Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association
Long-term Oxygen Therapy Improves Exercise Capacity In PH
Long-term oxygen improves exercise capacity in people with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), a study suggests.
Twelve weeks of supplemental oxygen led to a significant and clinically relevant improvements in exercise capacity, as assessed with the six-minute walking distance test (6MWD), by 42 meters (about 138 feet) over the distances walked at start of the study, "Long-term oxygen therapy in precapillary pulmonary hypertension — SOPHA study," which was published in Scientific Reports.
PH is marked by high blood pressure in the pulmonary arteries, the blood vessels that transport blood from the heart to the lungs. Precapillary PH includes PAH, where blood pressure increases due to the narrowing of pulmonary arteries, along with CTEPH, a rare form of pulmonary hypertension where blood clots block the pulmonary arteries, increasing blood pressure and reducing the amount of oxygen transported to the rest of the body.
High blood pressure in the lungs makes the heart work harder to pump blood, ultimately weakening heart muscles. People with these conditions have shortness of breath and fatigue, limiting their ability to exercise.
Current guidelines recommend oxygen supplementation in pulmonary hypertension patients, with some evidence that it improves exercise capabilities and quality of life.
Effects of oxygen therapy in PHWhether long-term oxygen therapy would improve 6MWD, quality of life, blood flow dynamics, and disease progression in PAH or CTEPH, isn't fully known, leading researchers to conduct SOPHA (NCT04207593), a single-center Phase 2 clinical trial in Germany, where 20 patients were randomly assigned to either 12 weeks of supplemental oxygen for 16 or more hours a day or no oxygen supplementation. The primary outcome was to determine if long-term oxygen therapy improved exercise capacity, as measured by the 6MWD.
Twelve patients had idiopathic PAH, or PAH with an unknown underlying cause, while four had PAH due to connective tissue disease. The study included three participants with CTEPH and one with portopulmonary hypertension, that is, when pulmonary hypertension occurs in the setting of portal hypertension, elevated blood pressure in the portal vein, which directs blood from the digestive tract to the liver.
Besides 6MWD improvements after long-term oxygen treatment relative to the study's start, treated patients showed significant walking distance benefits over the control group. On average, participants receiving long-term oxygen treatment could walk 38.9 meters more (127 feet) at follow-up, whereas the controls walked 12.3 meters (40 feet) less after 12 weeks.
The researchers also reported a trend towards improvement in quality of life, particularly in physical functioning scores, among those who received long-term oxygen.
In a per-protocol analysis, which only examined data from participants who fully adhered to the protocol, significant reductions were seen in pulmonary arterial pressure in the treated group relative to the controls, as well as a trend towards a decreased heart rate.
"This study highlights the importance of [long-term oxygen therapy] in terms of exercise capacity in patients with PAH and CTEPH," wrote the researchers, who acknowledged their study was limited by the small sample size, which didn't let them examine how long-term oxygen treatment could have different benefits for PH patients depending on their diagnostic subtype (i.E. PAH or CTEPH). They called for larger clinical trials to study this.
High Blood Pressure (Hypertension)
High blood pressure, or hypertension, is when your blood puts too much force on your blood vessels. Over time, the high pressure can cause other health problems.
Blood pumping through the circulatory system is under pressure, much like the water in the pipes of a house. And just as too much water pressure can damage pipes and faucets, elevated blood pressure can spell trouble for your body.
How common is high blood pressure?
High blood pressure is a big problem in both men and women. About 1 in every 2 adult Americans have high blood pressure. Many more are at a risk of it. High blood pressure is especially dangerous because you can have it for years without knowing. In fact, 1 in 3 Americans with the condition don't know it.
Despite these gloomy statistics, high blood pressure is not inevitable. There's plenty you can do to prevent, delay, and treat the condition.
Blood pressure usually rises with age. Your risk of high blood pressure begins to climb when you hit age 45, although it can happen when you're younger. Black people tend to get it at younger ages and often have worse hypertension.
High blood pressure risk factors
Many factors can lead to high blood pressure. Your diet plays a role. Too much salt, too little potassium, and too much alcohol have all been found to raise the risk of high blood pressure. Too much stress and too little physical activity both raise the danger of developing high blood pressure, as does being overweight or obese. And as with many chronic illnesses, high blood pressure tends to run in families, suggesting that genetics plays a role.
If you eat foods high in salt, or use medications like nonsteroidal anti-inflammatory drugs (such as ibuprofen and aspirin) or decongestants, you also have a higher risk of high blood pressure. Illegal drugs like cocaine also can raise blood pressure.
It's more common if you are:
High blood pressure and other health conditions
In some people, high blood pressure is related to other medical problems or can be a side effect of certain drugs. This form of the disease is called secondary hypertension because it happens secondary to other medical conditions.
Different conditions can make your blood pressure more likely to go up, including:
High blood pressure and medications
Some medicines that may raise blood pressure include:
Some prescription drugs also make high blood pressure more likely. Ask your doctor if any medicines you're taking may come with more risk of high blood pressure.
High blood pressure is usually diagnosed using the familiar blood pressure test that involves a cuff wrapped around the upper arm. The cuff is inflated and then sensors measure the pressure of blood beating against your arteries.
To get a good blood pressure reading, sit quietly in a comfortable chair for a few minutes first. (Photo Credit: E+/Getty Images)
Understanding your blood pressure readings:
Systolic blood pressure. This first number measures the pressure of your blood against your arteries when it beats.
Diastolic blood pressure. This second number measures the pressure when your heart is resting between beats.
Interpreting your blood pressure measures:
Normal. Your blood pressure is normal when it's less than 120 over less than 80.
Elevated. Your blood pressure is elevated if the first number is 120-129 and the second number is less than 80.
Stage 1 hypertension. You have stage 1 hypertension if the first number of your blood pressure is 130-139 and the second number is 80-89.
Stage 2 hypertension. You have stage 2 hypertension if the first number is 140+ and the second number is 90+.
Hypertensive crisis. Your blood pressure reading is a number greater than 180 over a number greater than 120.
Normal variation in blood pressure
Normal blood pressure goes up from about 64/40 at birth to about 120/80 in a healthy adult. If someone were to take your blood pressure right after you gave a speech or jogged five miles, it'd probably be slightly high. This isn't necessarily cause for alarm: It's natural for blood pressure to rise and fall with changes in activity or emotional state.
It's also normal for blood pressure to vary from person to person, even from one area of the body to another. But if your blood pressure stays high, you should talk with your doctor about treatment. Hypertension forces the heart to work far beyond its capacity. Along with injuring blood vessels, it can damage your brain, eyes, and kidneys.
Prehypertension
Your doctor could also tell you that you have something called prehypertension. That's when your blood pressure is just a bit higher than 120 over less than 80. About 75 million Americans fall into this category. Prehypertension can raise your risk of damage to your arteries, heart, brain, and kidneys. Many doctors say prehypertension should be treated. Still, there's no evidence that it provides long-term help.
High blood pressure doesn't usually show any signs. The only way to know for sure if your blood pressure is high is by having it checked. It's a good idea to watch it over time if you think you have high blood pressure or may be at risk.
If your blood pressure is very high, you may have signs including:
Many people who have high blood pressure don't realize they have it. It's often called "the silent killer" because it rarely causes symptoms, even as it causes serious damage to the body.
Over time, elevated pressure can cause a wide range of problems. Small bulges, called aneurysms, may form in blood vessels. The heart can become enlarged, raising the danger of heart attack and heart failure. Damage to blood vessels in the kidneys can cause them to fail. Because tiny blood vessels in the eyes are especially vulnerable to damage, hypertension can lead to vision problems and even blindness.
Left untreated, hypertension can lead to serious problems, such as:
Critically ill patients who have very high blood pressure may have "malignant hypertension." It is a medical emergency, and you should be treated in the emergency room. Symptoms might include chest pain, shortness of breath, vision changes, headache, and weakness.
Fortunately, high blood pressure can be controlled. The first step is to have your blood pressure checked regularly.
When to get immediate help
Your doctor may consider your blood pressure high if you get a high reading at least twice. If yours is 180/120 or higher, that's a hypertensive crisis. You need to get medical attention right away.
In as many as 95% reported high blood pressure cases in the U.S., the underlying cause can't be determined. This is essential hypertension.
High blood pressure tends to run in families. Age and race also play a role.
More than 40% of all Black people in the U.S. Have high blood pressure.
Diet and lifestyle also play a big role in essential hypertension. The link between salt and high blood pressure is especially noteworthy. People living on the northern islands of Japan eat more salt than anyone else in the world. They're also most likely to get hypertension.
Many people with high blood pressure are "salt sensitive." That means anything more a minimal amount will raise their blood pressure.
Other things associated with essential hypertension include:
When a direct cause of high blood pressure can be identified, that's secondary hypertension. Kidney disease is the most common cause.
Hypertension can also be caused by tumors or conditions that cause the adrenal glands (the small glands that sit atop your kidneys) to release large amounts of hormones that raise blood pressure.
Birth control pills — specifically those that have estrogen — and pregnancy can boost blood pressure. Other medicines can, too. Check with your doctor to see if anything you take may cause your numbers to go up.
Doctors have a wide range of high blood pressure medicines available to treat high blood pressure. These high blood pressure treatments include:
As effective as these drugs can be at controlling blood pressure, if you get to the point of needing them, you may have to take them for the rest of your life. That is one more good reason to focus on prevention.
You can lower or prevent high blood pressure and lower your odds of getting heart disease by making a few changes in your lifestyle.
High blood pressure and your diet
A healthy diet can go a long way toward preventing high blood pressure. Trying following the Dietary Approaches to Stop Hypertension eating plan, also known as the DASH diet, which emphasizes plenty of fruits and vegetables and low-fat or nonfat dairy products. Studies conducted by the National Institutes of Health have shown that the DASH diet can lower blood pressure. And the results show up fast — often within 2 weeks. Stay away from salt and saturated fats and eliminate trans fats. Focus instead on foods that are high in fiber, calcium, and magnesium.
The National High Blood Pressure Education Program recommends no more than 2,300 milligrams — equal to 1 teaspoon — of sodium a day. The ideal is even lower — only 1,500. For the average person, who consumes about 4,200 milligrams a day, that requires a big change. But studies show that the lower your salt intake, the lower your blood pressure.
Exercise for high blood pressure
Regular aerobic workouts condition the heart and keep blood vessels working properly. It's also wise to be as active as possible throughout your day, apart from your workout. Researchers at the University of Minnesota published results from a study of almost 4,000 people aged between 15 and 30 years who were followed over time. The more active they were, the lower their risk of hypertension.
High blood pressure and weight
If you're overweight, try to trim down. Even shedding a few pounds can make a big difference.
High blood pressure, smoking, and alcohol
If you smoke or drink a lot of alcohol, now's the time to stop. Your doctor can give you advice about the most effective ways to do that.
Manage your stress
Take steps to cope with everyday stressors and improve your mental health. Try relaxation, counseling, or a support group.
Sleep well
Aim for 7-9 hours of sleep every night. It's best to go to bed and wake up at regular times and to sleep in a calm, darkened room.
High blood pressure comes with risk factors for many other health conditions, but you could have it and not even know it. See a doctor to have your blood pressure checked. There are many healthy steps you can take to lower or prevent high blood pressure. Your doctor can also suggest treatment if you need it.
How can I bring my blood pressure down quickly?
Relaxing and lowering stress can lower your blood pressure quickly. But if you have chronic high blood pressure, you should talk to your doctor about steps to keep it low.
How do you feel when you have high blood pressure?
Most of the time, having high blood pressure doesn't feel like anything at all. Many people have it and don't even know. If your blood pressure goes very high, you could have a severe headache or other symptoms. See a doctor for a blood pressure reading.
When should I worry about my blood pressure?
It's a good idea to take steps to lower your blood pressure if you have high blood pressure or hypertension. If you get a blood pressure reading that's over 180/120, it's a medical emergency. See a doctor right away.
What causes your blood pressure to suddenly get high?
Stress can make your blood pressure go up suddenly. To get a good blood pressure reading, don't eat or drink right beforehand. Use the bathroom and sit quietly in a comfortable chair for at least 5 minutes first with both of your feet on the floor. It's best to check your blood pressure more than once to make sure you're getting an accurate reading.
Hypertension: A Guide To Causes, Risk Factors, Prevention & More
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What is Hypertension?Hypertension is a very common condition, affecting about half of all adults in the U.S. But it doesn't always have symptoms, so about one in three people don't know they have it.
Hypertension develops when the force of the blood coming from your heart consistently puts too much pressure on the walls of your arteries. Over time, this pressure can cause small tears in your arteries. Plaque can collect in and around these tears, causing your arteries to narrow and obstructing the flow of blood to and from your heart. (And learn about heart attack signs here.)
When plaque builds up inside your arteries, it can further increase your blood pressure and increase your risk of heart disease.
When you have high blood pressure, your heart has to work harder to move blood through your body. This puts strain on your heart muscle and can lead to problems like heart attack and heart failure.
Without proper treatment, hypertension can lead to:
Symptoms of HypertensionDoctors sometimes call hypertension the "silent killer," because people don't typically notice it until it starts causing health problems.
You might only experience high blood pressure symptoms if your blood pressure is very high.
Very high blood pressure can cause symptoms like:
Nosebleeds
Anxiety
Severe headaches
Chest pain
Dizziness
Vision changes
Buzzing in the ears
There are many different causes of high blood pressure, but often one single cause isn't found. When this happens, it's known as essential hypertension or primary hypertension.
High blood pressure can be caused by a combination of lifestyle factors like:
Having overweight or obesity
Eating unhealthy foods, especially salty foods
Not getting enough exercise
Not getting enough sleep
Drinking too much alcohol
Smoking
Experiencing a lot of stress
When a medical condition or medication causes high blood pressure, it's known as secondary hypertension.
Secondary hypertension can be caused by:
Sleep apnea
Pregnancy or preeclampsia
Problems with your adrenal glands
Chronic kidney disease
Renal artery stenosis (when the artery leading to your kidney is narrowed)
Medications like birth control pills or cold medications
There are many hypertension risk factors. Some, we have control over, others we have no say in.
Risk factors we have some control over include:
Eating an unhealthy diet (high in salty or processed foods)
Not exercising regularly
Drinking too much alcohol
Smoking
Stress
Not getting enough sleep
Living with overweight or obesity
Risk factors we don't have control over include:
Age. Our blood vessels thicken and stiffen as we age, which can lead to higher blood pressure.
Genetics. If you have a family member with high blood pressure, you're at increased risk of developing high blood pressure. Genetics can also affect how sensitive you are to the salt in your diet.
Medical conditions. Some medical conditions can increase your odds of high blood pressure. These include sleep apnea, diabetes, high cholesterol, thyroid problems, and chronic kidney disease.
Medications. Medications that can raise your blood pressure include antidepressants, birth control pills, decongestants, and non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and aspirin.
Race. You have a higher risk of high blood pressure if you're Black.
Gender. Men have a higher risk of high blood pressure than women in middle age, but women have a higher risk than men in older age.
The only way to find out if you have high blood pressure is to check your blood pressure with a blood pressure monitor. You should get your blood pressure checked at least once a year to make sure it's within a healthy range.
You can get tested by a healthcare professional in a doctor's office, clinic, or pharmacy. You can also buy an easy-to-use blood pressure cuff at a pharmacy or online retailer.
Blood pressure tests are quick and painless.
Before you test your blood pressure:
Avoid coffee, exercise, and cigarettes for 30 minutes
Go to the bathroom
Relax and sit down for five minutes before testing
Try — as best as possible — not to get too excited or nervous. This can increase your blood pressure and affect your reading.
During the test, a healthcare provider will put a blood pressure cuff around your upper arm. The cuff is connected to a small machine.
The cuff will inflate with air, and you'll feel some pressure around your arm. After a few seconds, the cuff will deflate, and you'll see your blood pressure reading on the machine.
Your healthcare provider may repeat the test a few times and check your blood pressure at different appointments before diagnosing you with high blood pressure.
They may also recommend an at-home test. There is a phenomenon known as "white coat hypertension" that can occur when your blood pressure is higher in a doctor's office than it is at home — often do to stress or nerves. An at-home test can help get a more accurate reading.
How Blood Pressure is MeasuredBlood pressure is measured with two numbers, measured in millimeters of mercury (mm Hg).
The first number — the top number — is your systolic blood pressure. This is the pressure of your blood against your artery walls when blood is pumped out of your heart.
The second number — the bottom number — is your diastolic blood pressure. This is the pressure of your blood against your artery walls back toward the heart, in between heartbeats.
You have hypertension when you consistently have:
Here's a full breakdown of blood pressure readings:
Hims
If you've checked your blood pressure and the reading indicates a hypertensive crisis, wait five minutes and then check it again. If it's still high, contact your healthcare provider immediately. (Learn more about cardiovascular here).
Call 911 if your reading indicates a hypertensive crisis and you're experiencing any of the following symptoms:
Diagnosis Next StepsIf your healthcare provider finds you have high blood pressure, they may recommend further testing to determine what's causing it or to find out whether it's damaged your organs.
They may test for:
High cholesterol
Kidney disease
Heart disease
They may also do a physical exam and ask about your symptoms, medical history, and family history. This can help them recommend the best treatment plan for you.
Your provider might recommend home blood pressure monitoring or have you come in for regular checkups.
Hypertension TreatmentThe treatment for hypertension will depend on how high your blood pressure is and what's causing it.
For example, elevated blood pressure and hypertension stage 1 may require some lifestyle changes. If you have hypertension stage 2, on the other hand, you may need medication alongside lifestyle changes.
Lifestyle ChangesThe treatment of hypertension often includes:
Eating heart-healthy foods. These include fruits, vegetables, whole grains, and low-fat dairy products. Your healthcare provider might recommend the DASH eating plan (Dietary Approaches to Stop Hypertension). This includes eating heart-healthy foods and limiting how much salt you eat.
Quitting smoking. Your provider can instruct you on the best way to quit. They may recommend smoking cessation resources like nicotine patches or gum, support groups, or prescription medications that help you quit.
Getting active. Try incorporating more movement into your week, including walking, jogging, swimming, standing, and general physical activity.
Losing weight. Losing three to five percent of your body weight — or more — can help reduce your blood pressure.
Getting more sleep. Aim for at least seven hours of shut-eye each night. Keeping a regular sleep schedule, winding down before bed, and cutting back on caffeine can help.
Cutting down on alcohol. You can do this by swapping alcoholic drinks for non-alcoholic versions, sparkling water, or sugar-free soft drinks.
Reducing stress. Take steps to keep your stress levels under control. This can include practicing meditation, exercising regularly, spending time in nature, or speaking to a therapist.
You may need to take medication if your blood pressure levels are high. You may need to take this medication for the rest of your life, and it may take a while to find the right dose for you.
Medications to lower blood pressure include:
Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are drugs that can relax and open up your blood vessels.
Angiotensin-2 receptor blockers (ARBs). These drugs also help your blood vessels relax and open up.
Diuretics. These medications help reduce how much water and salt is in your body.
Calcium channel blockers. As the name suggests, these medications block calcium from entering your heart's cells and arteries. This can relax and open up your blood vessels.
Alpha-blockers. Alpha-blockers can relax the muscles in your artery walls.
Beta-blockers. Beta-blockers can lower your heart rate and help your heart not work so hard. You might be prescribed a combined alpha- and beta-blocker.
Alpha-2 receptor agonists. These can block signals from your brain that narrow blood vessels and increase your heart rate.
Vasodilators. These help to open up your blood vessels so blood can flow more easily.
This sounds like a lot, but your healthcare provider can recommend the best antihypertensive medication for you, depending on your situation. They can also walk you through the potential side effects and what you can expect.
If you decide to lose weight to help with hypertension control, weight loss medications may be useful.
Drugs like Ozempic (semaglutide) and Mounjaro (tirzepatide) can help people lose weight, and some — like Wegovy and Zepbound — are FDA-approved for those with overweight or obesity and high blood pressure.
Your healthcare provider can walk you through the pros and cons of weight loss medications and which ones could help you.
Hypertension Prevention TipsYou can't always prevent high blood pressure, but there are some steps you can take to lower your odds of developing it.
Most of these steps involve healthy lifestyle changes.
You can reduce your chances of developing high blood pressure by:
Eating heart-healthy foods or following the DASH diet
Making physical movement part of your daily routine
Getting plenty of sleep
Maintaining a healthy weight
Limiting or avoiding alcohol
Managing stress
Quitting smoking
Keeping your cholesterol and blood sugar levels within healthy ranges
This article originally appeared on ForHers.Com and was syndicated by MediaFeed.Org.
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