Q: MY blood pressure worries me. The top number is very high, between 138 and 216, while the bottom number is in the 70s and 80s. But I have not used salt on my food for 30 years, I do not smoke and rarely drink. I eat lots of fruit and veg and have good cholesterol levels. I can’t work out why I have this problem. Can you suggest a solution?

KB

A: I CAN see why you are puzzled, and there are probably many readers in a similar position. Let me start with a short tutorial on what the blood pressure readings mean.

A reading consists of two figures. The top number is the systolic pressure, the pressure in the arteries when the heart contracts, pushing out blood (about 140ml, a teacupful) with each beat. A normal reading is 120 or lower.

The second figure, the diastolic pressure, is when the heart relaxes between beats – this should be 80 or lower. If the reading is consistently above 140 over 90, this is known as hypertension.

What you describe is a subtype called isolated systolic hypertension (ISH), where the systolic (top) reading is above 140 and the diastolic number is below 90. This condition affects older patients; studies have shown that systolic pressure rises and diastolic pressure falls after the age of 60. The elevated pressure is due to a reduction in the stretchiness or elasticity of the artery walls – part of the ageing process.

ISH accounts for up to 80 per cent of cases of high blood pressure in this age group. Other risk factors include obesity, lack of exercise, genetics (such as hypertension in one or both parents), and a high salt intake.

Treatment for all types of hypertension is essential because it can lead to heart disease, heart attacks, stroke, kidney dysfunction, and left ventricular hypertrophy (an enlargement and thickening of the walls of the heart’s main pumping chamber).

Treatment can involve lifestyle changes, such as salt restriction, exercise and weight loss, and long-term medication.

Even if you do not add salt to your food, bear in mind that many manufactured foods, such as ready-meals, contain a lot of ‘hidden’ salt. We shouldn’t be consuming more than 6g (around a teaspoon) of salt a day, so always check food labels.

Studies have confirmed the effectiveness of these lifestyle measures in controlling blood pressure. However, if they fail to bring the systolic reading down after some months, drug therapy must be started.

It is unclear whether you are already under the care of a specialist, but I would suggest you see your GP about starting on medication, as you appear to have ISH despite leading a healthy lifestyle.

This is not the place for me to describe the different classes of drugs available, that is a task for your GP, who has a full understanding of your medical history – crucial in your case as we don’t want to cause your diastolic reading to drop too low. If that happens, you can develop complications such as dizziness, or even fainting when you stand up.

The aim should be a gradual blood pressure reduction over three to six months. Of course, this takes time, observation, and regular appointments – rather scarce features at the best of times, let alone during a pandemic.

Q: WE are told continually that more men die from prostate cancer than women die from breast cancer, so why doesn’t the NHS routinely check for it?

NB

A: THERE are nearly 50,000 new cases of prostate cancer a year in the UK. One man in six will be diagnosed with it, and it’s responsible for more than 11,000 deaths a year. With such statistics, it would seem sensible to screen all men of a certain age. After all, we are often told that early treatment saves lives.

Introducing screening for prostate cancer, however, is far from simple. The prostate specific antigen (PSA) test is not ideal for screening and we are unable to determine whether a man has a slow-growing cancer that may never cause him any problems or an aggressive tumour that, unless treated, will be a killer.

Surgery, radiotherapy, chemotherapy and hormone-suppressant drugs all carry the risk of side-effects such as incontinence and impotence.

A European screening trial that monitored men for 13 years showed that routine screening with the PSA test cut deaths by 21 per cent. However, in order to save one life, 781 men had to be screened and 27 of them treated. In other words, the reduction in deaths was at the expense of considerable over-diagnosis and over-treatment.

On that basis, the most sensible route is for men to be aware and see the GP when they have urinary symptoms: increased frequency, particularly at night, a sense of incomplete emptying, poor stream, or straining to empty the bladder.

Mostly these symptoms are due to benign enlargement of the prostate, but when they persist, it is a reason to be checked.

The post Ask the GP: Could my high blood pressure be caused by isolated systolic hypertension (ISH)? appeared first on MyMedicPlus.

A recent study has added new evidence to a possible association between elevated systolic blood pressure (BP) and an increased risk of major valvular heart disease.

Analyses of more than 3500 patients who had a diagnosis of valvular heart disease revealed that those with increased systolic blood pressure had a 3.26 times greater risk of aortic stenosis.

In order to examine the potential association, investigators performed a mendelian randomization using individual patient data from the UK Biobank. Investigators identified cohort of 502,602 people between the ages of 40 and 96 at baseline that were recruited between 2006 and 2010. Data analyses were performed between June 2018 and Jan. 2019.

Systolic blood pressure was measured twice using automated equipment and, because of variation between first and second measurements, investigators used systolic blood pressure as the mean of the 2 measurements. International Classification of Diseases and Health Related Problems, Tenth Revision codes were used to identify incident aortic stenosis, aortic regurgitation, and mitral regurgitation.

For the purpose of their analyses, investigators only included a cohort of 329,237 participants with White British ancestry. This group was 53.99% women, had a mean age of 56.93 years, and 1.08% (3570) had a diagnosis of valvular heart disease. Of the 3570 patients with a diagnosis of valvular heart disease, there was 1491 cases (0.45%) of aortic stenosis, 634 cases (0.19%) of aortic regurgitation, and 1736 cases (0.53%) of mitral regurgitation. 


Investigators found that each genetically associated 20-mm Hg higher systolic BP was associated with approximately 3-fold greater odds of aortic stenosis in an age- and sex-adjusted model (OR, 3.29; 95% CI, 1.52-7.12; P = .002). Investigators noted that adjustment for additional variables had minimal change on the results. 



Additionally, investigators found a similar, yet less robust, association between systolic blood pressure and aortic regurgitation in both the age- and sex-adjusted model (OR, 2.56; 95% CI 0.73-8.85; P = .13) and in the fully adjusted model (OR, 2.59; 95% CI, 0.75-8.92; P = .13). Similar patterns were observed when investigators examined the association between systolic blood pressure and mitral regurgitation for the age- and sex-adjusted model (OR, 2.22; 95% CI, 1.09 to 4.52;P = .02) and the fully adjusted model (OR, 2.19; 95% CI, 1.07-4.47; P = .03).

Investigators noted multiple limitations within their study. Number of some types of valvular heart disease investigated were low, which lead to wide confidence intervals. Investigators lacked statistical power for detection of modest mediating associations. Due to the study relying on data from electronic health records, investigators acknowledge there may be some degree of misclassification. Lastly, the study population was restricted to Europeans.

Within their conclusion, investigators noted that because their study was a mendelian randomization and because of this is less prone to confounding and reverse causation, which suggests that blood pressure-lowering treatment may be a useful strategy for prevention of valvular heart disease.

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