston has shown that nutrition impacts eye health. Over a stretch of 10 years Dr. William Christen followed a group of 35,551 health professionals age 45 and older. They provided him with detailed information about their dietary habits and vitamin supplements-they were permitted to take multivitamin but were requested not to take vitamin A, vitamin E or beta-carotene. None of them had cataracts in the beginning of the study, but 2,031 did develop cataracts during the follow up period. Dr. Christen and his team analyzed the data and found that those individuals who were the highest consumers of carotenoids- individuals with an intake of 6,617 mcg of lutein and zeaxanthin- were 18% less likely to develop cataracts than those who consumed only 1,177 mcg per day. Also, the group that consumed higher amounts of vitamin E (intakes of about 262.4 mg per day) was 14% less likely to develop cataracts. Lutein is a substance that is found in high concentration in eye tissue. It is readily available in many foods, such as green and yellow vegetables, yellow-fleshed fruit and in egg yolks.

Eat Your Veggies To Protect Your Eyes

Eat Your Veggies To Protect Your Eyes

New research from the National eye Institute in Baltimore has also confirmed the benefits of carotenoids for healthy eyes. Lutein and zeaxanthin offer protection against age-related macular degeneration. There is no need to shop for supplements. Just bring on the green vegetables: broccoli, brussels sprouts, kale, collard greens, and spinach. Add some corn, the spice saffron and some eggs, and enjoy the taste and the health benefits.

More information about cataracts: http://nethealthbook.com/eye-diseases-and-eye-related-topics/cataract/

Reference: The Medical Post, March 8, 2008, page 25

Last edited November 3, 2014

Jan
01
2007

Nanotechnology For Better Healing

Nanofibers for the healing of wounds can become a new technique to promote faster healing with less scarring. The application of these tiny fibres that consist of peptides can be manifold. The fibers can self-assemble into a mesh that can help heal areas affected by trauma. A mesh of the fibers applied to a bleeding wound can help the surgeon to stop the bleeding.The fibres can “knit” an injury,but they also can work in repairing areas of trauma in vital organs and restore tissue. Researchers have raised the possibility of application for the central nervous system too. So far the experience has come from animal experiments. Nanotechnology has been applied in animals, where the optic nerve had been severed and with the application of nanofibers the nerve could be “knitted” together and as a result the vision was restored.
The research comes from the Institute of Technology from Cambridge, Massachusetts where Rutledge Ellis-Behnke,PhD reported that healing of the nerve could be observed already within 24 hours. An incidental finding was that bleeding could be stopped when nanofibers were applied.This technique is unlike any other like cauterization. It is fast and as a result blood loss during surgery can be minimized and time needed for surgical procedures can be decreased, which translates into a faster recovery time for the patient.

Nanotechnology For Better Healing

Nanotechnology For Better Healing

Researchers are optimistic about the potential for clinical use, as the fibers are biodegradable and are excreted through the urine within 3-4 weeks or taken up by the tissue adjacent to the treatment site in the body.

Reference: JAMA. 2007;297:31 (Jan.3, 2007)

Last edited November 2, 2014

Feb
01
2006

Macular Degeneration Risk Less With Vitamins

Age related macular degeneration (AMD) is one of the more frequent reasons for loss of vision in the ageing population. The disease is also the most prevalent reason for blindness in developed countries.
A group of researchers from the Netherlands made it their mandate to investigate, in which proportion antioxidants were useful in the prevention of AMD. Supplementation with vitamins C, D and E was used and also beta-carotene and zinc. The observations were made using questionnaires from the Rotterdam Study (1990-1993).

The group on which the research concentrated consisted of inhabitants 55 years of age or older living in a middle class suburb of Rotterdam. Of 5836 at the baseline with a risk of AMD 4765 had reliable data of their dietary habits. At the end of the study 4170 participated in the follow up.
Dietary intake of vitamin E and zinc was inversely associated with the development of AMD: the group with an intake of vitamin E and zinc had less macular degeneration than those whose diet was deficient. A higher than median intake of all the four nutrients, vitamin E, zinc, vitamin C and beta-carotene showed even more benefit. The risk to develop macular degeneration was reduced by an impressive 31 %.

Macular Degeneration Risk Less With Vitamins

Macular Degeneration Risk Less With Vitamins

These results are of importance to the ageing population and the elderly. A high dietary intake of the four nutrients is important in the risk reduction of age related eye diseases like AMD.

Reference: JAMA. 2005; 294:3101-3107; Vol. 294, No. 24, December 28, 2005

Last edited December 6, 2012

Sep
01
2005

Getting Ready For Ragweed Allergies Is Important

Allergies are often associated with watery eyes and sneezing, and in commercials that promote over-the counter anti-allergy pills (antihistamines) the effects are shown as merely bothersome. The commercials are often amusing. The facts for the allergy sufferer are neither amusing nor are allergies a minor bother. They have to be taken serious, as they can affect the quality of life and even be potentially life threatening. A very common plant that can be the culprit for serious allergies is ragweed. Two varieties of the plant are accounting for the worst problems, Ambrosia trifida and Ambrosia artemisiifolia. People who are sensitized to the pollen of ragweed have the most severe symptoms in the months of August to October. Nasal congestion, sneezing, a constantly runny nose and itchiness of eyes, nose and throat are the problems that are encountered by the patient, but asthma can be the more serious consequence. The quality of life in the peak season of ragweed shows significant deterioration for allergy sufferers, as nasal congestion alone is linked to poor sleep quality which in turn leads to decreased productivity at work or in school. A skin rash can be another form of an allergic reaction. It is the less common form of ragweed allergy, but left untreated it becomes chronic and progressively worse. Other herbal products (chamomile and arnica), which may be used as compresses and as an ontment, can cross-react with ragweed exposure and produce a skin rash or dermatitis. Adults are more affected than children, and people with outdoor occupation (farmers, gardeners, harvesters, carpenters) are the group most at risk. Unfortunately, ragweed particles are very small and very light, which makes it very difficult to avoid them in the peak season, but there are measures one can take to avoid exposure.

Getting Ready For Ragweed Allergies Is Important

Getting Ready For Ragweed Allergies Is Important

The peak time of pollen exposure is in the middle of the day, and it is a good idea to keep the windows closed to prevent large amounts of pollen from drifting into your home. The use of an air conditioner in the car or at home can be helpful. After spending time outdoors it can be helpful to change into fresh clothes and perhaps even take a shower. Drying clothes on the laundry line in peak season should be avoided, as they are prone to collect large amounts of pollen.

Getting Ready For Ragweed Allergies Is Important1

Ragweed Blossoms Late In The Season

Timing vacations to leave ragweed-infested areas for other parts of the country can also help. It is also important to take action as soon as symptoms are present. Letting things take their course, will just have a snowball effect. An allergist can do patch tests to determine whether there is a reaction to ragweed. If ragweed dermatitis is present, it has to be treated early on to avoid the difficult to treat chronic state, in which a lower UV threshold is also part of the condition. Decongestants may help with nasal congestion, but unfortunately they tend to cause side effects, such as sleeplessness and a rapid heart beat. The physician can point out the most effective antihistamine to the patient, and intranasal cortico steroids (INCS) may be preferable over oral antihistamines. Newer INCS medications have shown to provide quick control of nasal symptoms, and they can actually minimize the emergence of symptoms, if they are started before the ragweed season begins in mid summer.

More info about asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

Reference: Allergy & Asthma, Summer 2005, page 4-9, page 13-16

Last edited October 29, 2014

Aug
01
2005

New Drug Reverses Macular Degeneration

Age-related macular degeneration in the past meant blindness for the patient. In more recent years laser surgery could be a sight saver, but it also meant a more invasive treatment.
The arrival of new anti-angiogenic drugs that can reverse age-related macular degeneration has received a lot of attention at the recent Schepens International Society ophthalmology meeting. The new drugs Macugen (pegaptanib sodium injection) and Lucentis (ranibizumab) were showing that they stopped the disease in 95% of cases. They were injected into the vitreous of the eye, and the vision of those patients who took it, actually improved.
Macugen has been approved by Health Canada and will be launched for use in September 2005, according to Pfizer, the company behind the drug therapy.
The research goes back to the 1970’s with the discovery of a process that forms new blood vessels in the body allowing tumors to thrive and metastasize. This research revolutionized the understanding of cancer. The new anti-angiogenic drugs fight a protein that induces angiotensin and is responsible for the abnormal blood vessel growth under the retina. This blood vessel growth causes macular degeneration (the wet form).

New Drug Reverses Macular Degeneration

New Drug Reverses Macular Degeneration

Dr. Judah Folkman, a Harvard professor of cell biology, gave the presentation and he stated that this new approach would be “a lot of hope to patients.”

More information about macular degeneration: http://nethealthbook.com/eye-diseases-and-eye-related-topics/retinal-problems/macular-degeneration/

Reference: The Medical Post, July 5, 2005, page1, 58

Last edited October 29, 2014

May
01
2004

Age-Related Macular Degeneration Can Be Postponed

In a well-controlled study that was published earlier in 2004 Dr. Johanna M. Seddon

has shown that age-related blindness (AMD) is caused from an inflammation in the blood vessels, which is associated with an elevated blood marker, called C-reactive protein (CRP). The authors of this study also showed that the dry form of AMD would tend to deteriorate with age and/or from smoking cigarettes into the more serious wet form, a common cause of blindness.

The inflammatory component of cardiovascular disease is known to be controlled by the use of aspirin (ASA) or the statins, medication that is known to lower the bad LDL cholesterol. It is with this background that the author of the study that I am reviewing here, Dr. Jacque L. Duncan from the University of California at San Francisco, has examined the effects of ASA and of statins on AMD. 326 patients with AMD (204 with dry AMD, 104 with wet AMD from blood vessels forming underneath the retina and 18 with geographic atrophy) were followed between January 1990 and March 2003. Patients were at least 60 years old or older and followed at the San Francisco VA Hospital Eye Clinic.
Dr. Duncan found that patients with blindness due to wet AMD used ASA or statins significantly less than patients with stable AMD. Moreover, he found that patients who had AMD and took statins were 49% less likely to develop wet AMD and if they took ASA the were 37% less likely to develop wet AMD.

Age-Related Macular Degeneration Can Be Postponed

Age-Related Macular Degeneration Can Be Postponed

The study also suggests that there is a link between the inflammatory process that leads to heart attacks and strokes on the one hand and the further deterioration to blindness when dry AMD is not treated on the other hand. The notion that inflammation is the missing link in both of these processes is a relatively new finding.

More information about Macular Degeneration here.

Based on article by Dr. Jacque L. Duncan in the American Journal of Ophthalmology 2004;137: 615-624.

Last edited October 26, 2014

Mar
01
2004

Inflammatory Marker Linked To Blindness

Up to now age-related blindness or “age-related macular degeneration” (AMD) as it is medically called, has been a mystery. The retina is the light-sensitive area of the eye similar to the film in a camera. The “macula” is that part of the retina that has the highest visual acuity. Several studies have been conducted lately regarding age-related blindness that shed more light on this important health hazard of old age, studies that one day might even lead to a cure or powerful preventative measures to avoid it from ever developing.

One such study is the one by Dr. Johanna M. Seddon and co-workers published in the Feb. 11, 2004 issue of the Journal of the American Medical Association. Almost 1000 patients with various degrees of age-related degrees of blindness from the Age-Related Eye Disease Study (AREDS) were classified by the degree of their macular degeneration. I have produced the bar graphs below based on these studies.

Four groups were defined, namely those with no AMD who served as controls, those with mild AMD, those with moderate AMD and those with severe AMD who were legally blind. They suspected that an inflammatory marker in the blood stream of these patients, called C-reactive protein (CRP), might be present in the more severe cases of blindness when compared to the control group who did not have any inflammatory changes in the macula. As can be seen by the bar graph above this is exactly what the test results indicated. They also found that smokers (blue bars) tended to have slightly worse blood tests in terms of CRP (more inflammatory substances circulating in the system) within the same severity category of the age-related eye changes.

CRP (mg/L) Levels in Various Degrees of Severity of Age-related Macular Degeneration (AMD)

Inflammatory Marker Linked To Blindness

Inflammatory Marker Linked To Blindness

When the investigators studied the risk for the highest percentile of the CRP tests within various subgroups to show AMD they found several differences as is shown in the next table. First there was a low probability to develop AMD in a person with a normal looking macula and that risk was set at 1.0 as comparison. In contrast a person with a normal looking macula who smokes has a 1.5-fold risk of developing AMD later. Patients with a moderate degree of AMD have about a 2-fold risk of getting a severe degree of AMD later (smoking or not). It seems that once the inflammatory cycle has started, the process of causing a moderate degree of AMD is so strong that the effect of smoking will not add that much in comparison.

This is the first study of this kind that has established that CRP can be used as a screening for the risk to develop AMD. CRP has already been established as a test for monitoring progress in rheumatoid arthritis or to monitor for the risk of developing a heart attack or stroke.

Another study by Dr. Johanna M. Seddon and co-workers was published recently in the Archives of Ophthalmology. 261 people aged 60 years and older with established AMD were followed for 4.6 years and checked for deterioration. 101 patients had deterioration of their AMD.

Risk of Developing Age-Related Macular Degeneration (AMD) in Highest CRP Percentile
 Inflammatory Marker Linked To Blindness1

The authors analyzed the patients’ diet habits and found that increased fat intake was a high risk factor for deteriorating AMD. Both vegetable and animal fat had a 2-to 3-fold increased risk for deterioration of the AMD to a more severe stage (legal blindness). Fish, omega-3 fatty acid and nuts had a protective effect, but only when omega-6 fatty acid (linoleic acid) intake was low in the same group. The studies showed that the risk of age-related blindness was reduced by 40% when patients ate nuts at least once per week. The authors concluded that a “fat conscious diet” would be good for “maintaining good eye health” and at the same time be beneficial for prevention of heart attacks and strokes.

The authors will do further studies to investigate potential ways of helping patients with AMD and to understand the mechanisms of the disease process better.

References: 1. JAMA 2004;291:704-710  2. Arch Ophthalmol – 01-DEC-2003; 121(12): 1728-37

Last edited December 8, 2012

Jan
01
2003

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

In the January 18, 2003 issue of the Lancet (Lancet 2003; 361:195-200) Dr. Dr. Naveed Younis and his collegues published a study from the Royal Liverpool University Hospital, U.K. where diabetic patients underwent thorough eye examinations in regular intervals for 5 years. The question of this study was whether it mattered at what interval patients would be examined with regard to their eye-sight, so that perhaps blindness could be postponed or avoided through early interventions.

At the baseline of the study a special eye-photography method (three-field mydriatic photography) was used to document the blood vessel changes in the back of the eye. This helps the physician to assess whether or not there is a degree of retinopathy (blood vessel damage from diabetes) of the eyes or not. The investigators defined three groups:

For group one (no eye damage in the beginning of the study) there was a retinopathy rate of 0.3% at the end of the first year. Group two (moderate retinopathy in the beginning) showed a worsening of the retinopathy at the end of the first year of 5% (threatening blindness). Group three (significant retinopathy in the beginning) showed a rate of 15% of worsening retinopathy (threatening blindness) at the end of one year.

The Liverpool Eye Study...How Often The Eye Sight Of Patients With Diabetes Should Be Examined

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

This shows that not every person with diabetes is equal with respect of having the threat of blindness. The medical investigators found that about 70% of patients fell into the group that did not have serious diabetic retinopathy. However, the other 30% would not do well with simply yearly eye examinations as it is recommended now. Instead the authors of the Liverpool study were able to make practical recommendations as follows:

After a baseline eye examination those who belong into group one would get an eye examination every 3 years. Those with prior moderate retinopathy (group2) on the initial baseline examination would get examinations at yearly intervals (until the degree of retinopathy worsens). Group 3 with significant retinopathy at the beginning would, however, be examined every 4 months (new recommendation) so that blindness hopefully could be avoided or significantly postponed through interventional therapies.

The following link is telling you about hardening of the artieries (arteriosclerosis) and how diabetes accelerates this process:

The following site is about the metabolic effects of diabetes on the body and in particular also about the danger of diabetic retinopathy:

Diabetes: http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited December 10, 2012