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Blood Pressure and Hypertension Control Matter for Young Adults

Many young adults (18-39 year-olds) view themselves as physically healthy and may wonder why their doctor is concerned about their blood pressure. However, being young does not prevent you from developing elevated or high blood pressure. Uncontrolled blood pressure in young adults is a significant public health concern. In the U.S., 1 in 5 young men and 1 in 6 young women have hypertension. Hypertension control also varies by age group, with only 39% of U.S. young adults with hypertension having achieved control (blood pressure < 140/90 mmHg) compared with 58% of middle-aged adults (40-59 year-olds) and 54% of older adults (≥60 year-olds). Importantly, given that young adults with hypertension have more prolonged exposure to high blood pressure, they ultimately have a higher lifetime risk for cardiovascular disease. Early monitoring, diagnosis, and managed treatment are important to reduce the risk of serious medical conditions associated with uncontrolled hypertension.

Here’s a quick primer on blood pressure values and meanings and the effect of elevated blood pressure on cardiac structure and functioning:

Blood pressure is the force that blood applies to the walls of arteries as it’s pumped throughout the body.

Generally, your arteries can withstand some pressure, but there are limits to what the arteries can handle. For this reason, blood pressure is measured and monitored, and the values are categorized based on how the level of pressure affects our health. The four blood pressure categories are:

  • Normal: systolic less than 120, and diastolic less than 80
  • Elevated: 120 – 129, and less than 80
  • Hypertension (stage 1): 130 – 139, or 80 – 89
  • Hypertension (stage 2): 140 or higher, or 90 or higher
  • Hypertensive crisis: higher than 180, and/or higher than 120

Only normal blood pressure is considered healthy, while elevated or high blood pressure is associated with damaging the heart and arteries by forcing the heart to pump harder. When the heart works harder to pump blood, this can cause the heart muscles to thicken (altering the structure of the heart) and make it harder for the heart to fill with and pump blood (altering the functioning of the heart). The body’s arteries will also begin to narrow and harden, limiting the normal flow of blood.

Fortunately, high blood pressure is treatable and preventable. But uncontrolled hypertension affects nearly half of adults in the U.S., with many people unaware they even have the condition. The CDC recommends that knowing key facts about hypertension, getting your blood pressure checked regularly, and taking action to control your blood pressure if it is high is key to lowering your risk.

Source: “6 Facts About High Blood Pressure.” Venngage. https://venngage.net/pl/bVswgLzcpM

Since hypertension does not cause noticeable symptoms, it mustn’t be ignored. Over time, high blood pressure quietly damages the circulatory system and increases one’s risk of developing adverse health conditions – thus, hypertension is known as a silent killer. Additionally, high blood pressure is associated with poorer outcomes with COVID.

Steps to lower your blood pressure are often considered manageable and include common lifestyle modifications:

  • Smoking cessation
  • Maintaining a healthy weight
  • Consuming low levels of salt
  • Getting plenty of exercise
  • Limiting alcohol
  • Eating healthy

However, the patient experience among young adults with hypertension suggests significant barriers to receiving adequate blood pressure control management exist for this population. In a multi-center qualitative study, Johnson et al. (2016) identified unique emergent themes among young adults with hypertension that differed from prior hypertension qualitative studies in older age groups. Young adults voiced that the chronic disease diagnosis and the recommended lifestyle modifications made them feel older than their biological age. The participants also mentioned ongoing adverse psychological effects associated with their diagnosis and feeling a sense of self-blame and shame. This may be a critical point of intervention for healthcare teams to understand and address the negative emotional and mental health effects that a hypertension diagnosis has on young adults. Other emergent themes identified in the focus groups included the cost-benefit analysis performed by young adults when determining the necessity of recommended blood pressure treatment plan (e.g., lifestyle modifications, medication) and concern about experiencing negative social stigma based on their behavior choices reflecting new lifestyle modifications. Finally, most participants reported discarding hypertension education materials after leaving the clinic, citing that the materials were not tailored to young adults and their lifestyles.

These themes identified important barriers to young adult patients’ education on hypertension awareness and risks and opportunities for hypertension treatment non-adherence related to both medication and lifestyle modifications. Young adults with hypertension represent a unique population that could benefit from targeted interventions to improve hypertension control and cardiovascular disease prevention.

References:

  1. Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.
  2. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141:e139-596.
  3. Wall HK, Hannan JA, Wright JS. Patients with undiagnosed hypertension: Hiding in plain sight. JAMA2014;312(19):1973–1974.
  4. Parcha V, Patel N, Kalra R, Arora G, Arora P. Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults: Race-Stratified Analysis of the National Health and Nutrition Examination Survey. Mayo Clin Proc. 2020 Jul;95(7):1390-1403. doi: 10.1016/j.mayocp.2020.01.041. PMID: 32622447.
  5. Johnson HM, Warner RC, LaMantia JN, Bowers BJ. “I have to live like I’m old.” Young adults’ perspectives on managing hypertension: a multi-center qualitative study. BMC Family Practice. 2016 Dec;17(1):1-9.
  6. https://www.houstonmethodist.org/blog/articles/2020/jan/why-your-blood-pressure-matters-even-in-your-20s-and-30s/
  7. https://www.cdc.gov/bloodpressure/5_surprising_facts.htm
  8. “6 Facts About High Blood Pressure.” Venngage. https://venngage.net/pl/bVswgLzcpM

“The views, opinions, and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness, and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions, or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Managing High Blood Pressure by Managing Stress

manage stressWe are faced with a number of changes in our lives. The old saying, “life happens” generally means take the changes as they come and keep it moving. The human body is not equipped to distinguish between distress and eustress. Amazing life changes happens such as getting acknowledged for an accomplishment, passing the preliminary exams for a PhD program, getting the job of your dreams, or even getting the funding you have worked so hard to apply for consideration. Contrarily, changes that can be viewed as less than optimal such as being passed over for a promotion, losing the sole source of your family’s income, death of dreams, and rejection are all sources of stress. Good or bad, these events affect hypertensive rates potentially leading to a more serious chronic illness such as heart attacks, strokes, or even metabolic disease.

Often people, especially scientist and clinicians think their stress is just a way of life and there is nothing that can be done about that constant state. Scientist are always on the hunt for research funding and publishing; while clinicians holds the consequences of a person’s life in each of their decisions. These are significant burdens for a person to hold. It is imperative to manage stress as a means of preventing and treating high blood pressure. It is definitely easier said than done, but attempting these steps to control stress could lead to a better life:

  • Sleep quality and quantity can make a huge difference in managing mental alertness and energy but sleep allows the body time to relax and heal. Quality sleep can aid in the reduction of blood pressure leading to vascular repair.
  • Reiki principles that include meditation enhances muscle and mental relaxation. This include activities such as guided imagery, deep breathing, and massage therapy to act as stress-relievers.
  • Strengthen your social network. Connect with others by taking a class, joining an organization, or participating in a support group.
  • Try to resolve negative situations quickly so they do not fester. It is best to let go of adverse events and interactions; whether it is something that is in or out of your control
  • Don’t be afraid to ask for help from a counselor. Although there is a negative stigma surrounding seeing a therapist they are the best resource for dealing with stressful situations because your spouse, friends, and neighbors generally have as much going on as you and their opinions can be clouded by their own experiences.

I recently started working with a mentor to help with stress and how to interact with individuals to manage stress. As the young adults say, “I like to keep it 100” but often being brutally honest is not received well by the masses. I also made the determination that whether working or interacting on a personal level, I will not extend myself beyond my comfort zone nor will I compromise my values or ethics to fit into anyone’s idea of what I should be doing. Staying true to oneself is among the first steps to happiness and managing blood pressure. I have found that when I over extend myself, my stress level increases and my performance decrease in some areas (namely self care). My life, your life, is not worth negativity. Being that stress is inevitable, I choose the eustress. It is my opinion that this type of stress leads to self happiness and the contribution of the happiness of others.

Thank you for reading this blog. If you would like to share some of your methods for dealing with stress or how you keep your life stress limited, let me know comment or tweet @AnberithaT so we can share ideas.

 

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Apple Watch, Fitbit or RESPeRATE – Can They Assist in Lowering Blood Pressure?

which device should I choose?

We see people walking around with the wearable devices everyday without regard to whether they really make a difference with metabolic parameters. These devices all have the capability of prompting wearers to take steps, stand up when sitting, but they can also alert wearer to slow breathing. A poster presented at Experimental Biology in Orlando by Evan D. Jette, a student from the Usselman’s lab at McGill University in Montreal, QC, Canada made the argument these wearable devices can potentially lower blood pressure (BP). I was interested in whether there was more research surrounding these wearable devices, especially Fitbit and Apple because I noticed they were prevalent among conference goers.

Evan’s research suggested there was a trend with blood pressure among clinical populations (high BP or T2DM) indicating that slower breathing (~15 breaths per min) can potentially have a positive impact on diastolic BP. He further indicated that the Fitbit may have been optimal in lowering BP via respiratory rate due to the ability of the Fitbit to customize breathing to the wearer rather than generating a standardized rate for all subjects. These data leave me to wonder, since the RESPeRATE is marketed to lower blood pressure by controlling breathing, and most people own wearable devices such as commercially available Fitbits or Apple Watches, would these devices really assist in BP modulation?

There is a significant amount of literature surrounding the heart rate capability of the wearable devices, but negligible data referencing changes in blood pressure. The exception is RESPeRATE taking the stand that their product is “clinically proven to lower blood pressure”. In the study by Jette, participants that undergo low to moderate exercise exhibited no significant difference in heart rate with either the Fitbit or the Apple Watch. However, under extreme conditions such as high impact training, accuracy was reduced across both devices. The Fitbit provided heart rates that were equivalent to the Polar monitor (a heart rate monitor strapped to the subject’s chest). I wonder under these experimental conditions will RESPeRATE have similar outcomes.

Nevertheless, I did not find any data that supporting these wearable devices playing a role in reduced BP. I think the Usselman’s group is on to something with exploring the use of these wearable devices to modulate BP. However, a healthy lifestyle that incorporate the AHA Life’s Simple 7 will assist in blood pressure reduction. So, keep wearing your fitness devices to maintain an enhanced level of motivation and stay connected to a community of people that will support your BP reduction goal.

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Under Pressure: What Does Retina Say About Hypertension?

An eye oftentimes feels like the most underappreciated systems in the field of vascular biology. An eye is a highly vascular organ then it gets credit for and here’s why – ranging from high blood pressure or diabetes to early signs of stroke, an eye exam can, in fact, tell a physician a lot about one’s health. In a series of blog posts, I decided to highlight these key connections between the eye and the human body. This article will focus on the current knowledge linking eye and hypertension.

 

Hypertension or high blood pressure is predominantly caused due to increased resistance to the walls of the blood vessels. What this leads to is increased chances of developing diseases of the cerebral, cardiovascular or even peripheral arteries. Risk factors can range from dietary habits to genetics and ethnicity, and less than half of those with hypertension are unaware of their condition. Interestingly, the eye offers a very useful set-up to get a closer look at blood vessels – without even having to inject or cut open anything. This non-invasiveness of the eye has been widely used by clinicians and researchers to diagnose diseases of the blood vessels – hypertension being one of them. This article highlights some interesting findings that researchers derived simply by examining the retinal blood vessels.

A fundoscopic photograph of the back of the eye (like seen in the image below), allows to capture the retinal blood vessels. These blood vessels share many physiological and anatomical similarities with vessels in other systems, like the brain and the heart. Naturally, any changes in the structure or integrity of these vessels have been documented and researchers have found many links and associations with the pathology of hypertension5. I previously discussed how the retinal vessels gave a sneak peek into the brain and heart, where dimensions like the diameter or tortuosity were able to indicate early signs of stroke or cardiovascular diseases.

Source: Cheung et al., Hypertension. 2012;60:1094–1103

 

As early as the 1960s, scientists learned that narrowing of retinal arteries were important signs of hypertension. The population-based Rotterdam study published in 2005 looked at individuals in over 55 years of age and were “pre-hypertensive.” Their findings suggested that the narrowing of both retinal arterioles and venules were associated with increased risk of hypertension and preceded development of high blood pressure2. Similarly, the Blue Mountains Eye study in Sydney found that these abnormalities in the retinal vessels predicted a 5-year incidence of severe hypertension in a patient population of older cohort3.

Source: M. Kamran Ikram et al., Hypertension. 2005;47:189–194 

This image of an eye fundus shows a semi-automated system used to measure the diameters of arterioles and venules in the retina.

 

Making use of this unique retinal fundoscopic tool, another group explored measurement of blood flow to the retina, in response to light-flicker in patients with high blood pressure3. They found that hypertensive patients had impaired blood flow in the retina, possibly caused due to prolonged constricted vessels. This approach is among the first to test blood flow to the retinal, instead of measuring the vessel itself – adding another asset to retinal fundus images.

Retinal images have also been used in genetic linkage studies. Large population data sets are analyzed for tracing genes and variations of the genes associated with diseases among different individuals. It is clear that changes in the diameter of retinal vessels can precede hypertension, but are there genetic predeterminants to an individual’s retinal diameters? In 2006, the Beaver Dam Study found that apart from genetic linkages found between retinal diameters and hypertension and other associated diseases, there are genetic factors that predetermine the retinal diameters – independent of hypertension4.

This simply means that there are other factors present in our systems that are genetically related to the structure and size of one’s retinal vessels. Interestingly, another research group looked retinal vessels of 6-year-old students with hypertensive parents6. They found that only the girls (not boys) had narrowing retinal vessels and were predisposed to developing hypertension later in life. This also suggests a genetic link between retinal vessels and blood pressure.

Researchers around the world have used retinal parameters as indicators of hypertension. Evidently, retinal imaging provides for a powerful tool in identifying markers of cardiovascular complications. However, this still remains a tool widely used only among researchers, and validation of retinal imaging for clinical use still remains to be seen. With emerging advanced technology, clinicians should consider a non-invasive method like this one as a diagnostic tool.

 

References:

  1. M. Kamran Ikram et al., Retinal Vessel Diameters and Risk of Hypertension. Hypertension. 2005;47:189–194
  2. Smith et al., Retinal Arteriolar Narrowing Is Associated With 5-Year Incident Severe Hypertension. Hypertension. 2004;44:442–447
  3. Ritt et al., Impaired Increase of Retinal Capillary Blood Flow to Flicker Light Exposure in Arterial Hypertension. Hypertension. 2012;60:871–876.
  4. Xing et al., Genome-Wide Linkage Study of Retinal Vessel Diameters in the Beaver Dam Eye Study. Hypertension. 2006;47:797–802
  5. Cheung et al., Retinal Microvasculature as a Model to Study the Manifestations of Hypertension. Hypertension. 2012;60:1094–1103.
  6. Gopinath et al., Parental History of Hypertension Is Associated With Narrower Retinal Arteriolar Caliber in Young Girls. Hypertension. 2011;58:425–430.