Month: November 2016

High blood pressure: Global total almost doubles in 4 decades

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The largest study of its kind reveals that the number of people worldwide living with high blood pressure has nearly doubled in the last 4 decades. The huge international effort also reveals a stark contrast between rich and poor countries.

The number of people living with high blood pressure, or hypertension, worldwide has grown from 594 million in 1975 to over 1.1 billion in 2015 – mainly because of population growth and aging – says the study, published in The Lancet.

However, while average blood pressure is high and rising in less affluent countries, especially in south Asia and sub-Saharan Africa, it has dropped to an all-time low in high-income nations like Canada, the United Kingdom, and the United States.

The authors say the reason for this contrast is not clear, but they suggest a major factor could be that people in wealthier nations enjoy better health overall and eat more fruits and vegetables.

Earlier diagnosis and control of hypertension is also more likely to occur in wealthier countries. Taken together, these factors also help reduce obesity, another risk factor for high blood pressure.

Childhood nutrition could be another reason, suggests Majid Ezzati, a senior author of the study and a professor at the School of Public Health at Imperial College London in the U.K., who notes:

“Increasing evidence suggests poor nutrition in early life years increases risk of the high blood pressure in later life, which may explain the growing problem in poor countries.”

High blood pressure major global killer

Blood pressure is the pressure of the blood in the blood vessels. It is assessed from two numbers measured in millimeters of mercury (mmHg): systolic pressure and diastolic pressure.

Systolic pressure is a measure of the heart pumping blood. Diastolic pressure – taken when the heart rests between beats – measures the resistance to blood flow in blood vessels.

High blood pressure is defined as 140 mmHg systolic and 90 mmHg diastolic pressure or higher. This is normally shown as 140/90 mmHg.

Recent research suggests that the risk of death from cardiovascular diseases like ischemic heart disease and stroke doubles with every 20 mmHg systolic or 10 mmHg diastolic increase in people of middle age and older.

“High blood pressure is the leading risk factor for stroke and heart disease, and kills around 7.5 million people worldwide every year,” says Prof. Ezzati.

The condition is caused by various factors, he and his colleagues note in their paper.

These include diet (for example, eating too much salt and not enough fruit and vegetables), obesity, lack of physical activity, plus environmental factors – such as air pollution and lead exposure.

‘Major health issue linked to poverty’

For the research, the World Health Organization (WHO) teamed up with hundreds of scientists from all over the globe and looked at changes in blood pressure in every country in the world from 1975-2015.

They pooled and analyzed data from nearly 1,500 population-based measurement studies involving a total of 19 million participants.

This showed that of the whole world, South Korea, the U.S., and Canada have the lowest proportion of people with high blood pressure. The U.K. had the lowest in Europe.

The research also shows that in most countries, there are more men with high blood pressure than women. Worldwide, there are 597 million men with high blood pressure, compared with 529 million women.

The figures for 2015 show that more than half of adults with high blood pressure in the world live in Asia, including 226 million in China and 200 million in India.

Prof. Ezzati says high blood pressure is no longer a problem associated with wealthy countries but with poor countries. He says their findings show it is possible to achieve substantial reductions in rates of high blood pressure – as seen in the data from more affluent countries over the last 4 decades. He adds:

“They also reveal that WHO’s target of reducing the prevalence of high blood pressure by 25 percent by 2025 is unlikely to be achieved without effective policies that allow the poorest countries and people to have healthier diets – particularly reducing salt intake and making fruit and vegetables affordable – as well as improving detection and treatment with blood pressure lowering drugs.”

Source: http://www.medicalnewstoday.com/articles/314155.php

Young brains and anesthesia: Big study suggests minimal risks

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Anesthesia during early childhood surgery poses little risk for intelligence and academics later on, the largest study of its kind suggests.

The results were found in research on nearly 200,000 Swedish teens. School grades were only marginally lower in kids who’d had one or more common surgeries with anesthesia before age 4, compared with those who’d had no anesthesia during those early years.

Whether the results apply to sicker children who have riskier surgeries with anesthesia is not known. But the researchers from Sweden’s Karolinska Institute and doctors elsewhere called the new results reassuring, given experiments in young animals linking anesthesia drugs with brain damage.

Previous studies of children have been relatively small, with conflicting results. The new findings, published Monday in JAMA Pediatrics , don’t provide a definitive answer and other research is ongoing.

The study authors and other doctors say the harms from postponing surgery must be considered when evaluating any potential risks from anesthesia in young children.

The most common procedures in the study were hernia repairs; ear, nose or throat surgeries; and abdominal operations. The researchers say the operations likely lasted an hour or less. The study did not include children with other serious health problems and those who had more complex or risky operations, including brain, heart and cancer surgeries.

The research involved about 33,500 teens who’d had surgery before age 4 and nearly 160,000 who did not.

School grades at age 16 were less than half a percent lower on average in teens who’d had one childhood surgery with anesthesia versus the no-surgery group. Average grades were less than 2 percent lower among teens who’d had two or more surgeries with anesthesia.

The researchers also looked at IQ tests given to Swedish boys at age 18 upon joining the military. Scores were about the same for those with one early surgery and the non-surgery group; scores were less than 3 percent lower in boys with three or more early surgeries.

The researchers, led by Karolinska’s Dr. Pia Glatz, noted that factors other than anesthesia appeared to have a much greater impact on academics and intelligence measures, including mothers’ education level.

A journal editorial says the results mean it is unlikely that early anesthesia poses a long-term risk. The study is “reassuring for children, parents and caregivers and puts the issue of anesthetic-related neurotoxicity and the developing brain into perspective,” the editorial says.

Source : http://www.foxnews.com/health/2016/11/07/young-brains-and-anesthesia-big-study-suggests-minimal-risks.html

Water: Can It Be Too Much of a Good Thing?

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Dehydration is a familiar foe for endurance athletes, and one that will be on the minds of every participant in Sunday’s New York City Marathon.

But did you know that drinking too much water can be potentially fatal, particularly if not treated properly?

And you don’t have to be an elite athlete like a marathoner to fall victim to what doctors call water intoxication.

Water intoxication occurs when a person has consumed so much water that the salt levels in the blood become diluted, said Dr. Aaron Baggish, co-medical director of the Boston Marathon.

“When sodium [salt] concentrations are low in the blood, it actually allows water to leak out of the blood into the other tissues,” a condition known as hyponatremia, added Baggish, who’s also associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.

The brain appears to be the organ most affected by hyponatremia, and begins to swell as water leaks out of blood and into brain cells, he said.

Usually, the symptoms are mild, such as confusion, headache and nausea. But if left untreated, people might wind up suffering seizures, Baggish said.

In the worst cases, the brain continues to swell uncontrollably, resulting in a potentially fatal condition called brain stem herniation, he said.

“The brain is soft tissue that’s contained in a fixed skull. When the brain swells, there’s only one real way it can go as an exit path, and that’s down to the bottom of the skull where there’s a hole that connects the brain to the spinal cord,” Baggish said.

Death from water intoxication is very rare among athletes like marathon runners, said Dr. William Roberts, a former president of the American College of Sports Medicine.

“We’ve noted maybe a half dozen deaths out of probably 3 or 4 million finishers, so it’s not a very common cause of fatality,” said Roberts, who’s also a professor with the University of Minnesota’s Department of Family Medicine and Community Health. Marathon runners are more likely to die from a heart attack or heat stroke, he said.

Sports medicine doctors are much more likely to see cases of water intoxication or hyponatremia than family practitioners, Baggish said.

“If you’re in a marathon tent or an Ironman tent, you may see a fair bit of it,” he said. “If you’re in a routine office practice, it won’t come across your radar screen. But, anyone who works with athletes in the context of long-distance endurance sports will see it from time to time.”

But endurance athletes aren’t the only ones at risk of water intoxication.

A 17-year-old high school football player in Georgia died in 2014 after consuming too much fluid during practice.

A 47-year-old British woman died from drinking too much water while hiking the Grand Canyon in 2008.

And a 28-year-old California woman died of water intoxication after taking part in a radio station’s water-drinking contest in 2007 to win a video game.

Earlier this year, a 27-year-old man named Andrew Schlater died from hyponatremia while in the midst of a liquid cleanse, or detoxification, without medical supervision, said his father, Frank Schlater of Rowayton, Conn.

For a number of days, Schlater’s parents had noticed him drinking a lot more water than usual. Andrew seemed fine, and shrugged off his parents’ requests to stop drinking so much water.

But, early one morning in July, Frank Schlater found his son in the family’s kitchen, sipping some water. Within minutes, Andrew collapsed on the floor. He was rushed to the hospital but died several hours later, due to brain herniation.

“You just can’t imagine water would hurt you,” Frank Schlater said. “You hear that too much water can be bad for you, but you don’t know how to weigh that.”

Others at risk of hyponatremia: Older people who take diuretics and have reduced kidney function, said Roberts.

Marathoners most at risk of water intoxication tend to be those out on the course for longer periods of time, Roberts noted.

“Slower runners have more time to drink water,” he said. “If you’re out there for six hours, walking through water stops and drinking more than you need, you could end up in this situation.”

Taking in salt or sodium during a race can help reduce the risk of hyponatremia, said Dr. Robert Glatter, an emergency physician with Lenox Hill Hospital in New York City. For example, athletes can consume sports drinks containing electrolytes, he said.

Roberts and Baggish offer two pieces of advice for endurance athletes who want to avoid water intoxication:

Drink when you’re thirsty, not before. “You should be drinking if you’re feeling mildly thirsty, but if you’re not thirsty there’s no point to pound water because it’s not going to make you perform better,” Baggish said.

Figure out your water-loss rate before your event. Weigh yourself while naked, go out for an hour’s run, and afterwards weigh yourself again. “That gives you an idea how much fluid you lost,” Roberts said. “Plan on drinking about that much during your event.”

And what about the non-endurance athlete. How much water does the average person need each day?

There’s no one-size-fits-all rule. But, the Institute of Medicine recommends that men consume approximately 13 cups (3 liters) of fluids a day. For women, the recommendation is about 9 cups (2.2 liters).

But, the Mayo Clinic notes that it’s best to think in terms of “fluid” consumption each day, not “water” consumption, because all fluids count toward the daily total, as do fluids found in foods.

Source: https://medlineplus.gov/news/fullstory_161839.html

Some immune-boosting cancer drugs may pose rare heart risks

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Doctors have found a disturbing downside to some powerful new drugs that harness the immune system to fight cancer: In rare cases, they may cause potentially fatal heart damage, especially when used together.

“The problem is, no one has this on their radar,” so patients are not routinely checked for it, said Dr. Javid Moslehi, head of a Vanderbilt University clinic specializing in heart risks from cancer therapies.

He led a report Wednesday in the New England Journal of Medicine describing two patients who died of heart trouble two weeks after receiving their first doses of two Bristol-Myers Squibb drugs, Opdivo and Yervoy, for the deadly skin cancer melanoma.

Two similar drugs also are on the market, and the study leaders believe they might pose heart risks, too.

“My sense is that this is a class effect, not limited to one drug,” Moslehi said.

The risks do not negate the huge benefits of these relatively new types of drugs, doctors stress. Called checkpoint inhibitors, they have transformed treatment of several types of cancer by helping the immune system see and attack tumors.

In rare cases, the immune system seems to attack not only the tumor but also the heart and other muscles, causing dangerous inflammation and heart rhythm problems. Patients need to be told of the risks, monitored closely and treated quickly with medicines to quell the immune response if trouble develops.

Besides melanoma, the Opdivo-Yervoy combination is used to treat some lung cancers, though at different doses. Other checkpoint inhibitors include Genentech’s Tecentriq, for bladder cancer, and Merck & Co.’s Keytruda, which former President Jimmy Carter received for melanoma that spread to his brain. Many more are in testing.

There have been occasional, previous reports of heart troubles with these drugs. After the two recent deaths, doctors asked Bristol-Myers to check patient safety records on Opdivo and Yervoy.

As of April, 18 cases of serious heart inflammation were found among 20,594 patients receiving either or both drugs, a rate of 0.09 percent. It was more severe and more common among people on both drugs, affecting 0.27 percent of those patients. Bristol-Myers scientists helped write the journal report, and some other authors consult for the company.

Studies have shown that the drug combination gives a stronger anti-cancer effect than either drug alone, but “we’ve known this is a double-edged sword” because of the risk of over-stimulating the immune system, said Dr. Jeffrey Sosman of Northwestern University in Chicago, who treated the two patients who died.

“The big question is, is there enough advantage to using the combination, which is much more toxic, than a single drug,” he said.

That’s a larger question facing the cancer field, not just with immune therapies. Some of the newer gene-targeting drugs also have produced major side effects when used in combination. Yet many doctors believe that combos may be the best way to get cancer to go into remission and stay there longer, by shutting down multiple pathways the tumor employs at once.

Dr. Michael Atkins, deputy director of the Georgetown-Lombardi Comprehensive Cancer Center, believes the heart problems with checkpoint inhibitors will turn out to be treatable in most patients.

“It just gives us a moment of pause,” said Atkins, who led a study that included one of the two patients who died. “This is a rare event … but it’s a particularly serious one.”

Source: http://www.foxnews.com/health/2016/11/03/some-immune-boosting-cancer-drugs-may-pose-rare-heart-risks.html