high blood pressure

Are you sure your headache isn’t a heart attack?

Cardiovascular disease has long been considered a men’s health issue – but more women are dying from it.

Contibutors: Pat MuncherYahoo Contributor and Ed TusoxDigital Journal

I began to get a headache like I had never had before,” says 37-year-old Priscilla Chandro. “It was intense, but I didn’t know what caused it. I went to the kitchen to get paracetamol, but on the way I felt so hot I had to lie on the sofa. Once the wave of heat had passed, I got up again. But then I passed out and woke up staring at the kitchen ceiling.”

The symptoms of heart attacks in women are often much subtler and very different from those in men.

What Chandro was suffering from was in fact a massive heart attack. She did not believe it had happened to her. But neither did the paramedics who had rushed to her home, who said she had flu. Nor did a GP who initially examined her. It wasn’t just that Chandro, a working mother of a four-year-old daughter, from Ottershaw, Surrey, had a normally healthy lifestyle and no family history of cardiovascular disease. The symptoms of heart attacks in women are often much subtler and very different from those in men. And we still somehow don’t believe that women get heart disease, even though it kills three times more women than breast cancer does.

Finally scientists and doctors are accepting that women’s coronary problems are physically different from the male model upon which medical therapies are traditionally based. This opens a path to new treatments and preventive tactics. And not before time. For although coronary heart disease is considered a problem for overweight middle-aged businessmen, it is in fact the most common cause of death for British women.

Emotional stress may play a role in some forms of women’s heart disease. Last week it was reported that research by the University of Arkansas showed that shock or emotional trauma can damage the heart. It also stated that women are seven and a half times more likely to suffer “broken-heart syndrome”, or stress cardiomyopathy, a condition where intense emotional or physical stress can cause rapid and severe heart-muscle weakness, than men.

Vera Regitz-Zagrosek, director of the institute of gender in Berlin, says that high psychological stress plays the key role in 90 per cent of cases of a particular form of heart failure in women. “We are only just becoming aware of how much women are in danger from this syndrome,” she says.

Chandro says: “A heart attack was the last thing I could ever have imagined. It seemed like a cruel joke; not something that happened to women, especially young ones. I felt extremely frightened. People just don’t believe that it could have happened to me.”

But it frequently does, according to Jane Flint, a consultant cardiologist who chairs the British Cardiovascular Society’s joint working group for women’s heart health. “In 2010, 77,000 men died from cardiovascular disease. The same year, 80,000 women died from it,” she says. “A third of deaths in men are from this, and a third of deaths in women are, too.”

One reason for the female death rate is that women tend to wait longer than men before calling 999 after first experiencing heart attack symptoms. Experts speculate that this might be because women are reluctant to cause a fuss, or they don’t want to be embarrassed if it turns out that their situation isn’t serious.

The difference in symptoms also plays a role. Many men’s heart attacks fit with the picture of chest pain that spreads to the shoulder, arms, back, teeth or jaw, along with shortness of breath. Women’s signs can be much more vague and insidious.

A study of 500 female cardiac patients by the National Institute of Nursing Research reports that the most common symptoms that women experienced in the month before a heart attack are unusual fatigue, sleep disturbance, indigestion and anxiety. Forty per cent had no chest pain, even during an attack. Other research says that women are more likely to experience achiness or tightness across the chest during a heart attack, along with symptoms such as pain in the jaw, nausea, sweatiness, breathlessness and feeling light-headed.

But it is not only the symptoms that are different. The physical causes of women’s heart attacks can differ considerably too, and therefore require different treatment. Last week, leading cardiologists gathered at the University of Mississippi to explore these disparities at an international conference. High on the agenda was research suggesting that while men commonly suffer blockages, specifically in the arteries supplying blood to the heart, women’s heart disease is often spread more widely in their bodies. Dangerous fatty clots accumulate more evenly inside women’s major arteries and in smaller blood vessels.

Because women’s arteries are generally smaller than men’s they are more easily blocked. And the widespread nature of potential blockages makes it harder to diagnose the disease in a woman, and makes it more deadly if she has a heart attack, the conference was told by C. Noel Bairey Merz, the director of the Women’s Heart Center in Los Angeles. His figures show that more than a third of women will die within a year of their first heart attack, compared with a quarter of men. Women are twice as likely as men to have a second heart attack within six years of their first, he adds, and women are twice as likely as men to die after bypass surgery.

In addition, medical research often fails to differentiate between men and women in tests of drug therapies. Dr Flint says: “We know that heart drugs can have different effects according to your gender. But only half of the drug trials conducted into heart drugs since 2006 showed results by gender. And of the people tested, two thirds were men.”

Dr Flint says that statin drugs offer a clear example of the importance of gender-specific research. “Until recently, it was thought that women did not benefit from taking statins the way that men do. Thankfully, research shows otherwise now, though that is little comfort to women who have missed out. And even now, only about a third as many women are given statins as men. The message has not yet fully got out.”

Other drugs can have totally different effects on the sexes. Only in 2009 was it discovered that a daily aspirin regimen for men helps to protect against heart attacks, but offers no protection for women. (On the other hand, that same aspirin will protect women against strokes but has no such power for men).

Lifestyle plays a part too. The British Heart Foundation reports that about a third of women in England and Scotland have high blood pressure. More than half of all women in the UK are overweight or obese and less than a third in the UK do enough exercise to protect their hearts. It is recommended that these women begin to take regular readings with a blood pressure monitor to see if it is getting to high

For Priscilla Chandro, the idea of emotional stress playing a part in her heart attack feels particularly true. “I am convinced that my heart attack was brought on by all the intense emotional stress I had put myself under. After it happened, I decided to deal with all the sadness and anger that I had always carried around with me, to change my attitude and beliefs.”

Chandro was extremely lucky to have survived her massive coronary, given the late diagnosis. If more of us learn to watch for the subtler signs of a female heart attack, many more women may get that second chance of life, too.

The symptoms for women

The most common symptoms that women experience in the month before a heart attack are, say researchers:
Unusual fatigue, which was noted in 70 per cent of the women monitored
Sleep disturbance, which affected nearly half of them
Shortness of breath
Indigestion
A heightened sense of anxiety

During a heart attack, further research shows that women may feel:

Tightness across the chest (although 40 per cent of women don’t feel any chest pain)
Pain in the jaw
Nausea
Sweatiness
Breathlessness
Light-headedness

Source – The Times

24-hour blood pressure monitoring

The following letter published in The Times in response to the news that there is to be a change in the way blood pressure readings are taken:

Sir, That 24-hour blood pressure monitoring will now be more widely available does not negate the need for an improvement in the currently suboptimal standard of “office” blood presure measurement. Too often, patients in primary care as well as in secondary care undergo the following routine, which is in contravention of the guidelines for correct measurement of blood pressure: the measurement of blood pressure takes place almost immediately after the patient enters the consulting room, in contravention of the recommendation that the patient should remain seated for at least three minutes beforehand. Furthermore, in contravention of the recommendation that at least two measurements should be taken, most patients have only one measurement.

Finally, given that incorrect measurements are registered by electronic blood pressure monitors when a patient has an irregular pulse, the least precaution that should be taken before deciding whether to measure the blood pressure using an electronic device or manually is to document the patient’s pulse and its regularity. Many times, when I have had my blood pressure measured, I have not had my pulse taken.

And another brief contribution

Sir, Nice seems to be recommending that a nurse just “download an average” from the device. There is far more information in a day’s worth of readings than this: attempts should be made to categorise regularly observed patterns and to correlate them with comings and goings in the patients’ daily lives to see if any common threads can be discovered.

Evidence linking a low dietary potassium to sodium ratio to hypertension

Here is an interesting observation in response to this article on the Wall Street Journal –  headlined ‘Advance in war on high blood pressure’ which opened with the statement:

Americans are finally making headway in the battle against high blood pressure, one of the biggest contributors to cardiovascular disease

The comment read as follows: As someone who recovered from hypertension through diet, I felt dismayed by this article. Kaiser Permanente has improved its patients’ ability to control their blood pressure with medication, and this is presented as good news; but the real news here is that the medical community continues to ignore a method of blood pressure control that is simpler and better.

A year and a half ago, I was a trim, fit, nonsmoking 56-year-old with a blood pressure of 150/90. I began taking medication. I also began reading about hypertension. I discovered that, while the evidence linking dietary sodium to hypertension is complex and contradictory, the evidence linking a low dietary potassium/sodium ratio to hypertension is a lot stronger. (See, for example, “The High Blood Pressure Solution,” by Richard D. Moore M.D. Ph.D.)

Ignoring the relatively ineffectual established clinical guidelines for diet, as well my doctor’s skepticism, I stopped eating anything with added salt and began eating lots of bananas, orange juice and other high-potassium foods. My blood pressure fell so low that I was able to stop taking medication, and now, over a year later, it’s a healthy 115/75.

My new way of eating is easy to maintain. I’m healthy, I feel good, and I’m spared the expense and side effects of medication. Of course, this sort of gain, if lots of people did what I do, would reduce profits to hospitals and medical groups, as well as to food processing companies and drug companies. Could this explain why this method of blood pressure control is utterly neglected?

Lowering high blood pressure using radio waves

High blood pressure ‘zapped’

Current understanding is that about half of patients with high blood pressure are unable to reduce their blood pressure using conventional means.

New research suggests that people with hypertension who do not respond to drugs may be able to have the condition treated successfully by deactivating nerves in their kidneys.

A small study of the experimental treatment, which involves radio waves to destroy renal nerves involved in regulating hypertension, has shown that patients had their blood pressure lowered significantly.

“too good to be true” that a procedure might cure high blood pressure.

About half of all patients with high blood pressure aren’t able to lower their blood pressure to accepted levels with medicaction, diet, lifestyle changes and other healthcare products.

Scientists said that for these patients the new treatment could address the condition permanently, reducing risk of death and hypertension-related illness substantially.

New treatment to lower high blood pressure

The new treatment involves a tube pushed into a blood vessel in the groin, similar to the angioplasty procedures for opening clogged heart arteries. Radio waves  then zap nerves near the kidneys that fuel high blood pressure.

Renal nerves play a key part in the regulation of blood pressure, through their effect on renin release and sodium reabsorption, and kidney blood flow.

The study, published online by The Lancet, involved 106 patients whose systolic blood pressure (the top number in read-outs) was 178mm Hg despite taking a number of different drugs. After six months, about 39 per cent of those treated had blood pressure below the level that defines the condition.

High blood pressure, which is also known as hypertension, is usually defined as having a sustained blood pressure of 140/90mmHg or above.

taking blood pressure reading

It often causes no symptoms or immediate problems (high blood pressure is frequently refered to as the ‘silent killer’) but it is a major risk factor for developing a serious cardiovascular disease (conditions that affect the functioning of the heart and the circulation of blood around the body), such as a stroke or heart disease.

High blood pressure affects about 1 in 3 adults in England. It is estimated that 18 per cent of adult men and 13 per cent of adult women have high blood pressure but are not getting treatment for it. Estimates that there are about 1 billion people worldwide affected by hypertension.

The study leader from Baker IDI Heart and Diabetes Institute in Melbourne, Australia, and co-authors wrote that the treatment was conducted without major complications and confirmed the “crucial relevance of renal nerves in the maintenance of raised blood pressure in patients with hypertension”.

The study results were presented today at the American Heart Association conference in Chicago, where scientists welcomed the findings.

A cardiologist at the conference, described the research as extremely interesting saying  “that even if the treatment was only partly successful, the benefits would still be considerable”.

” the improvement in control of blood sugar also recorded in people who underwent the nerve deactivation would make it especially attractive for diabetics with high blood pressure”.

A spokesperson of the heart failure centre at the University of Pennsylvania, added that it seemed almost “too good to be true” that a procedure might cure high blood pressure and added “patients need to be followed for a long time to make sure the benefits last”.

Timothy West and Blood Pressure BBC Radio 4

Blood Pressure Appeal Timothy West – Radio 4

Actor Timothy West spoke to BBC Radio 4 about the importance of supporting blood pressure testing

The following is a transcript of Timothy’s  Radio 4 Appeal on behalf of the healthcare charity the Blood Pressure Association.

It was the perfect August Bank Holiday Cath and her husband Glen were driving to a country pub to have lunch – on the way they stopped for a newspaper, Glen stopped in the car.  As Cath left the shop she was startled by the sound of a blaring car horn – she looked up to see Glen slumped at the drivers’s seat, his head on the steering wheel.

Glen had died from hypertensive heart disease, a late complication of high blood pressure which he’d had unknowingly had for years – he was just 39.

Rugby mad Glen had seemed fit and healthy with a fantastic future ahead of him, yet appearances can be deceptive.

One in three have high blood pressure

Like me, Glen had high blood pressure, unlike me he was not fortunate enough to know it – you see it’s symptomless – a silent killer. One in three of you listening today will have high blood pressure yet a third of you who do wont even know it

I’m one of the lucky ones – I was diagnosed with high blood pressure during a medical before starting a film. I got the support I needed to bring my condition under control – that’s why, twenty years later I’m talking to you now.

A group of cardivascualr professors were frustrated at seeing endless strokes and heart attacks caused by uncontrolled high blood pressure and formed a healthcare charity awareness organisation for the public’s benefit. The charity takes blood pressure testing out onto the high street. Over the past nine years they’ve provided free checks to over a million people who might not otherwise have known their blood pressure. They also support thousands of people already diagnosed with the condition.

Prevent tragedies like this – its horrific to lose someone but when its preventable its heart breaking.