The Stroke Articles

Millions of Americans say they’re not getting enough sleep and that the lack of shut-eye affects their personal relationships, job performance, and mental and physical health, according to a new study.

A global survey of more than 30,000 people in 23 countries commissioned by the Philips Center for Health and Well-Being shows that people in the U.S. have one of the highest rates of sleep deprivation. The survey finds that 37% of Americans feel they don’t get enough sleep. Only France at 45% and Taiwan at 50% had higher incidences of sleep deprivation.

What’s Keeping Us From Sleeping?

So what’s the problem?

49% of Americans who don’t get enough sleep blame stress and worry.
38% say they are poor sleepers.
36% say they go to sleep late at night and get up very early.

And Americans realize that not getting enough sleep affects their lives.

57% say sleep deprivation is a factor in their level of physical health.
48% say lack of sleep affects their mental health.
46% say it affects their home life.
43% say it affects performance on the job.
41% report that it affects their relationships with others.
34% say it affects their level of community involvement.

Among key findings globally:

Americans, like people in most countries, report that they are dissatisfied with the amount of stress in their lives. In a question on stress in general, 66% of Americans said they worried about having enough money to pay bills. Other stressors:

The economy, cited by 74% of Americans.
67% reported feeling stress over health care costs.
48% said job loss had left them stressed.
49% felt stressed about getting enough sleep.
32% mentioned their boss as a major stressor.

Philips says its global survey is intended to raise discussion levels about sleep, stress, and other issues that affect health and well-being. Royal Philips Electronics is a health-care company with more than 118,000 employees in more than 60 countries.

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High blood pressure is common and often uncontrolled,
especially in elderly women, a new study shows.

As people age, they are more likely to have high blood pressure and less
likely to control the problem, states a report in The Journal of the
American Medical Association.

Dangerous Condition

High blood pressure raises the odds of heart attack and stroke, among other
health problems.

The new study showed that. Heart attacks, strokes, hospitalization for heart
failure, or other fatal heart problems were much more common among people older
than 80 with above-normal blood pressure.

About one in three American adults has high blood pressure, but nearly a
third of them don’t know it, states the American Heart Association’s web
site.

A quick test can check blood pressure. Lifestyle changes (such as a healthy
diet, stress control, and exercise) can help. Many patients may also need
medication to tame their blood pressure.

As America ages, high blood pressure may become even more widespread, write
the researchers. They included Donald Lloyd-Jones, MD, ScM, of the preventive
medicine department at Northwestern University’s medical school in Chicago.

What Is High Blood Pressure?

Curious about where you stand? Here’s a quick guide.

High blood pressure: Systolic blood pressure (the first number) of 140 or
more, and/or diastolic blood pressure (the second number) of 90 or more.

Prehypertension: Systolic blood pressure of 120-139 and/or diastolic blood
pressure of 80-89. People with this condition are at risk of developing high
blood pressure and should take steps lose weight, exercise, and eat a
healthy diet to help prevent that.

Normal adult (aged 18 or older): Systolic blood pressure of 119 or below
and diastolic blood pressure of 79 or below.

High Blood Pressure More Common With Age

Data came from nearly 5,300 participants in the Framingham Heart Study, done
in the 1990s. Three age groups were used: younger than 60, 60-79, and 80 or
older.

High blood pressure became more common with age. Here are the high blood
pressure percentages for each age group:

Younger than 60: 27%
60-79: 63%
80 and older: 74%

The percentages with normal blood pressure were:

Younger than 60: 39%
60-79: 14%
80 and older: 7%

Everyone else had prehypertension. Even people with prehypertension are at increased
risk of developing heart problems.

Blood Pressure Risky for Blacks

The study’s participants were mainly white. In the U.S., blacks tend to develop high blood pressure at an
earlier age and have more severe cases than whites.

Blood Pressure Control Worst in Elderly Women

Few people (32% overall) had gotten their high blood pressure under control.
“Control” meant getting blood pressure out of the “high”
category, not all the way down to “normal.”

The pills in your medicine cabinet may be raising your blood pressure.

Women who take a lot of acetaminophen (Tylenol) have nearly twice the risk of high blood pressure as those who don’t use the drug. Those who take a lot of ibuprofen (Advil, Motrin) or naproxen (Aleve) up their risk by as much as 78%.

The study did not link aspirin to high blood pressure in women. However, there was a trend toward more high blood pressure in women who frequently used aspirin.

The findings come from two studies that collected detailed information on more than 5,000 registered nurses aged 34 to 77. Harvard researcher John P. Forman, MD, says the findings mean women should think twice about taking common pain relievers.

“We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain,” Forman tells WebMD. “These medications, by virtue of their availability over the counter, are viewed as being safe or without risk. By pointing out risks associated with these drugs, [we hope] more informed choices can be made by women and their doctors.”

The Headache Factor

In earlier studies, Forman’s team found a link between the use of common painkillers and high blood pressure. However, it wasn’t clear whether one major reason for taking the drugs headache was itself behind the link to high blood pressure.

The current study finds that whether or not a woman suffered from headaches, the drugs still increased her risk of high blood pressure.

The study, which appears in the September issue of Hypertension, lumped ibuprofen, naproxen, and similar drugs into a single category: NSAIDs. About 80% of the women using NSAIDs were taking ibuprofen. Taking more than 400 milligrams of NSAIDs per day upped the risk of high blood pressure by 78% in older women and by 60% in younger women.

Daily use of more than 500 milligrams of acetaminophen raised the risk of high blood pressure by 93% in older women and by 99% in younger women.

Using ‘Greater Caution’

“High blood pressure affects about one in three adults in the U.S.,” Forman says. “As the two most frequently used drugs in this country, acetaminophen and NSAIDs may substantially contribute to the disease burden of high blood pressure. On an individual level … these agents should be used with greater caution.”

What does “greater caution” mean? Laurence S. Sperling, MD, director of the risk reduction program at Emory Heart Center in Atlanta, says it means that people can’t just pop pills without thinking about the consequences.

“Medicines we can buy over the counter and use without a doctor’s advice may not be as safe as we think,” Sperling tells WebMD. “People think Tylenol, especially, is pretty innocuous. We have to realize that any substance has risks if we use it on a regular basis.”

So what’s a person with pain supposed to do?

“What I tell people is we have to look at what’s right for you,” Sperling says. “If we can find something else that is safer, great. If not, we have to accept a higher risk because quality of life is part of the equation. The risk here is not phenomenal. It is not as if taking these drugs guarantees you will have a heart attack or stroke.”

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Tens of thousands of heart attacks, strokes, and deaths could be prevented each year if people took a combination of newer high blood pressure drugs rather than the old standbys.

Additionally, the newer regimen may cut the risk of diabetes by about one-third, says researcher Bjorn Dahlof, MD, associate professor of medicine at the University of Goteborg in Sweden.

“The more modern therapy fared better than the older treatment in almost every regard,” he tells WebMD.

Is Newer Really Better?

The new study does not agree with previous research showing that water pills (diuretics) were better at preventing heart failure and stroke than newer blood pressure drugs.

A landmark trial in 2002 showed that compared with the cheaper diuretic, people taking Norvasc had a 38% higher risk of developing heart failure and a 35% higher chance of being hospitalized with heart failure. Those on an ACE inhibitor, also a newer class of drugs, had a 15% higher risk of stroke, a 19% higher risk of developing heart failure, and other increased risks compared with people taking a diuretic.

In response to those previous findings, experts told WebMD in 2002 that doctors should begin drug treatment for high blood pressure with a diuretic.

Drugs Battle It Out

The new study, presented here at the annual meeting of the European Society of Cardiology, included more than 19,000 people with high blood pressure and at least three other heart disease risk factors, such as smoking and family history.

About half got Norvasc a member of the newer class of drugs known as calcium-channel blockers while the rest got atenolol, an older drug belonging to the class called beta-blockers. The study was funded by Pfizer, which manufacturers Norvasc. Pfizer is a WebMD sponsor.

If either of the drugs failed to lower blood pressure, another medication was added: People on Norvasc were also given the ACE inhibitor Aceon, while those on atenolol added a diuretic.

After 5.5 years, the trial was stopped prematurely when results showed the Norvasc-based treatment beat out the older approach: They were 23% less likely to have a stroke, 11% less likely to die, and 30% less likely to develop diabetes than people who took the beta-blocker. Both regimens were equally safe.

Additionally, 32% of the people with diabetes and 60% of those without diabetes achieved their blood pressure goals: less than 140/90 for patients without diabetes and 130/80 for patients with diabetes.

The study was simultaneously published online in The Lancet.

Blood Pressure or Something Else?

But overall, people who took Norvasc achieved blood pressures that were only about three points lower than those on beta-blockers, setting off a debate about whether blood pressure lowering or other factors are at play.

Getting blood pressure under control is good for the brain, new research shows.

Health experts already knew that curbing blood pressure can help avoid strokes, heart attacks, and other serious health problems.

Now, French doctors report that lowering blood pressure may halt or slow the progression of brain abnormalities called white matter hyperintensities (WMH). Their study appears in Circulation.

WMH and High Blood Pressure

WMH are white areas in the brain. They’re strongly linked to high blood pressure. WMH may be accompanied by dementia, depression, and trouble with walking.

“People with high blood pressure are more likely to develop WMH, and a larger volume of WMH are associated with cognitive decline, an increased risk of dementia, and accelerated brain aging in some hypertensive patients,” says Christophe Tzourio, MD, PhD, in an American Heart Association news release.

Tzourio works in Paris at INSERM, France’s national institute for health and medical research. With colleagues, he studied WMH and blood pressure treatment.

Brain and Blood Pressure Study

The study included 192 people. Participants were about 60 years old, on average. Most were men. All had had a stroke or “mini-stroke” (transient ischemic attack, or TIA) in the past five years.

At the study’s start, about half of the group had high blood pressure. MRI brain scans showed that 42% had no WMH, 13% had moderate WMH, and 19% had severe WMH.

About a third of the group got medicine to treat their high blood pressure. They either got an ACE inhibitor and a diuretic (water pills) or just the ACE inhibitor. The rest of the patients got a fake drug (placebo).

Study’s Findings

About three years later, more brain scans were done. The results:24 people had developed new WMH. People taking blood pressure medicines were 43% less likely to have new WMH than those taking the placebo. New WMH were smaller in patients taking the blood pressure medicines.

The results didn’t change after factoring in age, sex, stroke type, blood pressure at the study’s start, or WMH severity when the study began.

As expected, blood pressure dropped more with the prescription medicines than with the placebos.

Check Your Blood Pressure

The researchers call for more studies to find the best blood pressure treatments to curb WMH.

Meanwhile, there are plenty of reasons to get high blood pressure under control. “Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure, or kidney failure,” states the web site of the American Heart Association (AHA).

Nearly one in three U.S. adults has high blood pressure, but almost a third of them don’t know it, according to the AHA.

The first step: Get your blood pressure checked. Then, you and your doctor can see if lifestyle changes (like quitting smoking, upgrading your diet, or being more active) and medication could help.

The study was sponsored in part by Servier, a French pharmaceutical company.

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Frequent use of over-the-counter pain relievers has been linked to high blood pressure in women. But new research fails to show the same association in men.

Findings show that men who regularly took the pain relievers were no more likely than those who didn’t to have persistent high blood pressure, also known as hypertension.

So do men and women really have different risks? Probably not, says cardiologist and study researcher Michael Gaziano, MD, of Boston’s Brigham and Women’s Hospital and the VA Boston Health System.

Instead, the conflicting findings suggest that more study is needed to pin down the heart risks associated with long-term use of over-the-counter pain relievers.

“I don’t think anybody should be worried about using these drugs for short periods,” he tells WebMD.

Long-Term Risks Unknown

High blood pressure is a leading cause of stroke, heart attacks, heart failure, and kidney disease. Being overweight is the major risk factor for hypertension. Other recognized risks include smoking and getting little exercise.

Popular over-the-counter pain relievers include aspirin, ibuprofen (Advil, Motrin, and Nuprin) and naproxen (Aleve).

It is clear that many of these painkillers can raise blood pressure while they are in the system, but Gaziano says that does not present a health risk for most people.

“Many things raise your blood pressure in the short term, including walking up the stairs,” he says.

But many people take the pain relievers every day for chronic conditions like arthritis. And the heart risks associated with their frequent, long-term use are not well understood.

Side Effects of Pain Relievers

The widely publicized troubles of the prescription pain reliever Vioxx led to warnings being placed on all prescription anti-inflammatory pain relievers about the potential risks of heart disease and stroke.

Expanded information was also provided on anti-inflammatory over-the-counter drugs. While short-term, low-dose use has not been linked to heart attack and stroke, stronger reminders are now included on the label about limiting the dose and duration of treatment.

It’s recommended that patients not use over-the-counter anti-inflammatory drugs for more than 10 days without seeing their doctor.

Acetaminophen (Tylenol) is not an anti-inflammatory drug and has not been linked to heart disease and stroke. However, acetaminophen, like the anti-inflammatory drugs, has been linked to high blood pressure, according to the researchers.

Ask Your Doctor

The newly reported trial included just over 8,200 men followed for more than two decades. The men were participants in a larger, ongoing health study.

The participants were asked to recall the frequency of their pain-reliever use over a six-year period. None had high blood pressure at the beginning of the observation period, but about a quarter had it six years later.

After controlling for high blood pressure risk factors such as being overweight, smoking, and sedentary lifestyle, researchers found no obvious association between the frequency of pain- reliever use and hypertension.

The findings are published in the Sept. 12 issue of The Archives of Internal Medicine.

Baltimore cardiologist David A. Meyerson, MD, tells WebMD that the findings are interesting but far from definitive because the participants may have underreported or even overreported their use of pain relievers.

Meyerson practices at the Johns Hopkins Bayview Medical Center and is a national spokesman for the American Heart Association.

“I would hate for people who have heart or blood vessel disease or even hypertension to take from this study that they can use these drugs with impunity,” he says. “They need to discuss with their doctor whether taking these medications is safe and reasonable for them.”

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Taking aspirin at night may help lower blood pressure more
than taking aspirin in the morning, new research shows.

It’s the first finding of its kind. More studies are needed to check the
results before recommendations can be made.

The study was done in Spain. The researchers included Ram

The negative affect of job strain on your blood pressure may be eased if you have a supportive spouse at home.

A new study shows job strain can significantly increase blood pressure among workers over time. But having strong martial support may counteract those negative effects by reducing workers’ blood pressure a similar amount.

Researchers say the results suggest that people who have job strain as well as a strained marriage should see their doctor for a blood pressure check.

Job and Marital Strain a Bad Combo

In the study, researchers monitored the blood pressure of 216 men and women over the course of a year. All of the participants lived at home with a “significant other” and were employed; none was currently using medication to treat high blood pressure.

The participants’ blood pressure was measured at the start of the study and one year later with a monitor that measured blood pressure continuously for 24 hours. They also answered a questionnaire to measure marital cohesion and job strain at work.

“The amount of support given at home in the relationship is a major definition of marital cohesion,” says researcher Sheldon Tobe, MD, assistant professor of medicine at the University of Toronto, in a news release. “Did the partners talk about their daily activities? Did one partner pay attention and sympathize when the significant other had a stressful day? Did the partners spend time together?”

Job strain was defined as having high demands at work with little control.

“An example might be an operating room nurse who has high job demand, meeting physical and mental demands and low latitude for making personal decisions while on the job such as going for a lunch break,” says Tobe.

Marital Support Takes the Pressure Off

Researchers found job strain and lack of support from a spouse was associated with an increase of 2.8 points of systolic blood pressure (the top number in a blood pressure reading) over one year. But people with high job strain at work and high martial support at home experienced a decrease of 2.5 points of systolic blood pressure during the same period.

Tobe says doctors may not normally ask their patients about job strain or marital support, but these results show that stress at work and at home can have a significant impact on people’s health.

The findings were presented this week at the American Heart Association’s High Blood Pressure Research Meeting, in Washington, D.C.

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Beta-blockers may soon lose their place as one of the first line of treatments for high blood pressure, according to a new report.

Beta-blockers have been widely used to treat the nearly 1 billion people worldwide with high blood pressure for the last 30 years. But several recent studies have called the effectiveness of beta-blockers into question.

Primary hypertension, also known as essential hypertension, is high blood pressure without any known cause. It affects around 90% to 95% of those with the diagnosis of high blood pressure. Risk factors that can contribute to this include lifestyle issues such as diet, smoking, and obesity.

The latest blow comes in the form of a review of clinical trials involving more than 100,000 people published in the Oct. 18 issue of The Lancet that shows beta-blockers were no better at reducing the risk of heart attack than other blood pressure drugs and may raise the risk of stroke and death from any cause.

Beta-Blockers on Trial

In the review, Swedish researchers found people with high blood pressure who were treated with beta-blockers in these studies had a 16% higher risk of stroke than those treated with other high blood pressure medications, such as ACE inhibitors, calcium-channel blockers, and diuretics. This difference was significantly shown in the beta-blocker atenolol.

Additionally, there was no difference between the different types of high blood pressure drugs in regard to reducing the risk of heart attack.

The review also showed some evidence that beta-blockers may increase the of risk of stroke and the risk of death from any cause, but these findings were not significant.

In a separate analysis of seven studies that compared beta-blockers with no treatment at all (placebo), researchers found use of beta-blockers reduced the risk of stroke by about 19%, which is about half of the reduction in risk found in previous studies of beta-blockers and stroke.

Based on these results, researchers say beta-blockers should not remain as first choice in the treatment of high blood pressure and should not be used as the comparison drug in future studies of blood pressure-lowering medications.

High Blood Pressure Treatment Guidelines May Change

In an editorial that accompanies the study, D. Gareth Beevers of University Department of Medicine at City Hospital in Birmingham, England, says that there will still be some people who will need beta-blockers as a first line of treatment, but this group should be in the minority.

He says newer drugs in this class may also have other possible benefits and merit further study.

“It will be interesting to see how the many guideline committees respond to the latest information,” writes Beevers. “Their current endorsement of beta-blockers must surely be changed. But in the process they may be in danger of ‘throwing the baby out with the bathwater.’”

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which followed some 155,000 women for 12 years show that heavy coffee drinkers don’t risk developing high blood pressure.

There was, however, an entirely unexpected finding. Women who drank just one caffeinated cola drink every day had a slightly higher risk of high blood pressure. And that risk went up as women drank more daily colas, says researcher Wolfgang C. Winkelmayer, MD, ScD, of Brigham and Women’s Hospital and Harvard University in Boston.

“We did find an association between consumption of cola beverages, whether regular or diet, and increased risk of high blood pressure,” Winkelmayer tells WebMD. “No previous studies suggested such an association. But the finding was consistent, both for younger and older women. We were very surprised.”

Colas in the study included Coke, Pepsi, and other dark-colored sodas.

Winkelmayer and colleagues report their findings in the Nov. 9 issue of The Journal of the American Medical Association.

Cola Accused

The study shows a strong link between high blood pressure and caffeinated cola consumption. But it doesn’t prove cola drinks cause high blood pressure.

Even so, cola drinking remained a risk factor even when the researchers compared only women matched for age, weight, alcohol use, previous trouble with high blood pressure, use of birth control pills, physical activity, smoking, and use of other classes of beverages.

Compared with women who drank less than a can of regular cola a day:Women who drank one can of cola a day increased their high blood pressure risk by 9% in the first Nurses Health Study and by 13% in the second Nurses Health Study. Women who drank two to three cans of cola a day had an 11% higher risk in the first study and a 24% higher risk in the second study. Women who drank four or more cans of cola a day had a 44% higher risk in the first study and a 28% higher risk in the second study.

Compared with women who drank less than a can of diet cola a day:Women who drank one can of diet cola a day increased their high blood pressure risk by 7% in the first Nurses Health Study and by 5% in the second Nurses Health Study. Women who drank two to three cans of diet cola a day had a 6% higher risk in the first study and a 9% higher risk in the second study. Women who drank four or more cans of cola a day had a 16% higher risk in the first study and a 19% higher risk in the second study.