High blood pressure is often referred to as a “silent killer” since many people may have no symptoms they can easily notice. Over 50 million people suffer from high blood pressure, but nearly one third aren’t even aware of it. Hypertension is a major risk factor for heart disease, the nations’ number one killer.
Those who do experience the symptoms of high blood pressure have headackes, feel dizzy and sometimes nosebleeds. Unfortunately, by the time symptoms are felt, blood pressure is dangerously high. But many people with uncontrolled high blood pressure never have any of these symptoms.
Blood pressure is the force of the blood through your arteries as your heart pumps blood through your circulatory system. Blood pressure is reported as a fraction, with one number over the other. The top number, called the “systolic” pressure, is the force when your heart contracts, the bottom number, called the “diastolic” pressure, is the pressure when you hear relaxes between beats.
High blood pressure can result from several factors. The heart itself can impact blood pressure. The heart muscles itself can enlarge, causing higher pressure of blood exiting the heart. Cardiomyopathy or enlargement of the heart muscle also increases blood pressure. Excess weight makes your heart work harder to pump blood through the body.
Extra fluid in your circulatory system as a result of lots of salt intake, kidney problems or other medical conditions also puts a higher demand on the heart. Increased blood volume also causes more constriction within the blood vessels, translating into higher blood pressure.
The blood vessels play an important role in your blood pressure. Usually, the arteries are elastic and can expand and contract in rhythm with the hearts pumping action. High cholesterol and the plaques that form cause the arteries to lose their elasticity. Each time the heart pumps, the vessel can no longer stretch, and a higher pressure is created. Just think about what happens if you step on a garden hose.
Smoking constricts, or tightens your blood vessels, pushing the blood pressure even higher. Some medications you take such as steroids, non-steroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cold remedies, diet pills, cyclosporine, erythropoetin, tricyclic antidepressants and a type of anti-depressant called monoamine oxidase inhibitors can also contribute to increased BP. Oral contraceptive, which are hormones, can raise blood pressure and should be used cautiously and carefully monitored in patients with HTN.
If you are diagnosed with high blood pressure, your doctor will most likely order additional test to determine the cause of your elevated blood pressure. He or she will also recommend more frequent visits to monitor you. For moderate hypertension, lifestyle changes may be enough to normalize blood pressure.
One of the first things you can do is change your way of eating to avoid sodium or salt, and lower your fat intake. The National Institutes of Health's DASH diet (Dietary Approaches to Stop Hypertension) is rich in fruits, vegetables, and low-fat dairy foods and low in total and saturated fat. The DASH diet also reduces red meat, sweets, and sugary drinks, and it's rich in potassium, calcium, magnesium, fiber, and protein.
Increasing physical activity can help to lower your blood pressure. You should be doing at least 30 minutes of exercise a day, your risk of complications can be reduced. If you are overweight, starting a weigh loss plan can also help bring your blood pressure into the normal range.
If dietary and lifestyle changes alone don't normalize your blood pressure, the next step is medication. If your doctor recommend medication, it is vital that you take it exactly as directed. Because most people don’t notice any symptoms of hypertension, even if you are feeling well, it is crucial to stick to your medication regimen. Never stop taking medication without discussing it with your healthcare team, even if you feel fine.
Monday, July 25, 2011
Thursday, July 21, 2011
Danger also comes from too-low blood pressure
Don't think that low blood pressure is not harmful for you.
There is a new study of 10,001 people with coronary artery disease found what statisticians call a J-shaped curve of mortality, which means there is higher death rate for people with the lowest blood pressure. Dr. Franz H. Messerli, a professor of clinical medicine at Columbia University Medical Center and director of the hypertension program at St. Luke's-Roosevelt Hospital in New York City, reported on the finding Thursday at the American Society of Hypertension meeting in San Francisco.
"It stands to reason that there has to be a J-shaped curve," Messerli said. "If your blood pressure were zero, you would be dead."
He acknowledged that the people in the study were a bit out of the ordinary, with already-diagnosed coronary artery disease. The study was aimed at determining the effect of treatment with different amounts of a cholesterol-lowering statin drug, with blood pressure measured as a matter of routine.
When the results were in, the lowest rate of deaths and major coronary problems such as heart disease was seen not in the participants with the lowest blood pressure but in those slightly to the right on the curve, with a reading of 139.9 for systolic pressure (the reading when the heart contracts) and 79.2 for diastolic pressure.
Though Messerli stressed that this was "a unique population, with coronary artery disease, where the coronary arteries are compromised," he noted that "there has to be a point where lowering blood pressure is counterproductive."
That point can be seen on the curve of systolic pressure in this group, he said. "When you go from 120 to 130, even from 110 to 130, there is very little difference," Messerli said. "When it goes below 110, then all of a sudden it becomes very obvious."
The effect is more pronounced for diastolic pressure readings. "If you go to 70 or below, say to 60, there is a fourfold higher risk in the primary outcomes," he said.
A too-low reading, he noted, could mean that the brain is not getting enough blood. "Obviously, if there is a lack of blood, there can be danger similar to that when there is too much blood," Messerli said.
The finding in this particular group certainly doesn't mean that most people should worry about blood pressure being too low, he said. "By and large, within reason, lower is better," Messerli said.
But that might not be true in special cases, he said. "You can have a funny situation where one organ in the body is demanding more blood than is good for the rest of the body," Messerli said. "What is OK for the kidney and OK for the brain may not be OK for the heart."
Controlling high blood pressure remains a major concern for physicians, Messerli said. "There are a lot of patients who are untreated and uncontrolled," he said. "We need to do a better job."
Dr. Alan H. Gradman, professor of medicine at Temple University, said that the study should be treated with caution because the number of people with very low blood pressure was small, but he said that "it does suggest that there may well be a J curve in people with coronary artery disease."
Though many other studies have not shown a J curve, "which is why the idea that you can't go too low is out there," the new study results might mean a slight revision of that rule in some cases, Gradman said.
"If you treat people with coronary artery disease for hypertension, you don't want to go too low, to diastolic pressure below about 70," he said. "That's the take-home message here."
There is a new study of 10,001 people with coronary artery disease found what statisticians call a J-shaped curve of mortality, which means there is higher death rate for people with the lowest blood pressure. Dr. Franz H. Messerli, a professor of clinical medicine at Columbia University Medical Center and director of the hypertension program at St. Luke's-Roosevelt Hospital in New York City, reported on the finding Thursday at the American Society of Hypertension meeting in San Francisco.
"It stands to reason that there has to be a J-shaped curve," Messerli said. "If your blood pressure were zero, you would be dead."
He acknowledged that the people in the study were a bit out of the ordinary, with already-diagnosed coronary artery disease. The study was aimed at determining the effect of treatment with different amounts of a cholesterol-lowering statin drug, with blood pressure measured as a matter of routine.
When the results were in, the lowest rate of deaths and major coronary problems such as heart disease was seen not in the participants with the lowest blood pressure but in those slightly to the right on the curve, with a reading of 139.9 for systolic pressure (the reading when the heart contracts) and 79.2 for diastolic pressure.
Though Messerli stressed that this was "a unique population, with coronary artery disease, where the coronary arteries are compromised," he noted that "there has to be a point where lowering blood pressure is counterproductive."
That point can be seen on the curve of systolic pressure in this group, he said. "When you go from 120 to 130, even from 110 to 130, there is very little difference," Messerli said. "When it goes below 110, then all of a sudden it becomes very obvious."
The effect is more pronounced for diastolic pressure readings. "If you go to 70 or below, say to 60, there is a fourfold higher risk in the primary outcomes," he said.
A too-low reading, he noted, could mean that the brain is not getting enough blood. "Obviously, if there is a lack of blood, there can be danger similar to that when there is too much blood," Messerli said.
The finding in this particular group certainly doesn't mean that most people should worry about blood pressure being too low, he said. "By and large, within reason, lower is better," Messerli said.
But that might not be true in special cases, he said. "You can have a funny situation where one organ in the body is demanding more blood than is good for the rest of the body," Messerli said. "What is OK for the kidney and OK for the brain may not be OK for the heart."
Controlling high blood pressure remains a major concern for physicians, Messerli said. "There are a lot of patients who are untreated and uncontrolled," he said. "We need to do a better job."
Dr. Alan H. Gradman, professor of medicine at Temple University, said that the study should be treated with caution because the number of people with very low blood pressure was small, but he said that "it does suggest that there may well be a J curve in people with coronary artery disease."
Though many other studies have not shown a J curve, "which is why the idea that you can't go too low is out there," the new study results might mean a slight revision of that rule in some cases, Gradman said.
"If you treat people with coronary artery disease for hypertension, you don't want to go too low, to diastolic pressure below about 70," he said. "That's the take-home message here."
Monday, July 18, 2011
Right blood pressure monitor - how to choose it?
Choosing the best home blood pressure monitor for you
If you do decide to measure your blood pressure at home, you will need to get a home blood pressure monitor. There is a wide range of home blood pressure monitors available, but it is important to be sure that the blood pressure monitor you choose is accurate and the right one for you.Automatic blood pressure monitors
There are many different kinds of home blood pressure monitor, but it is easiest to use a monitor that is fully automatic (digital). Choose one that measures your blood pressure at your upper arm, rather than at your wrist or finger. Upper-arm blood pressure monitors usually give the most accurate and consistent results.Make sure your monitor is accurate
Make sure that the home blood pressure monitor you choose has been listed as 'clinically validated' for accuracy by the British Hypertension Society. This means that the digital monitor has gone through a series of tests to make sure it gives results that you and your doctor can trust.Please fill in the form at the end of this page for a list of clinically-validated home blood pressure monitors.
Make sure you have the right cuff size
An upper-arm blood pressure monitor will come with a cuff that you need to wrap around your arm. If you use a cuff that is the wrong size for you, your blood pressure reading will not be correct. Measure around your upper arm at the midpoint between your shoulder and elbow, and choose your cuff size from the chart below.| Upper Arm Blood Pressure Monitor cuff sizes | ||
| Measurement (cm) | Measurement (inches) | Cuff size |
| 18-22 cm | 7.1-8.7” | Small |
| 22-32 cm | 8.8-12.8” | Medium |
| 32-45 cm | 12.8-18” | Large |
Most home blood pressure monitors will come with a medium-sized cuff. You may have to order a different-sized cuff separately.
Choose a digital monitor to suit your budget
Blood pressure monitors can vary in price. This usually depends on the number of extra features that the digital monitor has, like a built-in memory for example.All you need to measure your blood pressure correctly is a clinically validated monitor, and a pen and paper to record your readings. Extra features can be helpful but they are not necessary. Choose a home blood pressure monitor that you can afford.
Keep your home blood pressure monitor calibrated
Because your blood pressure monitor works automatically, it will need to be re-calibrated at least once every two years to be sure it is giving you accurate results. To have your automatic home monitor re-calibrated, you will need to send it back to the manufacturer. There will probably be a fee for this service.
Clinically validated monitors
A and D Instruments home blood pressure monitors (S, St and L cuffs available to buy)
- A and D Instruments UA-704 monitor - £39.10
- A and D Instruments UA-705 monitor - £39.10
- A and D Instruments UA-774 monitor - £60.05
- A and D Instruments UA-767 monitor - £69.99
- A and D Instruments UA-782 monitor - £76.38
- A and D Instruments UA-85X monitor- Series comprising UA-851, UA-852, UA-853, UA-854, and UA-855 - £69.99
- A and D Instruments UA-779 monitor - £69.85
- A and D Instruments UA-767 Plus monitor - £79.99
- A and D Instruments UA-787 monitor - £82.80
- A and D Instruments UA-767 Plus Memory monitor - £85
- A and D Instruments UA-767PC monitor - £120.00
- A and D Instruments UA-767V monitor - £149.99
- A and D Instruments UA-767-BT monitor - £176.25
Boots the Chemist home blood pressure monitors (S, St & L cuffs)
- Boots Upper Arm (Omron HEM-742-UK) monitor - £29.95
- Boots Upper Arm BPM 569-0420 (HEM-7115-BS) monitor- Derivative of Omron M3-1 (HEM-7051-E) - £39.99
- Boots Upper Arm BPM 56-90-447 (HEM-7101) monitor- Derivative of Omron MX3 Plus (HEM-742-E) - £29.99
- Boots Upper Arm Intellisense 46-61-486 (HEM-757-UK) monitor- Derivative of HEM-757 - £78.29
- Boots Upper Arm Intellisense 56-90-404 (HEM 7041-BS) monitor - £79.99
- Boots Wrist Monitor 56-90-412 (HEM-6000) Derivative of Omron R7 (HEM-637-E2) - £79.99
Braun home blood pressure monitors (Wrist monitor, fits wrist 13-21cm)
- Braun BP VitalScan Plus 1650 (Wrist monitor) - £44.99
- Braun BP 3550 (Wrist monitor) – details awaited
Citizen home blood pressure monitors (St cuff only available, while wrist monitor fits wrist 13.5-19.5cm)
- Citizen CH-432B monitor - £22.95
- Citizen CH-656C (Wrist monitor) - £30
Health and Life home blood pressure monitors
- Health and Life HL88HA monitor - £39.99
- Health and Life HL168JD (Wrist monitor) - not currently sold in UK
Honsun home blood pressure monitors (also branded as Suresign)
- Honsun LD 3 monitor - £19.95
- Honsun LD30 monitor -Derivative of Honsun LD-578 - £24.99
- Honsun LD 578 monitor - £25.95
Kinetik home blood pressure monitors (also branded as Guardian and Mannings)
- Kinetik BPM Series 1 monitor - £29.99
- Kinetik BPM 1 K monitor - £29.99
Lloyds Pharmacy home blood pressure monitors
- Lloyds Pharmacy LBP 1 monitor - £29.99
- Lloyds Pharmacy LBPK 1 monitor - £29.99
- Lloyds Pharmacy BP11 monitor - £9.99
Microlife home blood pressure monitors (M and L cuffs)
- BPA/Microlife BP3AG1 monitor - £39.99 -
- Microlife WatchBP Home monitor - £69.99
- Microlife WatchBP Home monitor (with atrial fibrillation detection) - £89.00
- Microlife 3BTO-A (2) monitor - £59.99 – with two different sized cuffs. Also validated for use in pregnancy.
- Microlife BP 3BTO-A monitor - £49.89
- Microlife BP A100 monitor - £49.89
- Microlife BP A100 Plus monitor - £68.46
- Microlife - As easy as 123 monitor - £44.98
- Microlife BP 3AC1-1 monitor - £88.04
- Microlife BP 3AC1-1PC monitor - £88.04
Nissei home blood pressure monitors
- Nissei DS-400 monitor - £39.95
Omron home blood pressure monitors (S, St and L upper arm cuffs, while wrist monitor cuffs fit wrists 13.5-21.5cm)
- Omron M2 Compact monitor - £39.95
- Omron M2 Compact monitor (HEM 7102-E) - £41.95
- Omron M2 Basic (HEM-7116-E) monitor-Derivative of M3-I (HEM 7051-E) - £47.25
- Omron MX2 Basic monitor - £44.95
- Omron M2 (HEM 7117) monitor- Derivative of M3-I (HEM 7051-E) - £52.50
- Omron M1 Plus monitor - £50.00
- Omron M1 (HEM 4030-C-E) monitor- Derivative of M1 Plus (HEM 4011-C-E) - £52.50
- Omron MX3 Plus monitor - £58.67
- Omron M3 (HEM 7200-E) monitor- Derivative of M3-I (HEM 7051-E) - £62.95
- Omron M3 Intellisense (HEM-7051-E) monitor - £62.95
- Omron M4-I monitor - £79.95
- Omron M6 monitor - £79.99
- Omron M6 Comfort monitor - £99.95
- Omron M7 monitor - £99.95
- Omron M10-IT monitor - £99.95
- Omron MIT Elite (HEM-7300-WE) monitor- Derivative of Elite 700W (HEM-7300-WZ) - £99.95
- Omron MIT Elite Plus (HEM 7301-ITKE) monitor- Derivative of Elite 7300W (HEM 7300-EZ) - £119.95
- Omron R5-I (Wrist monitor) - £99.95
- Omron R6 (Wrist monitor) - £99.95
- Omron Elite 7300W monitor- £99.99
- Omron R7 (Wrist monitor) - £119.95
- Omron 705CP-II monitor - £149.95
- Omron 637-IT (Wrist monitor) - £149.95
- Omron 705IT monitor - £169.95
- Omron (HEM-907) monitor (validated for use in elderly individuals) - £350.95
Oregon Scientific home blood pressure monitors (fits wrists 13.5-21.5cm)
- Oregon Scientific BPW810 (Wrist monitor) - £99.00
- Oregon Scientific BPU 330 monitor - £119.00
Panasonic home blood pressure monitors
- Panasonic EW3106 monitor - £50-£60
- Panasonic EW3109 monitor - £70-£80
Proton Healthcare home blood pressure monitors
- Proton Healthcare 888UP monitor - £54.99
- Proton Healthcare 888EA monitor - £74.99
- Proton Healthcare 888JA Healthcare monitor - £74.99
- Proton Healthcare 868BF Healthcare monitor - £139.99
Seinex (also known as Fore-Care) home blood pressure monitor (S, St and L cuffs available to buy)
- Seinex (Fore-Care) SE-9400 monitor - £39.99
Sensacare home blood pressure monitor
- Sensacare SAW102 (Wrist monitor) - not currently sold in the UK
Stabil-O-Graph home blood pressure monitor (St, L and XL cuffs available to buy)
- Stabil-O-Graph monitor – £69.90
Visocor home blood pressure monitor
- Visocor HM40 (Wrist monitor) - not currently sold in the UK
Thursday, July 14, 2011
12 Ways to Lower Blood Pressure Naturally
High blood pressure is one of the most preventable conditions.
But it plays a contributing role in more than 15% of deaths in the
Certain groups of people—the elderly, African Americans, and those with a family history of high blood pressure—are more likely than others to have blood pressure that's particularly salt (or sodium) sensitive. But because there's no way to tell whether any one individual is sodium sensitive, everyone should lower his sodium intake, says Eva Obarzanek, PhD, a research nutritionist at the National Heart, Lung, and Blood Institute. How far? To 1,500 mg daily, about half the average American intake, she says. (Half a teaspoon of salt contains about 1,200 mg of sodium.)
According to a review of 15 studies, the less you drink, the lower your blood pressure will drop—to a point. A study of women at Boston's Brigham and Women's Hospital, for example, found that light drinking (defined as one-quarter to one-half a drink per day for a woman) may actually reduce blood pressure more than no drinks per day. One "drink" is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.
Scientists have long debated the effects of caffeine on blood pressure. Some studies have shown no effect, but one from
Lowering high blood pressure is as easy as one, two, tea: Study participants who sipped 3 cups of a hibiscus tea daily lowered systolic blood pressure by 7 points in 6 weeks on average, say researchers from Tufts University—results on par with many prescription medications. Those who received a placebo drink improved their reading by only 1 point.
Putting in more than 41 hours per week at the office raises your risk of hypertension by 15%, according to a
Need to bring down your blood pressure a bit more than medication or lifestyle changes can do alone? The right tunes can help, according to researchers at the
It’s time to heed your partner’s complaints and get that snoring checked out. Loud, incessant snores are one of the main symptoms of obstructive sleep apnea (OSA).
But it plays a contributing role in more than 15% of deaths in the United States
Fortunately, most people can reduce their blood pressure without medication. First get to a healthy weight. Then add these strategies.
1. Go for power walks
Hypertensive patients who walked at a brisk pace lowered pressure by almost 8 mmhg over 6 mmhg. Exercise helps the heart use oxygen more efficiently, so it doesn’t work as hard to pump blood. Get a vigorous cardio workout of at least 30 minutes on most days of the week. Try increasing speed or distance so you keep challenging your ticker.
2. Breathe deeply
Slow breathing and meditative practices such as qigong, yoga, and tai chi decrease stress hormones, which elevate renin, a kidney enzyme that raises blood pressure. Try 5 minutes in the morning and at night. Inhale deeply and expand your belly. Exhale and release all of your tension.
3. Pick potassium-rich produce
Loading up on potassium-rich fruits and vegetables is an important part of any blood pressure–lowering program, says Linda Van Horn, PhD, RD, professor of preventive medicine at Northwestern University Feinberg School of Medical. Aim for potassium levels of 2,000 to 4,000 mg a day, she says. Top sources of potassium-rich produce include sweet potatoes, tomatoes, orange juice, potatoes, bananas, kidney beans, peas, cantaloupe, honeydew melon, and dried fruits such as prunes and raisins.
4. Read food labels for sodium
Certain groups of people—the elderly, African Americans, and those with a family history of high blood pressure—are more likely than others to have blood pressure that's particularly salt (or sodium) sensitive. But because there's no way to tell whether any one individual is sodium sensitive, everyone should lower his sodium intake, says Eva Obarzanek, PhD, a research nutritionist at the National Heart, Lung, and Blood Institute. How far? To 1,500 mg daily, about half the average American intake, she says. (Half a teaspoon of salt contains about 1,200 mg of sodium.)
Cutting sodium means more than going easy on the saltshaker, which contributes just 15% of the sodium in the typical American diet. Watch for sodium in processed foods, Obarzanek warns. That’s where most of the sodium in your diet comes from, she says. Season foods with spices, herbs, lemon, and salt-free seasoning blends.
5. Indulge in dark chocolate
Dark varieties contain flavanols that make blood vessels more elastic. In one study, 18% of patients who ate it every day saw blood pressure decrease. Have 1/2 ounce daily (make sure it contains at least 70% cocoa).
6. Take a supplement
In a review of 12 studies, researchers found that coenzyme Q10 reduced blood pressure by up to 17 mmhg over 10 mmhg. The antioxidant, required for energy production, dilates blood vessels. Ask your doctor about taking a 60 to 100 mg supplement up to 3 times a day.
7. Drink alcohol—but not too much
According to a review of 15 studies, the less you drink, the lower your blood pressure will drop—to a point. A study of women at Boston's Brigham and Women's Hospital, for example, found that light drinking (defined as one-quarter to one-half a drink per day for a woman) may actually reduce blood pressure more than no drinks per day. One "drink" is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.
Other studies have also found that moderate drinking—up to one drink a day for a woman, two for a man—can lower risks of heart disease. "High levels of alcohol are clearly detrimental," says Obarzanek. "But moderate alcohol is protective of the heart. If you are going to drink, drink moderately."
8. Go decaf
Scientists have long debated the effects of caffeine on blood pressure. Some studies have shown no effect, but one from Duke University Medical Center
Caffeine can raise blood pressure by tightening blood vessels and by magnifying the effects of stress, says Jim Lane, PhD, associate research professor at Duke and the lead author of the study. "When you're under stress, your heart starts pumping a lot more blood, boosting blood pressure," he says. "And caffeine exaggerates that effect." If you drink a lot of joe, pour more decaf to protect your ticker.
9. Take up tea
Lowering high blood pressure is as easy as one, two, tea: Study participants who sipped 3 cups of a hibiscus tea daily lowered systolic blood pressure by 7 points in 6 weeks on average, say researchers from Tufts University—results on par with many prescription medications. Those who received a placebo drink improved their reading by only 1 point.
The phytochemicals in hibiscus are probably responsible for the large reduction in high blood pressure, say the study authors. Many herbal teas contain hibiscus; look for blends that list it near the top of the chart of ingredients—this often indicates a higher concentration per serving.
10. Work (a little) less
Putting in more than 41 hours per week at the office raises your risk of hypertension by 15%, according to a University of California , Irvine , study of 24,205 California
11. Relax with music
Need to bring down your blood pressure a bit more than medication or lifestyle changes can do alone? The right tunes can help, according to researchers at the University of Florence in Italy
12. Seek help for snoring
It’s time to heed your partner’s complaints and get that snoring checked out. Loud, incessant snores are one of the main symptoms of obstructive sleep apnea (OSA). University of Alabama
If you have sleep apnea, you may experience many brief yet potentially life-threatening interruptions in your breathing while you sleep. In addition to loud snoring, excessive daytime tiredness and early morning headaches are also good clues. If you have high blood pressure, ask your doctor if OSA could be behind it; treating sleep apnea may lower aldosterone levels and improve BP.
Sunday, July 3, 2011
Migraine Plus High Blood Pressure May Raise Stroke Risk: Expert
Milan, Italy - Although some issues still need to be clarified, accumulating evidence suggests that migraine should one day be considered a risk factor for cardiovascular disease or, more specifically, stroke, says one expert.
Those with migraine and high BP develop hypertension at early age
The prevalence of hypertension and migraine comorbidity is clinically rare, but doctors should pay attention when they see this, because it might help identify patients at risk of an event.
Those with comorbidity up to five times more likely to have had stroke
During a lecture on migraine and hypertension at the European Society of Hypertension (ESH) European Meeting on Hypertension 2011 here today, Dr Enrico Agabiti-Rosei (University of Brescia, Italy) discussed findings from a study published earlier this year, which showed that those who had hypertension and suffered from migraine had a higher probability of a history of cerebrovascular events than hypertensive-only patients.
"The prevalence of hypertension and migraine comorbidity is clinically rare, but doctors should pay attention when they see this, because it might help identify patients at risk of an event. Migraine might be considered as a factor to be included in the score for risk of stroke," he observed.
To heartwire, he commented: "When a young person has hypertension it's important, particularly if it's a woman, to look for the possible presence of migraine. Once comorbidity is found, it's very important to make an appropriate screening of cardiovascular risk factors, because what a doctor can do is try to reduce as much as possible these risk factors that are correctable by treatment—this includes not only hypertension but also high cholesterol, diabetes, and so on."
Issues that remain to be resolved, he said, include whether migraine itself is a modifiable risk factor for stroke and whether the treatment of migraine can reduce the risk of stroke. "We need more studies in order to assess the true importance of this relationship. We need prospective studies to confirm this interesting result."
Those with migraine and high BP develop hypertension at early age
In his talk, Agabiti-Rosei outlined previous studies in the field, mainly epidemiologic and observational, that have indicated a correlation between migraine and CVD events, mainly stroke. "Migraine seems to be associated with vascular damage, perhaps endothelial dysfunction," he noted.
The prevalence of hypertension and migraine comorbidity is clinically rare, but doctors should pay attention when they see this, because it might help identify patients at risk of an event. And although migraine with aura as opposed to migraine alone has shown the greatest association with CVD in prior work, he told heartwire that the diagnosis of migraine in much of this research was not necessarily that scientific, having often been based on the results of questionnaires.
To examine the characteristics of those with both hypertension and migraine, he and his colleagues performed a large, multicenter, cross-sectional survey in Italy—the Hypertension and Migraine Comorbidity: Prevalence and Risk of Cerebrovascular Events (MIRACLES) study—in which they compared prior events in patients with both conditions with those who had hypertension alone.
The study included 2973 patients with hypertension, migraine, or both, of whom 517 (17%) suffered from hypertension-migraine comorbidity, 1271 (43%) from hypertension only, and 1185 (40%) from migraine only.
In those with both conditions, the onset of comorbidity occurred at about 45 years of age, with migraine starting significantly later than in the migraine-only group, and hypertension significantly earlier than in the hypertension-only group. Blood pressure was more difficult to control in those with both conditions, and such individuals frequently had a positive family history for both migraine and hypertension.
Those with comorbidity up to five times more likely to have had stroke
The comorbidity group had a higher prevalence (4.4%) of history of cerebrovascular events, compared with those with hypertension only (3.1%) or migraine alone (0.7%), with an odds ratio of a predicted history of stroke/transient ischemic attack (TIA) of 1.76 (95% CI 1.01-3.07) compared with the hypertension group. And in the age range of 40 to 49 years, prevalence of history of stroke/TIA was fivefold greater (4.8% in those with comorbidity vs 0.9% in the hypertension group).
Agabiti-Rosei said that although they carefully diagnosed migraine with aura in MIRACLES, the majority of patients just had migraine, so no separate analysis on migraine with aura was performed.
In conclusion, he said: "The prevalence of hypertension-migraine comorbidity is clinically relevant and might help identify patients at future risk for cardiovascular events."
"Doctors should look for this association, and of course migraine onset is at a relatively young age in comparison with hypertension onset, but as you know, our purpose is to try to convince doctors to measure BP quite early, starting at a young age, even in adolescents and children," he commented to heartwire.
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