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Is Your Doctor's Age Bias Making Your High Blood Pressure Worse?
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Older adults are more likely than younger people to have high blood pressure and suffer from serious health conditions that can be caused or worsened by hypertension, such as heart disease and stroke. But research suggests that high blood pressure in older patients often isn't being treated as aggressively as it should be.
A Harvard study found that more than 70 percent of older Americans who need more intensive treatment for high blood pressure aren't receiving it, and some health experts say they think age bias could play a role in those decisions. The assumption by doctors that high blood pressure is inevitable after a certain age, and concerns about side effects of lower blood pressures on older people, could be factors in this undertreatment.
"There's a bias towards older people because doctors are concerned that they won't do well on these lower blood pressures," says Beverly Green, M.D., senior investigator for Kaiser Permanente Washington Health Research Institute. Doctors may have concerns about older patients becoming lightheaded, which could increase fall risk, and the effect on cognitive abilities, especially for someone already experiencing cognitive decline. But many of these concerns have been challenged by research, Green says, and it's older people who actually benefit the most from the lower blood pressures.
Older people may not receive enough blood pressure medicationHypertension becomes more common with age: The Centers for Disease Control and Prevention (CDC) says 74.5 percent of those over age 60 have high blood pressure, which is defined as a reading of 130/80 mm Hg. Yet a study published in Hypertension found that physicians were treating high blood pressure less aggressively in recent years, with fewer medications being prescribed overall. Lead author Brent Egan, M.D., vice president of the American Medical Association's cardiovascular disease prevention group, says a fall in blood pressure diagnosis and treatment from 2015 to 2018 was primarily explained by a decline in the effectiveness of hypertension management plans.
"Fewer patients were being diagnosed with hypertension, fewer were being treated, and those being treated were more likely to report taking a single blood pressure medication when most patients require two or more blood pressure medications to control their hypertension," Egan says.
From Birth To Adulthood: Tips For Navigating CAH
Congenital Adrenal Hyperplasia (CAH) is a genetic disorder that affects the adrenal glands, which play a crucial role in hormone production. This condition can shape the lives of those affected from birth through adulthood, influencing physical development, emotional well-being, and overall health. With proper management and care, individuals with CAH can lead healthy, fulfilling lives, but the journey often comes with unique challenges at each stage of life.
This article explores how CAH impacts individuals from infancy to adulthood and what families and individuals can expect as they navigate living with this condition.
What is Congenital Adrenal Hyperplasia?Congenital Adrenal Hyperplasia refers to a group of inherited disorders that result from a deficiency in enzymes needed for the adrenal glands to produce essential hormones such as cortisol, aldosterone, and androgens. The most common form of CAH is caused by a deficiency in the enzyme 21-hydroxylase. This leads to insufficient cortisol and aldosterone production, coupled with an overproduction of androgens, which are male sex hormones.
These hormonal imbalances can affect growth, sexual development, and other body functions. Depending on the type and severity of CAH, the impact can range from mild to life-threatening.
Infancy: The Early ChallengesFor many children with CAH, the journey begins at birth. In its severe form, known as classic CAH, the disorder can present immediately with serious symptoms, often within the first few weeks of life.
Salt-Wasting CAHOne of the most severe forms is salt-wasting CAH, where the body loses excessive amounts of salt, leading to dehydration, vomiting, low blood pressure, and potentially fatal complications. This condition requires immediate medical intervention.
In some infants, simple virilizing CAH (another form of classic CAH) can lead to ambiguous genitalia in females due to excessive androgen production. Boys with simple virilizing CAH usually appear physically normal at birth but may experience symptoms related to early puberty later on.
Parents of children with CAH often face difficult decisions, particularly regarding gender-related issues, such as whether to pursue reconstructive surgery for female infants with ambiguous genitalia.
Childhood: Managing Growth and DevelopmentAs children with CAH grow, managing their condition becomes a balancing act. Hormone replacement therapy continues to play a crucial role in helping children develop normally, but adjustments in treatment are often necessary to ensure proper growth and overall well-being.
Growth ChallengesAnother common issue in children with CAH is early puberty. Excess androgens can cause early development of secondary sexual characteristics, such as pubic hair, body odor, and deepening of the voice in boys. This early puberty can be emotionally challenging for children who may feel out of sync with their peers.
Regular monitoring by healthcare providers and fine-tuning of hormone therapy can help manage these symptoms, allowing children with CAH to develop at a more typical pace.
Adolescence: Navigating Puberty and IdentityPuberty is a critical time for individuals with CAH, as it can bring both physical and emotional challenges. Hormonal imbalances may become more pronounced, and the social and psychological effects of living with CAH can become more complex.
Physical ChangesFor teenagers with CAH, puberty can either come too early or be delayed, depending on how well their condition has been managed. Girls may experience irregular periods, excessive body hair (hirsutism), or severe acne due to elevated androgen levels. Boys may continue to show signs of early puberty, which can impact their self-esteem and body image.
Gender Identity and Body ImageAdolescents with CAH, particularly girls who were born with ambiguous genitalia, may struggle with body image and gender identity. The decision to undergo surgery in infancy may have long-term psychological impacts. Adolescence is often when these feelings surface, and counseling or psychological support can be critical in helping young people navigate these emotions.
Teens with CAH may also face difficulties in relationships, as concerns about fertility or sexual development can become sources of anxiety. Open communication with healthcare providers, alongside support from family and peers, is essential during this period.
Adulthood: Living with CAHAs individuals with CAH reach adulthood, they often transition from pediatric to adult endocrinologists, but their need for ongoing care remains. Hormone therapy must continue, and regular monitoring is essential to prevent complications such as adrenal crises or long-term health issues.
Reproductive Health and FertilityFertility can be a concern for both men and women with CAH. Women with non-classic or classic CAH may experience irregular periods or ovulation issues, making it difficult to conceive. However, with appropriate medical care, many women with CAH can still achieve pregnancy.
For men, high androgen levels can sometimes affect fertility, though this is less common than in women. Fertility treatments are available for both men and women, and counseling can help couples understand their options.
Adrenal Crises in AdulthoodAlthough adrenal crises are more common in infancy, adults with CAH remain at risk, particularly during periods of illness, injury, or extreme stress when the body's need for cortisol increases. Knowing how to manage adrenal crises and adjusting hormone therapy during stressful times is vital to avoid life-threatening situations.
Adults with CAH are advised to carry a medical alert bracelet and emergency hydrocortisone injections to ensure they can receive prompt treatment during an adrenal crisis.
Mental and Emotional Well-BeingLiving with a chronic condition like CAH can take a toll on mental health. Anxiety, depression, and body image issues are not uncommon among adults with CAH. Access to mental health care, support groups, and counseling can make a significant difference in helping individuals maintain emotional well-being while managing their condition.
The Lifelong Journey with CAHCongenital Adrenal Hyperplasia shapes the lives of those it affects from infancy to adulthood. It requires careful management, regular medical care, and emotional support throughout each stage of life. While the condition presents unique challenges, advances in medical treatment and hormone therapy have enabled individuals with CAH to lead fulfilling, healthy lives.
Early diagnosis through newborn screening, appropriate hormone replacement therapy, and ongoing monitoring are key to minimizing the impact of CAH. Families and individuals affected by this condition should educate themselves, build a strong support network, and work closely with healthcare providers to manage the disorder effectively.
With the right care, people with CAH can thrive from birth through adulthood, living life to its fullest potential.
New Blood Test Pinpoints Preeclampsia Risk During Labor
Doctors may soon use a simple blood test to detect preeclampsia risk in laboring women, enabling preventive measures for safer deliveries. Routine blood tests may identify laboring women at risk for preeclampsia, a leading cause of maternal death as per research presented at the ANESTHESIOLOGY® 2024 annual meeting. This could prompt timely interventions to protect both mother and baby (1✔ ✔Trusted SourceANESTHESIOLOGY® 2024 annual meetingGo to source). Between 5% and 10% of pregnant women develop preeclampsia (sudden high blood pressure and protein in the urine), according to the Centers for Disease Control and Prevention (CDC). 'Did You Know?Preeclampsia affects 5-8% of pregnancies worldwide. #preeclampsia #maternallabor' Black women are 60% more likely to develop preeclampsia than white women, and more likely to die or have serious outcomes such as kidney damage, the CDC notes.
While preeclampsia can develop as early as the 20th week of pregnancy, the study focused on identifying women who were at risk for preeclampsia when they were admitted to the hospital in labor.
Researchers have determined doctors can predict a woman's risk of developing preeclampsia by calculating the ratio of two blood proteins — fibrinogen and albumin — measured in routine blood tests done when women in labor enter the hospital.
Fibrinogen is involved in blood clotting and inflammation, while albumin helps maintain fluid balance and carries hormones, vitamins, and enzymes throughout the body.Both can be disrupted with preeclampsia — fibrinogen may be elevated, albumin may be reduced, or both can occur.
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Protecting Moms and Babies from Preeclampsia Risk There is no universally established normal value for this fibrinogen-to-albumin ratio (FAR), which can range from 0.05 to 1 or higher.Higher FAR values are often associated with increased inflammation, infection, or serious health conditions, and the higher the FAR, the greater the concern.
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This trend has been consistently seen when FAR is used to evaluate other inflammatory conditions, such as rheumatoid arthritis, cardiovascular diseases, and inflammatory bowel disease.In the study, researchers analyzed the records of 2,629 women who gave birth between 2018 and 2024, 1,819 who did not have preeclampsia, 584 who had preeclampsia with mild features or symptoms (including blood pressure of 140/90 mm Hg or higher, but no significant signs of organ damage), and 226 who had preeclampsia with severe features or symptoms (including blood pressure of 160/110 mm Hg or higher and signs of organ damage, including severe headaches, high liver enzymes, visual disturbances, low platelet count or kidney impairment).
The researchers determined those who had a higher FAR were more likely to develop preeclampsia than those with a lower FAR.
They found that the predicted likelihood of developing any degree of preeclampsia was 24% for patients with a FAR of at least 0.1 on admission to the hospital, and it rose to more than 41% when that value was above 0.3.
If a woman in labor is found to be at increased risk for preeclampsia based on the FAR and other clinical indicators — such as being older than 35 or having chronic high blood pressure or obesity — obstetricians and anesthesiologists can take extra precautions to reduce the risk and ensure the patient's blood pressure and fluid levels remain stable and controlled.
For example, they can order more frequent blood pressure checks or lab tests. If the FAR indicates a woman is at risk for preeclampsia with severe symptoms, an epidural for pain management can be placed early before it becomes too risky.
"While FAR has been associated with other inflammatory conditions, its specific application to preeclampsia and preeclampsia with severe symptoms has not been reported in a group this large and racially diverse," said Lucy Shang, B.A., lead author of the study and a medical student at the Icahn School of Medicine at Mount Sinai, New York.
"Our study shows that FAR can be a predictive tool that gives anesthesiologists and obstetricians a new method for assessing a laboring mom's risk of developing preeclampsia when they are admitted to the hospital."
She noted that while this ratio should be assessed for all pregnant women, calculating the FAR is especially important for women who are at higher risk for preeclampsia, such as Black women and those with high blood pressure and obesity.
"Additional research is needed to determine the exact range of the FAR that would be considered concerning and would be helpful to incorporate into routine prenatal care as a predictive tool for early identification of preeclampsia," she said.
Reference:
Source-Eurekalert
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