Patients admitted to intensive heart care with chest pains have a better chance of surviving if they have high blood pressure. This is shown in a study by scientists at Linköping University in Sweden published in the world’s largest medical journal JAMA.

High blood pressure is usually associated with poor prognoses in heart disease. But that means blood pressure monitored at rest. The new findings show that it is important to factor in the situation in which the blood pressure is measured.

The study, by researchers Ulf Stenestrand, Fredrik Nyström, Magnus Wijkman, and Mats Fredriksson of Linköping University, comprised 119,151 patients admitted to intensive heart care for acute chest pain between 1997 and 2007. The data was retrieved from RIKS-HIA, a register that covers all Swedish intensive heart care units.

The blood pressure first measured upon admission was related to the risk of the patient dying during the care period or within a year. It turned out that the higher the upper, systolic, pressure was, the lower was the risk of dying. Among patients who had more than 162 mm Hg, the fatality risk was 22 percent lower than for those in the interval 128-144. The latter in turn ran a 40-percent lower risk of dying than those whose systolic blood pressure was under 128 mm Hg.

“The really big news in the study is that the risk continued to decline at even higher levels, all the way up to 200 mm Hg, after which the reduction in risk leveled off,” says Fredrik Nyström, professor of internal medicine.

The differences between the various groups were even clearer when the researchers examined the patients’ risk of dying only from cardiovascular disease. The improved prognosis was also valid for high-risk groups, such as diabetics, smokers, and obese patients.

It was previously known that low blood pressure can be associated with poor prognoses for certain types of heart disease, but in those cases the low blood pressure was caused by heart failure.

Using beta-blockers as a second-line therapy in combination with certain anti-hypertensive drugs significantly lowers blood pressure in patients with hypertension, according to a systematic review by Cochrane Researchers. This review also goes some way to explaining the differences in the way that patients respond to beta-blockers and other classes of blood pressure lowering drugs.

Beta-blockers are commonly used in the treatment of hypertension (high blood pressure) to help reduce the risk of stroke and cardiovascular disease. They can be used alone or as a second-line therapy in combination with a wide range of anti-hypertensive drugs. The idea behind combining two different drugs to treat hypertension is that each has a different mechanism of action and thus may help tackle different mechanisms involved in causing the condition. In this way, greater decreases in blood pressure may be achieved than with single drug therapy.

The review included 20 trials involving a total of 3,744 patients. Overall, the researchers found that adding beta-blockers as the second-line drug, in combination with thiazide diuretics or calcium channel blockers, caused an additional blood pressure reduction. The reduction was around 30% greater when the dose was doubled.

This data was compared with a Cochrane Review published in Issue 4, 2009 that examined the blood pressure lowering effect of second-line thiazide diuretics. They concluded that the two drugs produced different patterns of blood pressure lowering. Second-line beta-blockers were found to be more effective at reducing diastolic blood pressure (the minimum pressure in the arteries between beats when the heart relaxes to fill with blood) but had little or no effect on pulse pressure, while second-line thiazides significantly decreased pulse pressure in a dose-related manner.

“We feel that these findings are generalisable to most patients being treated for hypertension where a beta-blocker is added as a second-line drug to a first-line thiazide,” said lead researcher, Jenny Chen, who works in Pharmacology and Therapeutics at the University of British Columbia in Vancouver, Canada. “The finding that beta-blockers produce a different pattern of blood pressure lowering to thiazides when used as second-line drugs certainly deserves further attention as it might explain why beta-blockers appear to be less effective than thiazide diuretics at reducing adverse cardiovascular outcomes, particularly in older individuals.”

“The major limitation of this work is that we only know what happens when you add beta-blockers to thiazides and calcium channel blockers. It is possible that adding beta-blockers to other classes of drugs might produce a different result,” said Chen.

They turn Dad’s hair gray, but children can now take partial credit for the health of Mom’s heart.

A new Brigham Young University study found that parenthood is associated with lower blood pressure, particularly so among women.

Julianne Holt-Lunstad, a BYU psychologist who studies relationships and health, reports her findings Jan. 14 in the peer-reviewed journal Annals of Behavioral Medicine.

Of course parenthood is not the only route to low blood pressure – daily exercise and a low-sodium diet also do the trick. The noteworthy aspect of the study is the idea that social factors may also protect physical health.

“While caring for children may include daily hassles, deriving a sense of meaning and purpose from life’s stress has been shown to be associated with better health outcomes,” Holt-Lunstad said.

The study involved 198 adults who wore portable blood pressure monitors, mostly concealed by their clothes, for 24 hours.

The monitors took measurements at random intervals throughout the day – even while participants slept. This method provides a better sense of a person’s true day-to-day blood pressure. Readings taken in a lab can be inflated by people who get the jitters in clinical settings. It’s a real phenomenon known as the “white coat” effect, and it can mess up the results of studies done without the portable monitors.

A statistical analysis allowed the researchers to account for other factors known to influence blood pressure – things like age, body mass, gender, exercise, employment and smoking – and zero in on the effect of parenthood. For parents overall, the 24-hour blood pressure readings averaged 116 / 71.

All other things being equal, parents scored 4.5 points lower than non-parents in systolic blood pressure (the top number) and 3 points lower than non-parents in diastolic blood pressure. Holt-Lunstad says the size of the difference is statistically significant, but she warns against hastily making major life changes based on this finding alone.

“This doesn’t mean the more kids you have, the better your blood pressure,” Holt-Lunstad said. “The findings are simply tied to parenthood, no matter the number of children or employment status.”

The effect was more pronounced among women, with motherhood corresponding to a 12-point difference in systolic blood pressure and a 7-point difference in diastolic blood pressure.

And if fulfilling relationships make your body feel better, it’s no surprise what stressful relationships can do. See this story on “frenemies” for more about that.

High blood pressure may put women at greater risk for dementia later in life by increasing white matter abnormalities in the brain, report researchers from the University of Pittsburgh Graduate School of Public Health in a study published online in the Journal of Clinical Hypertension.

“Hypertension is very common in the U.S. and many other countries, and can lead to serious health problems,” said Lewis Kuller, M.D., Dr.P.H., professor of epidemiology, University of Pittsburgh Graduate School of Public Health. “Proper control of blood pressure, which remains generally poor, may be very important to prevent dementia as women age.”

The study, part of the multisite and long-term Women’s Health Initiative Memory Study (WHIMS), included 1,424 women 65 or older who had their blood pressure assessed annually and underwent magnetic resonance imaging (MRI) of the brain. Researchers assessed white matter lesions, which are associated with increased risks for dementia and stroke. White matter makes up 60 percent of the brain and contains nerve fibers responsible for communication among the brain’s regions.

Women who, at the start of the study, were hypertensive, meaning a blood pressure of 140/90 or higher, had significantly more white matter lesions on their MRI scans eight years later than participants with normal blood pressure. Lesions were more common in the frontal lobe, the brain’s emotional control center and home to personality, than in the occipital, parietal or temporal lobes.

“Women should be encouraged to control high blood pressure when they are young or in middle-age in order to prevent serious problems later on,” said Dr. Kuller. “Prevention and control of elevated blood pressure and subsequent vascular disease in the brain may represent the best current preventive therapy for dementia.”

New research from the Northwestern University Feinberg School of Medicine has found that an alternative therapy may be possible for treating some types of hypertension using an enzyme called ACE2.

The research, conducted on mice in the laboratory of Daniel Batlle, M.D., professor of medicine at the Feinberg School and staff nephrologist at Northwestern Memorial Hospital, will appear in the January issue of Hypertension in a paper by lead author Jan Wysocki, a post-doctoral fellow in nephrology at the Feinberg School.

According to Batlle, while current hypertension therapies such as ACE inhibitors work to block the formation of angiotensin II – a protein that causes blood vessels to constrict and drives blood pressure up – the approach with ACE2 is novel because it focuses on breaking down angiotensin II already in the system.

“This therapeutic approach can also be superior to existing therapies that block the activity of the renin-angiotensin system, but only partially, and therefore, provide a more complete and effective suppression of this system to treat not just hypertension but many other medical conditions where angiotensin 2 overactivity is undesirable,” Batlle said.

People over 80 years are being treated too aggressively for high blood pressure, warns an expert in an editorial in BMJ Clinical Evidence this week.

According to Dr James Wright, the latest evidence suggests that less aggressive drug therapy may be more effective at reducing mortality in this age group. Based on this evidence, he suggests clinicians change what they are presently doing and move towards a more conservative approach for people aged over 80.

Despite limited evidence about high blood pressure (hypertension) treatment in the over 80s, UK and US guidelines recommend that people over 80 should receive the same treatment as people of any other age. This means using combinations of drugs to reach a target blood pressure of 140/90 mmHg.

But could this be doing more harm than good, asks Wright?

He points to the results of a recently updated Cochrane review which suggest that our present approach may be “excessively aggressive.”

This review includes data from two new trials which looked specifically at the effect of antihypertensive drugs in people over the age of 80. Interestingly, the only trial that found a significant reduction in mortality was the most conservative in terms of number of drugs and dose of drugs allowed. The treatment regime involved three easy steps, with a target blood pressure of 150/80 mmHg.

Using this approach would require little adjustment of drug doses and would markedly simplify and reduce the cost of managing these patients, says Wright.

However, he points out that only half of the people on this regimen would achieve a target blood pressure of 150/80 mmHg. This is below recommendations set out for UK GPs in the Quality and Outcomes Framework (QOF), which suggest that 70% of all patients should meet treatment targets.

Trials are now needed to compare this conservative approach with the more aggressive treatment strategies in common use today, he writes. In the meantime, clinicians should change what they are presently doing and move towards a more conservative approach for people aged over 80.

University of Iowa researchers have shown that a protein channel helps nerve sensors in blood vessels keep blood pressure in check. Without the protein channel, known as ASIC2, the sensors are unable to send the brain the signals it needs to properly control blood pressure.

The finding, which was based in animal models, is important because it could be used to create new treatments to prevent high blood pressure (hypertension). The study results appear in the Dec. 24 print issue of the journal Neuron.

“Sensors in your body’s blood vessels sense when your blood pressure goes up, for instance, when you get mad at someone,” said the study’s principal investigator Frank Abboud, M.D., professor of internal medicine and molecular physiology and biophysics and director of the Cardiovascular Research Center at the University of Iowa. “These built-in sensors perceive the change and trigger a nearly instantaneous adjustment by sending signals to the brain, which in turn tells the blood vessels how to adjust.

“By knowing more about what makes these sensors — known as baroreceptors — malfunction, we may be able to find ways to make them work properly and prevent high blood pressure,” added Abboud, who also holds the Edith King Pearson Chair in Cardiovascular Research and is emeritus head of the UI Department of Internal Medicine.

In the current study, the team showed that the ASIC2 channel was present in the nerve cells of mice blood vessels and that when the channel was defective, the nerve activity was also defective. They also created a mouse model that did not have the gene that codes for the protein channel and thus had no ASIC2 channels. These mice without ASIC2 channels had high blood pressure. The channels play a key role in the electrical activity that is needed to control blood pressure.

“The ASIC2 channel allows a current to be generated at the nerve endings in blood vessels,” he said. “However, when there is no ASIC2, those nerve endings become defective and cannot produce electrical current, and the nervous system loses the ability to get the blood vessels to dilate when necessary. As a result, the vessels remain constricted and the blood pressure stays high even when it should not.”

The finding builds on previous research by Abboud, UI colleagues and other investigators — thanks in part to attention paid years earlier to an organism that may seem to have little in common with humans — a worm. Abboud said that previous studies done in the 1990s in the worm C. elegans showed that certain mechanosensors were needed for the worm to perceive touch. When a particular gene was absent, the worm lost the function of those mechanosensors.

“On a hunch, we wondered whether similar mechanosensors were still present in humans even after years of evolution,” Abboud said. “So about 10 years ago, we looked at sensors in neck blood vessels of humans since we knew that external compression, such as what a wrestler might experience while wrestling, can be a problem.

“The blood vessel sensors in the neck keep blood pressure from getting too high or too low. Based on what we saw at that time, we studied rat models and found genes coding for sensors. With this current study, we were able to expand our investigation and identify the function of the protein channel expressed by the gene,” he added.

Do stressful situations make your blood pressure rise? If so, your phosducin gene could be to blame according to a team of researchers, at the University of Freiburg, Germany, and the Medical College of Wisconsin, Milwaukee, that has identified a role for the protein generated by the phosducin gene in modulating blood pressure in response to stress in both mice and humans.

The team, led by Lutz Hein and Ulrich Broeckel, generated mice lacking phosducin and found that they had increased baseline blood pressure when compared with normal mice and that they showed enhanced increases in blood pressure in response to post-operative stress. Analysis in humans indicated that a number of phosducin gene variants were associated with certain stress-dependent blood pressure responses. Further, one gene variant in particular was associated with elevated baseline blood pressure. These data led the authors to suggest that phosducin might be a good target for drugs designed to alleviate stress-induced high blood pressure. In an accompanying commentary, however, Guido Grassi, at Clinica Medica, Italy, notes that further studies are needed before the therapeutic implications of these data can really be determined.