Routinely drinking alcohol may raise blood pressure even in adults without hypertension

Even in adults without hypertension, blood pressure readings may climb more steeply over the years as the number of daily alcoholic drinks rise, according to an analysis of seven international research studies published today in Hypertension, an American Heart Association journal.

With the statistical power of seven international research studies, this analysis confirms for the first time there was a continuous increase in blood pressure measures in both participants with low and high alcohol intake. Even low levels of alcohol consumption were associated with detectable increases in blood pressure levels that may lead to a higher risk of cardiovascular events.

"We found no beneficial effects in adults who drank a low level of alcohol compared to those who did not drink alcohol," said senior study author Marco Vinceti, M.D., Ph.D., a professor of epidemiology and public health in the Medical School of the University of Modena and Reggio Emilia University in Italy and an adjunct professor in the department of epidemiology at Boston University's School of Public Health. "We were somewhat surprised to see that consuming an already-low level of alcohol was also linked to higher blood pressure changes over time compared to no consumption -- although far less than the blood pressure increase seen in heavy drinkers."

"Our analysis was based on grams of alcohol consumed and not just on the number of drinks to avoid the bias that might arise from the different amount of alcohol contained in 'standard drinks' across countries and/or types of beverages," said study co-author Tommaso Filippini, M.D., Ph.D., an associate professor of epidemiology and public health in the Medical School of the University of Modena and Reggio Emilia in Italy, and affiliate researcher at the University of California Berkeley School of Public Health.

Researchers reviewed the health data for all participants across the seven studies for more than five years. They compared adults who drank alcohol regularly with non-drinkers and found:
 

• Systolic (top number) blood pressure rose 1.25 millimeters of mercury (mm Hg) in people who consumed an average of 12 grams of alcohol per day, rising to 4.9 mm Hg in people consuming an average of 48 grams of alcohol per day. (In the U.S., 12 ounces of regular beer, 5 ounces of wine or a 1.5 ounce shot of distilled spirits contains about 14 grams of alcohol. Usual alcohol content differs in alcohol available in other countries.)
• Diastolic (bottom number) blood pressure rose 1.14 mm Hg in people consuming an average of 12 grams of alcohol per day, rising to 3.1 mm Hg in people consuming an average of 48 grams of alcohol per day. These associations were seen in males but not in females. Diastolic blood pressure measures the force against artery walls between heartbeats and is not as strong a predictor of heart disease risk in comparison to systolic.

"Alcohol is certainly not the sole driver of increases in blood pressure; however, our findings confirm it contributes in a meaningful way. Limiting alcohol intake is advised, and avoiding it is even better," Vinceti said.

Although none of the participants had high blood pressure when they enrolled in the studies, their blood pressure measurements at the beginning did have an impact on the alcohol findings.

"We found participants with higher starting blood pressure readings, had a stronger link between alcohol intake and blood pressure changes over time. This suggests that people with a trend towards increased (although still not "high") blood pressure may benefit the most from low to no alcohol consumption," said study co-author Paul K. Whelton, M.D., M.Sc., the Show Chwan Chair in Global Public Health in the department of epidemiology at Tulane University's School of Public Health and Tropical Medicine in New Orleans and president of the World Hypertension League. Whelton is also the chair of the American Heart Association's 2017 Hypertension Practice Guidelines and a member of the writing committee for the Association's 2021 Scientific Statement on Management of Stage 1 Hypertension in Adults.

According to American Heart Association recommendations, if you don't drink already, don't start. If you do drink, talk with your doctor about the benefits and risks of consuming alcohol in moderation. The Association also does not recommend drinking any form of alcohol to gain potential health benefits. Instead, follow the Association's lifestyle and health metrics for optimal cardiovascular health called Life's Essential 8: eat healthy food, be physically active, don't smoke, get enough sleep, maintain a healthy weight, and control cholesterol, blood sugar and blood pressure levels.

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Being fit partially offsets negative impact of high blood pressure

High fitness levels may reduce the risk of death from cardiovascular disease in men with high blood pressure, according to a 29-year study published today in the European Journal of Preventive Cardiology, a journal of the ESC.

"This was the first study to evaluate the joint effects of fitness and blood pressure on the risk of dying from cardiovascular disease," said study author Professor Jari Laukkanen of the University of Eastern Finland, Kuopio, Finland. "The results suggest that being fit helps protect against some of the negative effects of high blood pressure."

Nearly 1.3 billion adults aged 30 to 79 years worldwide have high blood pressure (hypertension). Hypertension is a major risk factor for heart attack and stroke and a leading cause of premature death globally. Previous studies have shown that high cardiorespiratory fitness is linked with greater longevity. This study examined the interplay between blood pressure, fitness and risk of death from cardiovascular disease.

The study included 2,280 men aged 42 to 61 years living in eastern Finland and enrolled in the Kuopio Ischaemic Heart Disease Risk Factor Study. Baseline measurements were conducted between 1984 and 1989. These included blood pressure and cardiorespiratory fitness, which was assessed as maximal oxygen uptake while riding a stationary bicycle. Blood pressure was classified as normal or high, and fitness was classified as low, medium or high.

The average age at baseline was 53 years. Participants were followed up until 2018. During a median follow up of 29 years, there were 644 deaths due to cardiovascular disease. The risk of death from cardiovascular disease was analysed after adjusting for age, body mass index, cholesterol levels, smoking status, type 2 diabetes, coronary heart disease, use of antihypertensive medication, alcohol consumption, physical activity, socioeconomic status, and high sensitivity C-reactive protein (a marker of inflammation).

Considering blood pressure alone, compared to normal values, high blood pressure was associated with a 39% increased risk of cardiovascular mortality (hazard ratio [HR] 1.39; 95% confidence interval [CI] 1.17-1.63). Considering fitness alone, compared with high levels, low fitness was associated with a 74% elevated likelihood of cardiovascular death (HR 1.74; 95% CI 1.35-2.23).

To evaluate the joint associations of blood pressure and fitness with risk of cardiovascular death, participants were categorised into four groups: 1) normal blood pressure and high fitness (this was the reference group for comparison); 2) normal blood pressure and low fitness; 3) high blood pressure and high fitness; 4) high blood pressure and low fitness.

Men with high blood pressure and low fitness had a more than doubled risk of cardiovascular death compared to those with normal blood pressure and high fitness (HR 2.35; 95% CI 1.81-3.04). When men with high blood pressure had high fitness levels, their elevated risk of cardiovascular risk persisted but was weaker: it was 55% higher than those with normal blood pressure and high fitness (HR 1.55; 95% CI 1.16-2.07).

Professor Laukkanen said: "Both high blood pressure and low fitness levels were each associated with an increased risk of cardiovascular death. High fitness levels attenuated, but did not eliminate, the increased risk of cardiovascular mortality in men with elevated blood pressure."

The paper states: The inability of cardiorespiratory fitness to completely eliminate the risk of cardiovascular mortality in those with high blood pressure could partly be due to the strong, independent and causal relationship between blood pressure and cardiovascular disease.

Professor Laukkanen concluded: "Getting blood pressure under control should remain a goal in those with elevated levels. Our study indicates that men with high blood pressure should also aim to improve their fitness levels with regular physical activity. In addition to habitual exercise, avoiding excess body weight may enhance fitness."

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Ten-minute scan enables detection and cure of the commonest cause of high blood pressure

Doctors at Queen Mary University of London and Barts Hospital, and Cambridge University Hospital, have led research using a new type of CT scan to light up tiny nodules in a hormone gland and cure high blood pressure by their removal. The nodules are discovered in one-in-twenty people with high blood pressure.

Published today in Nature Medicine, the research solves a 60-year problem of how to detect the hormone producing nodules without a difficult catheter study that is available in only a handful of hospitals, and often fails. The research also found that, when combined with a urine test, the scan detects a group of patients who come off all their blood pressure medicines after treatment.

128 people participated in the study of a new scan after doctors found that their Hypertension (high blood pressure) was caused by a steroid hormone, aldosterone. The scan found that in two thirds of patients with elevated aldosterone secretion, this is coming from a benign nodule in just one of the adrenal glands, which can then be safely removed. The scan uses a very short-acting dose of metomidate, a radioactive dye that sticks only to the aldosterone-producing nodule. The scan was as accurate as the old catheter test, but quick, painless and technically successful in every patient. Until now, the catheter test was unable to predict which patients would be completely cured of hypertension by surgical removal of the gland. By contrast, the combination of a 'hot nodule' on the scan and urine steroid test detected 18 of the 24 patients who achieved a normal blood pressure off all their drugs.

The research, conducted on patients at Barts Hospital, Cambridge University Hospital, and Guy's and St Thomas's, and Universities of Glasgow and Birmingham, was funded by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership, Barts Charity, and the British Heart Foundation.

Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, said: "These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan. When they glow for a few minutes after our injection, they are revealed as the obvious cause of Hypertension, which can often then be cured. Until now, 99% are never diagnosed because of the difficulty and unavailability of tests. Hopefully this is about to change."

Professor William Drake, co-senior author of the study and Professor of Clinical Endocrinology at Queen Mary University of London, said:"This study was the result of years of hard work and collaboration between centres across the UK. Much of the 'on the ground' energy and drive came from the talented research fellows who, in addition to doing this innovative work, gave selflessly of their time and energy during the national pandemic emergency. The future of research in this area is in very safe hands."

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Parkinson's medication improved blood pressure in teens with Type 1 diabetes

Teens with Type 1 diabetes (T1D) who took bromocriptine, a medication used to treat Parkinson's disease and Type 2 diabetes, had lower blood pressure and less stiff arteries after one month of treatment compared to those who did not take the medicine, according to a small study published today in Hypertension, an American Heart Association journal.

High blood pressure and stiff arteries contribute to the development of heart disease. People with T1D, a lifelong, chronic condition in which the pancreas doesn't produce enough insulin to control blood sugar levels, have a higher risk of developing heart disease than those without the condition. Those diagnosed with T1D as children have even higher risks for heart disease than people diagnosed in adulthood. Therefore, researchers are interested in ways to slow down the onset of vascular disease in children with T1D.

"We know that abnormalities in the large vessels around the heart, the aorta and its primary branches, begin to develop in early childhood in people with Type 1 diabetes," said lead study author Michal Schäfer, Ph.D., a researcher and fourth-year medical student at the University of Colorado School of Medicine in Aurora, Colorado. "We found that bromocriptine has the potential to slow down the development of those abnormalities and decrease the risk for cardiovascular disease in this population."

The multidisciplinary team conducted this study to examine the impact of bromocriptine on blood pressure and aortic stiffness compared with a placebo in adolescents with Type 1 diabetes. Bromocriptine is in a class of medications called dopamine receptor agonists. It increases levels of dopamine, a chemical in the brain, which leads to an increase in the body's responsiveness to insulin, called insulin sensitivity. Bromocriptine has been FDA-approved since 2009 to treat adults with Type 2 diabetes due to its effect on insulin sensitivity.

The study included 34 participants (13 male, 21 female) ages 12 to 21 years who had been diagnosed with Type 1 diabetes for at least a year, and their HbA1c (glycosylated hemoglobin -- a measure of blood glucose) was 12% or less. An HbA1c level of 6.5% or higher indicates diabetes. They were randomly divided into two groups of 17, with one group receiving bromocriptine quick-release therapy and the other receiving a placebo once daily. The study was conducted in two phases. Participants took the first treatment or placebo for 4 weeks in phase 1, then had no treatment for a 4-week "wash-out" period, followed by phase 2 with 4 weeks on the opposite treatment. In this "crossover" design, each participant served as their own control for comparison.

Blood pressure and aortic stiffness were measured at the start of the study and at the end of each phase. Aortic stiffness was determined by assessing the large arteries with cardiovascular magnetic resonance imaging (MRI) and a measurement of the velocity of the blood pressure pulse called pulse wave velocity.

The study found:
 

• Compared to placebo, blood pressure was significantly decreased with bromocriptine. On average, bromocriptine therapy resulted in a systolic blood pressure decrease of 5 mm Hg and a diastolic blood pressure decrease of 2 mm Hg at the end of 4 weeks of treatment.
• Aortic stiffness was also reduced with bromocriptine therapy. The improvement in aortic stiffness was most pronounced in the ascending aorta with a lowered pulse wave velocity of about 0.4 meters/second, and an increase in distensibility, or elasticity, of 8%. In the thoraco-abdominal aorta, bromocriptine was associated with a lowered pulse wave velocity of about 0.2 meters/second, with a 5% increase in distensibility.

"A stiff aorta predisposes a patient to other health issues, such as organ dysfunction or atherosclerosis and higher stress or strain on cardiac muscle," Schäfer said. "We were able to take it a notch further and show, using more sophisticated metrics, that these central large arteries are impaired, and impairment among adolescents and young adults with Type 1 diabetes may be decelerated with this drug."

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How measuring blood pressure in both arms can help reduce cardiovascular risk and hypertension

Blood pressure should be measured in both arms and the higher reading should be adopted to improve hypertension diagnosis and management, according to a new study.

The research, led by University of Exeter, analysed data from 53,172 participants in 23 studies worldwide to examine the implications of choosing the higher or lower arm pressure.

The study, published in Hypertension, found that using the higher arm blood pressure reading reclassified 12 per cent of people as having hypertension, who would have fallen below the threshold for diagnosis if the lower reading arm was used.

Although International guidelines advise checking blood pressure in both arms, the practice is currently not widely adopted in clinics.

Study lead Dr Christopher Clark, from the University of Exeter, said: "High blood pressure is a global issue and poor management can be fatal. This study shows that failure to measure both arms and use the higher reading arm will not only result in underdiagnosis and undertreatment of high blood pressure but also under-estimation of cardiovascular risks for millions of people worldwide."

The team found that using the higher arm measurement compared to using the lower arm resulted in reclassification of 6572 (12.4%) of participants' systolic blood pressures from below to above 130 mm Hg, and 6339 (11.9%) from below to above 140 mm Hg, moving them above commonly used diagnostic thresholds for hypertension.

Dr Clark continued: "It's impossible to predict the best arm for blood pressure measurement as some people have a higher reading in their left arm compared to right and equal numbers have the opposite. Therefore, it's important to check both arms as detecting high blood pressure correctly is a vital step towards giving the right treatment to the right people."

"Our study now provides the first evidence that the higher reading arm blood pressure is the better predictor of future cardiovascular risk."

The study also revealed that higher arm blood pressure readings better predicted all-cause mortality, cardiovascular mortality, and cardiovascular events, compared to the lower arm reading. The authors stressed the importance of assessing both arms in the diagnosis and management of hypertension and cardiovascular diseases.

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About 3 grams a day of omega-3 fatty acids may lower blood pressure, more research needed

About 3 grams daily of omega-3 fatty acids, consumed in foods or supplements, appears to be the optimal daily dose to help lower blood pressure, according to a research review published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are typically found in fatty fish, such as salmon, tuna, sardines, trout, herring and oysters. Some people also take combined DHA and EPA in supplements. While some studies suggest that consumption of omega-3 fatty acids may lower blood pressure, the optimal dosage needed to lower blood pressure has not been clear. The National Institutes of Health has established an adequate intake of omega-3 fatty acids for healthy people at 1.1- 1.6 grams daily, depending on age and sex.

"According to our research, the average adult may have a modest blood pressure reduction from consuming about 3 grams a day of these fatty acids," said study author Xinzhi Li, M.D., Ph.D., assistant professor and program director of the School of Pharmacy at Macau University of Science and Technology in Macau, China.

Researchers analyzed the results of 71 clinical trials from around the world published from 1987 to 2020. The studies examined the relationship between blood pressure and the omega-3 fatty acids DHA and EPA (either individually or combined) in people aged 18 and older with or without high blood pressure or cholesterol disorders. There were nearly 5,000 participants combined, ranging in age from 22 to 86 years. Participants took dietary and/or prescription supplement sources of fatty acids for an average of 10 weeks.

The analysis found:
 

• Compared to adults who did not consume EPA and DHA, those who consumed between 2 and 3 grams daily of combined DHA and EPA omega-3 fatty acids (in supplements, food or both) had reduced systolic (top number) and diastolic (bottom number) blood pressure by an average 2 mm Hg.
• Consuming more than 3 grams of omega-3 fatty acids daily may have added blood pressure-lowering benefit for adults with high blood pressure or high blood lipids:
• At 3g a day of omega-3s, systolic blood pressure (SBP) decreased an average of 4.5 mm Hg for those with hypertension, and about 2 mm Hg on average for those without.
• At 5g a day of omega-3s, SBP declined an average of nearly 4 mm Hg for those with hypertension and less than 1 mm Hg on average for those without.
• Similar differences were seen in people with high blood lipids and among those older than age 45.

About 4-5 ounces of Atlantic salmon provide 3 grams of omega 3 fatty acids. A typical fish oil supplement contains about 300 mg of omega-3s per pill, but doses vary widely.

"Most of the studies reported on fish oil supplements rather than on EPA and DHA omega-3's consumed in food, which suggests supplements may be an alternative for those who cannot eat fatty fish such as salmon regularly," Li said. "Algae supplements with EPA and DHA fatty acids are also an option for people who do not consume fish or other animal products."

The U.S. Food and Drug Administration (FDA) announced in June 2019 that it did not object to the use of certain health claims that consuming EPA and DHA omega-3 fatty acids in food or dietary supplements may reduce the risk of hypertension and coronary heart disease. However, they noted that the evidence was inconclusive and highly inconsistent.

"Our study supports the FDA guidance that EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease by lowering high blood pressure, especially among people already diagnosed with hypertension," he said. "However, while our study may add a layer of credible evidence, it does not meet the threshold to make an authorized health claim for omega-3 fatty acids in compliance with FDA regulations."

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Eating protein from a greater variety of sources may lower risk of high blood pressure

Eating a balanced diet including protein from a greater variety of sources may help adults lower the risk of developing high blood pressure, according to new research published today in Hypertension, a peer-reviewed journal of the American Heart Association.

Nearly half of the U.S. population has hypertension, or high blood pressure -- one of the leading contributors to cardiovascular disease. When left untreated, high blood pressure damages the circulatory system and is a significant contributing factor to heart attack, stroke and other health conditions.

"Nutrition may be an easily accessible and effective measure to fight against hypertension. Along with fat and carbohydrates, protein is one of the three basic macronutrients," said study author Xianhui Qin, M.D., of the National Clinical Research Center for Kidney Disease at Nanfang Hospital, Southern Medical University in Guangzhou, China.

There is a strong association between poor diet quality and increased risk of cardiovascular disease and death from cardiovascular disease. In its 2021 dietary guidance to improve cardiovascular health, the American Heart Association advises people eat healthy sources of protein, mostly from plants and may include seafood and low-fat or fat-free dairy products, and, if desired, lean cuts and unprocessed forms of meat or poultry. The American Heart Association recommends eating one to two servings, or 5.5 ounces, of protein daily.

The study authors analyzed health information for nearly 12,200 adults living in China who were part of at least 2 out of 7 rounds of the China Health and Nutrition Survey from 1997 to 2015 (surveys taken every 2-4 years). Participants' initial survey was used as a baseline, while data from their last round was used as a follow-up for comparison. Participants were an average age of 41 years, and 47% were men. The survey measured dietary intake in three consecutive 24-hour dietary recalls and a household food inventory. A trained interviewer collected 24-hour dietary information over 3 days in the same week during each round of the survey.

Participants were given a protein "variety score" based on the number of different sources of protein eaten out of 8 reported: whole grains, refined grains, processed red meat, unprocessed red meat, poultry, fish, egg and legumes. One point was given for each source of protein, with a maximum variety score of 8. The researchers then evaluated the association for new onset hypertension in relation to the protein variety score.

New-onset hypertension was defined as systolic (top number) blood pressure greater than or equal to 140 mm Hg and/or diastolic (bottom number) blood pressure greater than or equal to 90 mm Hg, taking blood pressure-lowering medicine, or self-reporting that a physician diagnosed high blood pressure since their last survey visit. Average time to follow-up was 6 years.

The analysis found:
 

• More than 35% of the nearly 12,200 participants developed new-onset high hypertension during follow-up.
• Compared to participants with the lowest variety score for protein intake (less than 2), those with the highest variety score (4 or higher) had a 66% lower risk of developing high blood pressure.
• For each of the 8 protein types, there was a window of consumption amount where the risk of hypertension was lower. Researchers described this as the appropriate level of consumption.
• When total quantity of protein intake was considered, the amount consumed was divided into five categories (quintiles), from least to most intake. People who ate the least amount of total protein and those who ate most protein had the highest risk for new onset of hypertension.

"The heart health message is that consuming a balanced diet with proteins from various different sources, rather than focusing on a single source of dietary protein, may help to prevent the development of high blood pressure," Qin said.

A limitation of the study is its observational design. Because researchers used prior health information, they could not definitively prove protein intake of any kind or quantity caused or prevented new-onset hypertension.

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Poor sleep can triple risk for heart disease

Individual aspects of poor sleep can be detrimental to heart health. But if you combine them, the risk of heart disease can increase by as much as 141 percent. That's the finding of a new study published in the journal Scientific Reports.

The University of South Florida-led study reviewed sleep data of 6,820 U.S. adults with an average age of 53 who self-reported their sleep characteristics and heart disease history. Among the participants, 633 also wore a research device (actigraphy) around their wrist that captured sleep activity.

Researchers focused on multiple aspects of sleep health, such as regularity, satisfaction, alertness during waking hours, timing of sleep, sleep efficiency and sleep duration and linked them to physician-diagnosed heart disease. They found that each additional increase in self-reported sleep health problems was associated with a 54 percent increased risk of heart disease. The estimated risk of heart disease associated with an increase in sleep health problems was much higher for those who provided sleep data by both self-report and the research device. They had a 141 percent increase -- a figure that could be perceived to be more accurate.

"These findings show the importance of assessing 'co-existing sleep health problems' within an individual to capture the risk of heart disease. This is one of the first studies showing that, among well-functioning adults in midlife, having more sleep health problems may increase the risk of heart disease," said lead author Soomi Lee, assistant professor of aging studies and director of the STEALTH lab at USF. "The higher estimated risk in those who provided both self-report and actigraphy sleep data suggests that measuring sleep health accurately and comprehensively is important to increase the prediction of heart disease."

The research team asked participants about their health, including if their physician confirmed a heart condition such as arrythmia, heart murmur or an enlarged heart. High blood pressure was not considered a diagnosis as it's labeled a risk factor for heart disease rather than a heart disease condition. They also controlled for family history of heart disease and sociodemographic factors, such as race, sex, smoking, depression and physical activity.

Researchers found that while women reported having more sleep health problems, men were more likely to suffer heart disease -- yet gender did not impact the overall correlation between the two factors. They also found that Black participants had more sleep health problems and a higher prevalence of heart disease than white participants, but the strong association between sleep health and heart disease did not differ by race in general.

Lee says while sleep health is important for all ages, the team focused on middle adulthood as it spans for a longer period of time and consists of diverse and more stressful life experiences due to work and family roles. This is also when precursors for heart disease and age-related sleep issues begin to arise.

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Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting optimal heart health targets

Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting targets to reduce heart disease risk. Fortunately, available therapies can help when combined with new approaches that address social determinants of health and other barriers to care, according to a new American Heart Association scientific statement published today in the Association's flagship journal Circulation. A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.

"This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance Type 2 diabetes treatment and care and reduce CVD risk," said Joshua J. Joseph, M.D., M.P.H., FAHA, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University College of Medicine in Columbus, Ohio. "Far too few people -- less than 20% of those with Type 2 diabetes -- are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes."

Type 2 diabetes is the most common form of diabetes, affecting more than 34 million people in the U.S., representing nearly 11% of the U.S. population, according to the U.S. Centers for Disease Control and Prevention's 2020 National Diabetes Statistics Report, and cardiovascular disease (CVD) is the leading cause of death and disability among people with Type 2 diabetes (T2D). Type 2 diabetes occurs when the body is unable to efficiently use the insulin it makes or when the pancreas loses its capacity to produce insulin. People with T2D often have other cardiovascular disease risk factors, including overweight or obesity, high blood pressure or high cholesterol. Adults with T2D are twice as likely to die from CVD -- including heart attacks, strokes and heart failure -- compared to adults who do not have T2D.

The new scientific statement, based on the writing group's extensive review of clinical trial results through June 2020, addresses the gap between existing evidence on how best to lower cardiovascular risk in people with T2D and the reality for people living with T2D. Targets to reduce CVD risk among people with T2D include managing blood glucose, blood pressure and cholesterol levels; increasing physical activity; healthy nutrition; obesity and weight management; not smoking; not drinking alcohol; and psychosocial care. Greater adherence to an overall healthy lifestyle among people with T2D is associated with a substantially lower risk of CVD and CVD mortality.

"In the United States, less than 1 in 5 adults with T2D not diagnosed with cardiovascular disease are meeting optimal T2D management goals of not smoking and achieving healthy levels of blood sugar, blood pressure and low-density lipoprotein (LDL) cholesterol, also known as 'bad' cholesterol," Joseph said.

A surprisingly large proportion -- as high as 90% -- of factors to effectively manage CVD with T2D includes modifiable lifestyle and societal factors. "Social determinants of health, which includes health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes," he said. "People with T2D face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients."

Shared decision-making among patients and health care professionals is essential for successfully managing T2D and CVD. A comprehensive diabetes care plan should be tailored based on individual risks and benefits and in consideration the patient's preferences; potential cost concerns; support to effectively manage T2D and take medications as prescribed, including diabetes self-management education and support; promotion and support of healthy lifestyle choices that improve cardiovascular health including nutrition and physical activity; and treatment for any other CVD risk factors.

"One avenue to continue to address and advance diabetes management is through breaking down the four walls of the clinic or hospital through community engagement, clinic-to-community connections and academic-community-government partnerships that may help address and support modifiable lifestyle behaviors such as physical activity, nutrition, smoking cessation and stress management," Joseph said.

The statement also highlights recent evidence on treating T2D that may spur clinicians and patients to review and update their T2D management plan to also address CVD risk factors:

New ways to control blood sugar

The American Heart Association's last scientific statement on blood sugar control was published in 2015, just as research was starting to suggest that glucose-lowering medications may also reduce the risk of heart attack, stroke, heart failure or cardiovascular death.

"Since 2015, a number of important national and international clinical trials that specifically examined new T2D medications for lowering cardiovascular disease and cardiovascular mortality risk among people with Type 2 diabetes have been completed," Joseph said. "GLP-1 (glucagon-like pepdite-1) receptor agonists have been found to improve blood sugar and weight, and they have been game changers in reducing the risk of heart disease, stroke, heart failure and kidney disease." GLP-1 medications (injectable synthetic hormones such as liraglutide and semaglutide) stimulate the release of insulin to control blood sugar, and they also reduce appetite and help people feel full, which may help with weight management or weight loss.

In addition, SGLT-2 (sodium-glucose co-transporter 2) inhibitors (oral medications such as canaglifozin, dapagliflozin, ertugliflozin and empagliflozin) have also been found to be effective in reducing the risks of CVD and chronic kidney disease. SGLT-2 inhibitors spur the kidneys to dispose of excess glucose through the urine, which lowers the risk of heart failure and slows the decrease in kidney function that is common among people with T2D.

"Cost may be a barrier to taking some T2D medications as prescribed, however, many of these medications are now more commonly covered by more health insurance plans," Joseph said. "Another barrier is recognition by patients that these newer T2D medications are also effective in reducing the risk of heart disease, stroke, heart failure and kidney disease. Increasing public awareness about the link between CVD and T2D and provide support, education and tools that help improve T2D and reduce CVD risk are at the core of the Know Diabetes by Heart™ initiative, from the American Heart Association and American Diabetes Association."

Personalized blood pressure control

The statement highlights that individualized approaches to treating high blood pressure are best. These approaches should consider ways to minimize the side effects of hypertension treatment and avoid potentially over-treating frail patients.

Importance of lowering cholesterol levels

Statin medications remain the first line of lipid-lowering therapy, and the Association suggests other types of medications may be considered for people unable to tolerate a statin or who aren't reaching their LDL cholesterol targets with a statin. These medications may include ezetimibe, bempodoic acid, bile acid resins, fibrates and PCSK-9 inhibitors, depending on the individual's overall health status and other health conditions.

Re-thinking aspirin use

Older adults (ages 65 years and older) with T2D are more likely than those who do not have T2D to take a daily low-dose aspirin to help prevent cardiovascular disease. However, it may be time to review if daily low-dose aspirin is still appropriate. Recently published research suggests the increased risk of major bleeding from aspirin may outweigh the benefits, and newer, more potent antiplatelet medications may be more effective for some people.

The statement reinforces the importance of a comprehensive, multidisciplinary and individualized approach to reduce CVD risk among people with T2D. Optimal care should incorporate healthy lifestyle interventions, and medications and/or treatments including surgery that improve T2D management and support healthy weight and weight loss. Social determinants of health, structural racism and health equity are important factors that must also be considered and addressed.

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New target may help protect bones as we age

Drugs we take like prednisone can weaken our bones and so can aging, and scientists working to prevent both have some of the first evidence that the best target may not be the logical one.

They are finding that in aging bone, the mineralocorticoid receptor, better known for its role in blood pressure regulation, is a key factor in bone health, says Dr. Meghan E. McGee-Lawrence, biomedical engineer in the Department of Cellular Biology and Anatomy at the Medical College of Georgia.

And drugs that block the receptor, like the hypertension medications spironolactone and eplerenone, may help protect bone cells, says McGee-Lawrence, corresponding author of the study in the Journal of Bone and Mineral Research.

Drugs like prednisone are glucocorticoids, which are better known for their roles in reducing inflammation and suppressing the immune response, which is why they work so well for problems like irritable bowel syndrome and arthritis. But, like aging, they can also disrupt the healthy, ongoing dynamic of bone being made and being destroyed.

Our natural glucocorticoid levels increase with age, and bone, at least when we are young, has more glucocorticoid receptors than mineralocorticoid receptors. Glucocorticoids can actually coax stem cells to make bone-forming osteoblasts, but it also causes those osteoblasts to store more fat, and too much fat in the bone, like anywhere on our body, is probably not good and typically correlates with bone loss, McGee-Lawrence says.

So reducing the impact of glucocorticoid receptors seemed like a logical way to protect bone.

The MCG scientists had already been surprised to find that the loss of functioning glucocorticoid receptors did not protect against bone loss in younger mice on calorie-restricted diets. In fact, there was increased fat accumulation in the bone marrow and worsened osteoporosis.

This time they were looking at the impact of endogenous glucocorticoids in an aging model, and found again that when the glucocorticoid receptor was blocked, older mice also experienced more fat accumulation in the bone marrow and worsening bone disease.

They also found that the mice had a smaller muscle mass, chose to move around less than mice typically do and had higher blood pressure.

Another surprise was that when they used drugs to inhibit the mineralocorticoid receptor, many of the problems were reversed.

"The only way we have found to get rid of that lipid storage by osteoblasts was to inhibit the mineralocorticoid receptor with drugs," she says, and fortunately because of the receptors' clear role in blood pressure there are already drugs that do that.

"I think what it means is if we want to understand what these stress hormones, these endogenous glucocorticoids, are doing we cannot just think about signaling through one receptor," McGee-Lawrence says. For older bone, she thinks mineralocorticoid receptors may be a better target.

"We thought that knocking out the glucocorticoid receptor would make things better, but it made them worse," McGee-Lawrence says. "We think the mineralocorticoid receptor may explain a lot of what is going wrong in aging bone."

Both receptors are members of the steroid receptor family and mineralocorticoid receptors are thought to have equal affinity for mineralocorticoids and glucocorticoids. It may be the signaling paths are different in young and older individuals, she notes.

McGee-Lawrence and her colleagues already have some evidence that bone's expression of mineralocorticoid receptors goes up, potentially significantly, as you age. They have early mixed results on whether glucocorticoid receptors go down with age and are exploring more about what happens with both receptor levels as well as learning more about the role of mineralocorticoid receptors in bone, particularly aging bone.

"We want to know what would cause bone cells to change which receptors they are expressing and how they are responding to these," she says. "But there are a lot of things that happen with aging. We know inflammation changes with aging, so there are a lot of different cues that could cause these things to change."

The whole body impact they saw from their manipulation of receptors, like a higher blood pressure from deleting the glucocorticoid receptor, also is evidence of bone's importance as an endocrine organ, she says.

"By changing glucocorticoid signaling in the bone, not only are we seeing changes in the bone, but we are seeing changes in the fat, muscle, adrenal glands, in physical activity," she says which means something from the bone is communicating with all these other body systems, an emerging role of research in her field.

In fact, the increased fat presence in the bone marrow found in osteoporosis has resulted in it also being considered a metabolic disease of the bone, much as obesity, particularly excess weight around the middle, is considered a metabolic disease. Increased fat in the bone marrow is associated with disuse, like following a spinal cord injury, a high-fat diet, taking glucocorticoids, like steroids, and aging.

While the fat is a ready energy source for bone cells, too much can hinder bone cell formation. The scientists don't yet know whether the cells are no longer using fat well or they are pulling more in, or both; they do know fat accumulating in the bone cells coincides with less bone being made, she reiterates.

"We are trying to figure out exactly why these things are going wrong so that we can pick the right avenue to pursue for a treatment strategy," she says.

There is a lot of evidence in people that the synthetic glucocorticoids we take via pill or injection, can impact bone, creating an unhealthy imbalance between the amount of bone made and the amount broken down.

A focus of the research at MCG has been examining the bone impact from our endogenous glucocorticoids, the ones we make, a less-explored area. For years, McGee-Lawrence and her colleagues have been studying bone-forming osteoblasts which, like most cells, don't function optimally as we age.

But it may be that even synthetic glucocorticoids also work through these alternative receptors to damage the bone, which means trying to prevent their damage may also mean a different target, she says, noting again that the pathway may change as the person ages.

Interestingly some other tissues that are known to have a lot of mineralocorticoid receptors inactivate glucocorticoids, which bone cannot do, but perhaps it compensates by not having a lot of mineralocorticoid receptors, at least in youth, she says.

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Spouses really are together in sickness and in health suggests new study

A couple's health is surprisingly intertwined according to a recent cohort study that looked at Dutch and Japanese marriages.

The study discovered that spouses have a high degree of commonality in not only lifestyle habits, but body shape, blood pressure, and even incidence of some diseases.

When it comes to marriage, the adage "birds of a feather flock together" is relatively true. Previous studies have indicated that we gravitate towards people of similar social class, educational background, race, and weight. The scientific name for this is assertive mating, and it means that spouses are often genetically similar. This allows researchers to explore environmental factors in greater detail.

Researchers examined 5,391 pairs from Japan and 28,265 from the Netherlands, drawing on data from the Tohoku Medical Megabank Project, and the Lifelines study in the Netherlands.

Couples from both countries shared similar lifestyle habits and physical traits such as smoking, drinking, weight, abdominal circumference, and body mass index. When the researchers dived further into the data, they determined that couples had corresponding blood pressure, cholesterol, and triglycerides levels. Moreover, related incidents of hypertension, diabetes, and metabolic syndrome were also found.

Many of the correlations were between couples with low genetic similarity and high lifestyle similarity, suggesting the importance of healthy choices. The researchers encourage healthcare guidance for couples and a healthy dose of competition between partners that encourages each other to improve their health, especially against diseases shaped by lifestyle and environment.

So, the next time you go for a checkup, why not bring your partner? Better yet, challenge them to a walk to the clinic.

From Science Daily

Eating whole grains linked to smaller increases in waist size, blood pressure, blood sugar

Middle- to older-aged adults who ate at least three servings of whole grains daily had smaller increases in waist size, blood pressure, and blood sugar levels over time compared to those who ate less than one-half serving per day, according to new research.

Published July 13, 2021, in the Journal of Nutrition, the study by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University examined how whole- and refined-grain intake over time impacted five risk factors of heart disease: Waist size, blood pressure, blood sugar, triglyceride, and HDL ("good") cholesterol.

Using data from the Framingham Heart Study Offspring Cohort, which began in the 1970s to assess long-term risk factors of heart disease, the new research examined health outcomes associated with whole- and refined-grain consumption over a median of 18 years. The 3,100 participants from the cohort were mostly white and, on average, in their mid-50s at the start of data collection.

The research team compared changes in the five risk factors, over four-year intervals, across four categories of reported whole grain intake, ranging from less than a half serving per day to three or more servings per day. According to the Dietary Guidelines for Americans 2020-2025, the recommended amount of whole grains is three or more servings daily. An example of a serving is one slice of whole-grain bread, a half cup of rolled oats cereal, or a half cup of brown rice.

The results showed that for each four-year interval:
 

• Waist size increased by an average of over 1 inch in the low intake participants, versus about ½ inch in the high intake participants.
   
• Even after accounting for changes in waist size, average increases in blood sugar levels and systolic blood pressure were greater in low intake participants compared to high intake participants.

The researchers also studied the five risk factors across four categories of refined-grain intake, ranging from less than two servings per day to more than four servings per day. Lower refined-grain intake led to a lower average increase in waist size and a greater mean decline in triglyceride levels for each four-year period.

"Our findings suggest that eating whole-grain foods as part of a healthy diet delivers health benefits beyond just helping us lose or maintain weight as we age. In fact, these data suggest that people who eat more whole grains are better able to maintain their blood sugar and blood pressure over time. Managing these risk factors as we age may help to protect against heart disease," said Nicola McKeown, senior and corresponding author and a scientist on the Nutritional Epidemiology Team at the USDA HNRCA.

"There are several reasons that whole grains may work to help people maintain waist size and reduce increases in the other risk factors. The presence of dietary fiber in whole grains can have a satiating effect, and the magnesium, potassium, and antioxidants may contribute to lowering blood pressure. Soluble fiber in particular may have a beneficial effect on post-meal blood sugar spikes," said Caleigh Sawicki. Sawicki did this work as part of her doctoral dissertation while a student at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and while working with the Nutritional Epidemiology Team at the USDA HNRCA.

The greatest contributor to whole-grain intake among participants was whole-wheat breads and ready-to-eat whole-grain breakfast cereals. The refined grains came mostly from pasta and white bread. The difference in health benefits between whole and refined grains may stem from the fact that whole grains are less processed than refined grains. Whole grains have a fiber-rich outer layer and an inner germ layer packed with B vitamins, antioxidants, and small amounts of healthy fats. Milling whole grains removes these nutrient-dense components, leaving only the starch-packed refined grain behind.

"The average American consumes about five servings of refined grains daily, much more than is recommended, so it's important to think about ways to replace refined grains with whole grains throughout your day. For example, you might consider a bowl of whole-grain cereal instead of a white flour bagel for breakfast and replacing refined-grain snacks, entrees, and side dishes with whole-grain options. Small incremental changes in your diet to increase whole-grain intake will make a difference over time," McKeown said.

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5-minute breathing workout lowers blood pressure as much as exercise, drugs

Working out just five minutes daily via a practice described as "strength training for your breathing muscles" lowers blood pressure and improves some measures of vascular health as well as, or even more than, aerobic exercise or medication, new CU Boulder research shows.

The study, published June 29 in the Journal of the American Heart Association, provides the strongest evidence yet that the ultra-time-efficient maneuver known as High-Resistance Inspiratory Muscle Strength Training (IMST) could play a key role in helping aging adults fend off cardiovascular disease -- the nation's leading killer.

In the United States alone, 65% of adults over age 50 have above-normal blood pressure -- putting them at greater risk of heart attack or stroke. Yet fewer than 40% meet recommended aerobic exercise guidelines.

"There are a lot of lifestyle strategies that we know can help people maintain cardiovascular health as they age. But the reality is, they take a lot of time and effort and can be expensive and hard for some people to access," said lead author Daniel Craighead, an assistant research professor in the Department of Integrative Physiology. "IMST can be done in five minutes in your own home while you watch TV."

Developed in the 1980s as a way to help critically ill respiratory disease patients strengthen their diaphragm and other inspiratory (breathing) muscles, IMST involves inhaling vigorously through a hand-held device which provides resistance. Imagine sucking hard through a tube that sucks back.

Initially, when prescribing it for breathing disorders, doctors recommended a 30-minute-per-day regimen at low resistance. But in recent years, Craighead and colleagues have been testing whether a more time-efficient protocol -- 30 inhalations per day at high resistance, six days per week -- could also reap cardiovascular, cognitive and sports performance improvements.

For the new study, they recruited 36 otherwise healthy adults ages 50 to 79 with above normal systolic blood pressure (120 millimeters of mercury or higher). Half did High-Resistance IMST for six weeks and half did a placebo protocol in which the resistance was much lower.

After six weeks, the IMST group saw their systolic blood pressure (the top number) dip nine points on average, a reduction which generally exceeds that achieved by walking 30 minutes a day five days a week. That decline is also equal to the effects of some blood pressure-lowering drug regimens.

Even six weeks after they quit doing IMST, the IMST group maintained most of that improvement.

"We found that not only is it more time-efficient than traditional exercise programs, the benefits may be longer lasting," Craighead said.

The treatment group also saw a 45% improvement in vascular endothelial function, or the ability for arteries to expand upon stimulation, and a significant increase in levels of nitric oxide, a molecule key for dilating arteries and preventing plaque buildup. Nitric oxide levels naturally decline with age.

Markers of inflammation and oxidative stress, which can also boost heart attack risk, were significantly lower after people did IMST.

And, remarkably, those in the IMST group completed 95% of the sessions.

"We have identified a novel form of therapy that lowers blood pressure without giving people pharmacological compounds and with much higher adherence than aerobic exercise," said senior author Doug Seals, a Distinguished Professor of Integrative Physiology. "That's noteworthy."

The practice may be particularly helpful for postmenopausal women.

In previous research, Seals' lab showed that postmenopausal women who are not taking supplemental estrogen don't reap as much benefit from aerobic exercise programs as men do when it comes to vascular endothelial function. IMST, the new study showed, improved it just as much in these women as in men.

"If aerobic exercise won't improve this key measure of cardiovascular health for postmenopausal women, they need another lifestyle intervention that will," said Craighead. "This could be it."

Preliminary results suggest MST also improved some measures of brain function and physical fitness. And previous studies from other researchers have shown it can be useful for improving sports performance.

"If you're running a marathon, your respiratory muscles get tired and begin to steal blood from your skeletal muscles," said Craighead, who uses IMST in his own marathon training. "The idea is that if you build up endurance of those respiratory muscles, that won't happen and your legs won't get as fatigued."

Seals said they're uncertain exactly how a maneuver to strengthen breathing muscles ends up lowering blood pressure, but they suspect it prompts the cells lining blood vessels to produce more nitric oxide, enabling them to relax.

The National Institutes of Health recently awarded Seals $4 million to launch a larger follow-up study of about 100 people, comparing a 12-week IMST protocol head-to-head with an aerobic exercise program.

Meanwhile, the research group is developing a smartphone app to enable people to do the protocol at home using already commercially available devices.

Read more at Science Daily

New discovery explains antihypertensive properties of green and black tea

 A new study from the University of California, Irvine shows that compounds in both green and black tea relax blood vessels by activating ion channel proteins in the blood vessel wall. The discovery helps explain the antihypertensive properties of tea and could lead to the design of new blood pressure-lowering medications.

Published in Cellular Physiology and Biochemistry, the discovery was made by the laboratory of Geoffrey Abbott, PhD, a professor in the Department of Physiology and Biophysics at the UCI School of Medicine. Kaitlyn Redford, a graduate student in the Abbott Lab, was first author of the study titled, "KCNQ5 potassium channel activation underlies vasodilation by tea."

Results from the research revealed that two catechin-type flavonoid compounds (epicatechin gallate and epigallocatechin-3-gallate) found in tea, each activate a specific type of ion channel protein named KCNQ5, which allows potassium ions to diffuse out of cells to reduce cellular excitability. As KCNQ5 is found in the smooth muscle that lines blood vessels, its activation by tea catechins was also predicted to relax blood vessels -- a prediction confirmed by collaborators at the University of Copenhagen.

"We found by using computer modeling and mutagenesis studies that specific catechins bind to the foot of the voltage sensor, which is the part of KCNQ5 that allows the channel to open in response to cellular excitation. This binding allows the channel to open much more easily and earlier in the cellular excitation process," explained Abbott.

Because as many as one third of the world's adult population have hypertension, and this condition is considered to be the number one modifiable risk factor for global cardiovascular disease and premature mortality, new approaches to treating hypertension have enormous potential to improve global public health. Prior studies demonstrated that consumption of green or black tea can reduce blood pressure by a small but consistent amount, and catechins were previously found to contribute to this property. Identification of KCNQ5 as a novel target for the hypertensive properties of tea catechins may facilitate medicinal chemistry optimization for improved potency or efficacy.

In addition to its role in controlling vascular tone, KCNQ5 is expressed in various parts of the brain, where it regulates electrical activity and signaling between neurons. Pathogenic KCNQ5 gene variants exist that impair its channel function and in doing so cause epileptic encephalopathy, a developmental disorder that is severely debilitating and causes frequent seizures. Because catechins can cross the blood-brain barrier, discovery of their ability to activate KCNQ5 may suggest a future mechanism to fix broken KCNQ5 channels to ameliorate brain excitability disorders stemming from their dysfunction.

Tea has been produced and consumed for more than 4,000 years and upwards of 2 billion cups of tea are currently drunk each day worldwide, second only to water in terms of the volume consumed by people globally. The three commonly consumed caffeinated teas (green, oolong, and black) are all produced from the leaves of the evergreen species Camellia sinensis, the differences arising from different degrees of fermentation during tea production.

Black tea is commonly mixed with milk before it is consumed in countries including the United Kingdom and the United States. The researchers in the present study found that when black tea was directly applied to cells containing the KCNQ5 channel, the addition of milk prevented the beneficial KCNQ5-activating effects of tea. However, according to Abbott, "We don't believe this means one needs to avoid milk when drinking tea to take advantage of the beneficial properties of tea. We are confident that the environment in the human stomach will separate the catechins from the proteins and other molecules in milk that would otherwise block catechins' beneficial effects."

This hypothesis is borne out by other studies showing antihypertensive benefits of tea regardless of milk co-consumption. The team also found, using mass spectrometry, that warming green tea to 35 degrees Celsius alters its chemical composition in a way that renders it more effective at activating KCNQ5.

"Regardless of whether tea is consumed iced or hot, this temperature is achieved after tea is drunk, as human body temperature is about 37 degrees Celsius," explained Abbott. "Thus, simply by drinking tea we activate its beneficial, antihypertensive properties."

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Calories by the clock? Squeezing most of your calories in early doesn't impact weight loss

 Restricting meals to early in the day did not affect weight among overweight adults with prediabetes or diabetes, according to preliminary research to be presented at the American Heart Association's Scientific Sessions 2020. The meeting will be held virtually, Friday, November 13 -- Tuesday, November 17, 2020.

"We have wondered for a long time if when one eats during the day affects the way the body uses and stores energy," said study author Nisa M. Maruthur, M.D., M.H.S., associate professor of medicine, epidemiology and nursing at Johns Hopkins University in Baltimore. "Most prior studies have not controlled the number of calories, so it wasn't clear if people who ate earlier just ate fewer calories. In this study, the only thing we changed was the time of day of eating."

Maruthur and colleagues followed 41 overweight adults in a 12-week study. Most participants (90%) were Black women with prediabetes or diabetes, and average age of 59 years. Twenty-one of the adults followed a time-restricted eating pattern, limiting eating to specific hours of the day and ate 80% of their calories before 1 p.m. The remaining 20 participants ate at usual times during a 12-hour window, consuming half of their daily calories after 5 p.m. for the entire 12 weeks. All participants consumed the same pre-prepared, healthy meals provided for the study. Weight and blood pressure were measured at the beginning of the study; then at 4 weeks, 8 weeks and 12 weeks.

The analysis found that people in both groups lost weight and had decreased blood pressure regardless of when they ate.

"We thought that the time-restricted group would lose more weight," Maruthur said. "Yet that didn't happen. We did not see any difference in weight loss for those who ate most of their calories earlier versus later in the day. We did not see any effects on blood pressure either."

The researchers are now collecting more detailed information on blood pressure recorded over 24 hours, and they will be compiling this information with the results of a study on the effects of time-restricted feeding on blood sugar, insulin and other hormones.

"Together, these findings will help us to more fully understand the effects of time-restricted eating on cardiometabolic health," Maruthur said.

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High flavanol diet may lead to lower blood pressure

 People who consume a diet including flavanol-rich foods and drinks, including tea, apples and berries, could lead to lower blood pressure, according to the first study using objective measures of thousands of UK residents' diet.

The findings, published in Scientific Reports, studied the diet of more than 25,000 people in Norfolk, UK and compared what they ate with their blood pressure. In contrast to most other studies investigating links between nutrition and health, the researchers did not rely on study participants reporting their diet, but instead measured flavanol intake objectively using nutritional biomarkers -- indicators of dietary intake, metabolism or nutritional status that are present in our blood.

The difference in blood pressure between those with the lowest 10% of flavanol intake and those with the highest 10% of intake was between 2 and 4 mmHg. This is comparable to meaningful changes in blood pressure observed in those following a Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) diet. Notably, the effect was more pronounced in participants with hypertension.

Professor Gunter Kuhnle, a nutritionist at the University of Reading who led the study said:

"Previous studies of large populations have always relied on self-reported data to draw conclusions, but this is the first epidemiological study of this scale to objectively investigate the association between a specific bioactive compound and health. We are delighted to see that in our study, there was also a meaningful and significant association between flavanol consumption and lower blood pressure.

"What this study gives us is an objective finding about the association between flavanols -- found in tea and some fruits -- and blood pressure. This research confirms the results from previous dietary intervention studies and shows that the same results can be achieved with a habitual diet rich in flavanols. In the British diet, the main sources are tea, cocoa, apples and berries.

"The methodology of the study is of equal importance. This is one of the largest ever studies to use nutritional biomarkers to investigate bioactive compounds. Using nutritional biomarkers to estimate intake of bioactive food compounds has long been seen as the gold standard for research, as it allows intake to be measured objectively. The development, validation and application of the biomarker was only possible because of the long-term commitment of all collaborators. In contrast to self-reported dietary data, nutritional biomarkers can address the huge variability in food composition. We can therefore confidently attribute the associations we observed to flavanol intake."

An international team from the University of Reading, Cambridge University, the University of California Davis, and Mars, Incorporated studied 25,618 participants from the European Prospective Investigation into Cancer (EPIC) Norfolk study and found that the biggest difference was observed in participants with the highest blood pressure. This suggests if the general public increased its flavanol intake, there could be an overall reduction in cardiovascular disease incidence.

Hagen Schroeter, Chief Science Officer at Mars Edge, said:

"This study adds key insights to a growing body of evidence supporting the benefits of dietary flavanols in health and nutrition. But, perhaps even more exciting was the opportunity to apply objective biomarkers of flavanol intake at a large scale. This enabled the team to avoid the significant limitations that come with past approaches which rely on estimating intake based on self-reported food consumption data and the shortcomings of current food composition databases."

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Blood pressure medications help even the frailest elderly people live longer

Taking blood pressure medication as prescribed helped even the frailest elderly people (65 and older) live longer, and the healthiest older people had the biggest survival boost, according to a large study in northern Italy published today in Hypertension, an American Heart Association journal.

"We knew that high blood pressure medication was protective in general among older people, however, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomized trials," said Giuseppe Mancia, M.D., lead study author and professor emeritus at the University of Milano-Bicocca in Milan, Italy.

Researchers reviewed data on almost 1.3 million people aged 65 and older (average age 76) in the Lombardy region of northern Italy who had 3 or more high blood pressure medication prescriptions in 2011-2012. Examining the public health care database, researchers calculated the percentage of time over the next seven years (or until death) that each person continued to receive the medications. Because almost all medications are free or low-cost and dispensed by the public health service, this corresponds roughly to people's adherence in using the medication in Italy.

To look separately at outcomes among older people with various medical conditions, researchers used a previously developed score that accounts for 34 different health factors and has a close relationship with mortality.

Researchers compared roughly 255,000 people who died during the 7-year follow-up with age-, gender-, and health-status-matched controls who survived and divided them into four groups of health status: good, medium, poor or very poor.

The probability of death over 7-years was 16% for people rated in good health at the beginning of the study. Mortality probability increased progressively to 64% for those rated in very poor health.

Compared with people with very low adherence to blood pressure medications (dispensed pills covered less than 25% of the time period), people with high adherence to blood pressure medications (more than 75% of the time period covered) were:

    44% less likely to die if they started in good health; and

    33% less likely to die if they started in very poor health.

A similar pattern was seen with cardiovascular deaths. The greatest survival benefit was among the people who started in good health, and the most modest survival benefit was in those who started in very poor health.

"Our findings definitely suggest that even in very frail people, antihypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group," Mancia said.

No matter what a person's initial health status, survival benefits were greatest in those who received blood pressure medication to cover more than 75% of the follow-up period, compared with those with intermediate (25-75%) or low levels (less than 25%) of coverage, highlighting the importance of consistent use of blood pressure medications.

"Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don't take them," Mancia said.

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High blood pressure during and after exercise may be markers for disease later in life

Higher blood pressure during exercise and delayed blood pressure recovery after exercise are associated with a higher risk of hypertension, preclinical and clinical cardiovascular disease and death among middle-aged to older adults. Blood pressure responses to exercise are significant markers of cardiovascular disease and mortality risk in young to middle-aged adults. However, few studies have examined the associations of midlife blood pressure responses to submaximal (less than the maximum of which an individual is capable) exercise with the risk of cardiovascular outcomes and mortality in later life.

Researchers from Boston University School of Medicine (BUSM) evaluated the association of blood pressure changes and recovery with indicators of preclinical disease among participants from the Framingham Heart Study (average age 58 years, 53 percent women). They then followed these participants to assess whether these blood pressure changes were associated with the risk of developing hypertension, cardiovascular disease or dying.

They observed that both higher exercise systolic blood pressure (SBP) and exercise diastolic blood pressure (DBP) were associated with a greater risk of developing hypertension. Additionally, both delayed SBP and DBP recovery after exercise were associated with higher risk of cardiovascular disease and death.

"The way our blood pressure changes during and after exercise provides important information on whether we will develop disease in the future; this may help investigators evaluate whether this information can be used to better identify people who are at higher risk of developing hypertension and CVD, or dying later in life," explained corresponding author Vanessa Xanthakis, PhD, assistant professor of medicine and biostatistics at BUSM and an Investigator for the Framingham Heart Study.

Xanthakis recommends that people know their blood pressure numbers, speak to their physician regarding changes during and after exercise and follow a healthy lifestyle (including a regular physical activity schedule) to help lower risk of disease later in life.

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