Sunday, February 5, 2017

For a healthy brain, treat high blood pressure

Blood pressure medications might lower your risk for Alzheimer's and other types of dementia.
Fighting high blood pressure also fights dementia—and studies hint that successful hypertension treatment may lower a person's risk of memory loss, thinking problems, and even Alzheimer's disease.
"There seems to be a synergistic process in which a person's risk factors for cardiovascular disease work together to decrease cognitive function in general," suggests Dr. Robert Green, associate professor at Harvard Medical School and Brigham and Women's Hospital. Dr. Green studies the genetics of Alzheimer's disease and other neurological conditions.
What the evidence shows
New studies recently published online in the journal Neurology offer intriguing evidence that drug treatments for high blood pressure may go beyond just stroke prevention to include lowering dementia risk across the board. For example:
  • A study of 2,197 over-70 men in the Honolulu-Asia Aging Study suggested that after six years, those taking beta blockers (a class of blood pressure drugs) may have had a 31% lower risk of mild cognitive impairment than men not taking beta blockers, even if they were on other blood pressure drugs. No protection was seen in men whose blood pressure remained high despite beta blocker treatment.
  • A study of nearly 2,000 normal adults over age 75 in the Ginkgo Evaluation in Memory Study found no protection from ginkgo supplements—but found that those taking any of several classes of blood pressure–lowering drugs had a 42% to 59% lower risk of Alzheimer's disease.
High blood pressure is "not just the No. 1, but also the No. 2 and No. 3 most important risk factor for stroke," notes Dr. Sudha Seshadri, professor of neurology at Boston University School of Medicine. "Stroke, because it takes out part of the brain, doubles the risk of having dementia."
Blood pressure drugs are safe and widely used, so it makes sense to look at them as possible modifiers of dementia progression, Dr. Seshadri says. She is quick to add that these studies do not prove blood pressure drugs have an anti-Alzheimer's effect, and that they don't explain why being on blood pressure medication might prevent or delay dementia.
High BP makes brain vulnerable
The new studies aren't the first to link blood pressure–lowering drugs to decreased dementia risk. Over all, the evidence is contradictory. Some earlier studies found effects for one class of drugs, others found effects for other classes, and some found little or no effect. A recent analysis of these studies was unable to find that any particular medication was better than others at dementia prevention.
"High blood pressure does mean poorer performance in some cognitive domains, but the link to dementia is less clear," Dr. Seshadri says. "Is it that hypertension is bad for your brain, or that being on anti-hypertensive medication is good for your brain? It is hard to separate the two."
Over the course of a lifetime, many people may accumulate small injuries to the blood vessels of the brain that impair brain function. "So you want to minimize all the potential for further injury," he says. "In that context high blood pressure is another risk factor, both at the macro level of stroke and at the micro level of the mental slowness and sluggishness we may experience as we get older."
Dr. Seshadri agrees that there are many factors and many pathways that eventually lead to the breakdown of brain function we call dementia. High blood pressure likely plays a role in this decline.
Overall heart health best
At this point, no one is advising people with normal blood pressure to take antihypertensive drugs to prevent dementia. But the research offers another good reason to make lifestyle changes to reduce or control blood pressure.
"The feeling among neurologists is that hypertension does increase risk of dementia," Dr. Seshadri says. "This is probably true for people who develop high blood pressure in their 30s and 40s, but might also be true for high blood pressure starting later in life, when people are at most risk of dementia."
Hypertension isn't the only heart disease risk factor that contributes to dementia risk.

"Heart health takes a multifactorial approach—lowering cholesterol, watching your blood pressure, eating healthy foods, staying active—and so does brain health," Dr. Seshadri says. "If you can get everything up to speed and fix what is vulnerable, you may keep both your heart and your brain running better."?

Friday, February 3, 2017

How to tame stubbornly high blood pressure

How to tame stubbornly high blood pressure

How to tame stubbornly high blood pressure

Resistant hypertension poses a serious threat to your heart's health.
About one in three American adults has high blood pressure, defined as a top (systolic) blood pressure reading of 140 or higher or a bottom (diastolic) reading of 90 or higher. Also known as hypertension, this often-symptomless condition is a leading cause of stroke and heart attack. The good news is that more people have their blood pressure under control than in years past. The bad news? Nearly 10 percent of people who've been prescribed multiple medications to treat their hypertension still have dangerously elevated blood pressure readings.

Defining resistant HTN

"When people have high blood pressure despite being on three different medications, including a thiazide diuretic, they have what's known as resistant hypertension," says Dr. Joshua Beckman, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. (Thiazide diuretics are often the first drugs doctors prescribe for high blood pressure.)
Resistant hypertension is especially worrisome because the risk of death from heart attack and stroke rises in tandem with blood pressure. But pinpointing the underlying cause can be tricky. For instance, some people who appear to have resistant hypertension may have "white-coat hypertension," which refers to an abnormally high blood pressure reading in a medical setting. The problem is thought to result from stress or anxiety, which raises blood pressure. To rule this out, your doctor may recommend using a home blood pressure monitor, or send you home with a device that automatically takes your blood pressure every 15 to 30 minutes over a 24-hour period.
Some people with apparent resistant hypertension simply may not be taking their medicines. Dr. Beckman suspects this may be the reason for many cases of resistant hypertension, a conclusion he bases on his involvement in a major clinical trial to address the problem. In a group of people thought to have resistant hypertension, researchers compared an experimental catheter-based procedure with the standard drug therapy—in this case, a regimen of at least three blood pressure medications. "But once we got them in the study and following a closely tracked drug regimen, some of them no longer had resistant hypertension," says Dr. Beckman.

Blood pressure drugs: Many options and combinations

There are more than 200 different drugs to treat high blood pressure. They fall into several classes:
  • diuretics
  • ACE inhibitors and angiotensin-receptor blockers
  • calcium-channel blockers
  • beta blockers
  • aldosterone blockers.
Exactly which classes of blood pressure medications your doctor prescribes may depend on other medical conditions you have, such as angina or atrial fibrillation. Side effects can also limit which classes of medications are used. Many commonly prescribed drugs are available as generics. Combination medications pack two different classes into one pill, such as a diuretic with a beta blocker or an ACE inhibitor with a calcium-channel blocker.

Wednesday, February 1, 2017

Avoiding ADHD’s Wide Net: One Parent, One Child at a Time

Alternatives to consider before accepting an ADHD diagnosis (and drugs).

Posted Sep 09, 2015

ustin is eight years old and his parents and grandparents think he has ADHD. At home he is irritable and difficult to manage. He doesn’t socialize well with friends at school and his academic performance doesn’t match his ability. 
After spending a few days with his grandparents, Justin’s behavior does a flip-flop—he is calmer, less combative and impulsive. His grandparents are concerned that once diagnosed with ADHD, a clear possibility, Justin will be prescribed Adderall or Ritalin. Given the current trend of putting young children on stimulant or similar medications, Justin’s grandparents are probably correct.
The number of children diagnosed with ADHD is staggering. Some 11 million young children and high school students in this country are labeled ADHD and two-thirds of them take stimulant drugs. These are stunning numbers, frightening if you have a young child diagnosed with ADHD who may wind up taking one of these drugs, often for life.  They can have some very unpleasant side effects and are addictive.
Have We Been Misled?

Source: Avery/Penguin Group
In less than 30 years, the ADHD “disorder” that applied to 3 percent of US children in 1987 skyrocketed to 11 percent and growing. Not so in other countries, making it a uniquely American epidemic. In her book, A Disease Called Childhood: Why ADHD Became an American Epidemic, Marilyn Wedge, PhD, a family therapist, explains the explosion in detail and offers sensible and, in many cases, must-try alternatives when parents are urged to use drugs to alter what might be an emotional or behavioral problem and not a “biological disorder.”
A confluence of factors created the rise of ADHD to its current and widespread proportions. In an engaging and well-documented manner, Wedge explains how the Diagnostic and Statistical Manual of Mental disorders (DSM), a reference manual written by the American Psychiatric Association, broadened its definition of ADHD sweeping in more children under the ADD/ADHD umbrella. For example, the 1968 edition defined ADD as “short attention span, restlessness, distractibility and over activity, especially in young children,” noting that such behavior “usually diminishes in adolescence.”
By 1980 the definition expanded to include children who were disorganized, procrastinated, and acted impulsively, and in 1987 ADD (attention deficit disorder) became ADHD, or ADD with hyperactivity, in the DSM version III.
Throughout the 1990s the distinction between what might be a central nervous system disorders and factors like abuse, problems at school or issues in the home became blurred. In later editions many of the DSM markers to make an ADHD diagnosis were widened to cover: difficulty waiting for his turn, fidgets, makes careless mistakes or is impulsive, to name a few qualities that are, for many children, just part of childhood.
Over the years, while the various editions of the DSM stretched the definition of ADHD, academics from prestigious universities jumped on the drug bandwagon, some being paid by the pharmaceutical companies. The movement to “tame” our children with drugs became ubiquitous.
Avoiding ADHD’s Wide Net
As Wedge points out, one can’t help but think that “society has moved the goalposts of normal childhood.” Wedge urges parents to consider what might be causing the troubling behaviors and make adjustments within the family or at school before popping pills into their child’s mouth. 
Did all of these children need to be drugged in the first place? Wedge thinks not. Her case is solid and should make physicians, psychiatrists, teachers, and most of all, parents carefully evaluate what is going on in their child’s life that may be causing inattention, hyperactivity, anxiety or other behaviors so quickly given an ADHD diagnosis followed by a prescription.
Before you accept an ADHD diagnosis, as a parent it is your responsibility to consider what might be causing your child’s difficult behaviors: Are you and your spouse arguing? Might your child fear a divorce? Is your child being bullied at school? Is something amiss between siblings that you may be unaware of and that your child sees as upsetting or threatening? How much food dye is in the foods the child eats? What TV programs does he watch—might they be too fast-paced or violent and are they having a negative effect on your son or daughter’s ability to concentrate?
One Parent, One Child at a Time
Most parents today are attempting to raise “star” children. Might your child feel pressured to perform and succeed? It is true that stimulant drugs improve focus and attention—just ask college students, some 35 percent use them whether or not they have an ADHD diagnosis. Wedge puts it this way, “Our expectations have changed and parents seek medication for their kids primarily to drive them to raise their grades.”
Before you agree to Ritalin, Adderall and similar drugs for your child or teen who isn’t acting and/or achieving exactly as you hoped he or she would, bear in mind that according to the Drug Enforcement Administration, these drugs are “as addictive and subject to abuse as cocaine and morphine.”
The pharmaceutical industry has lots to lose when parents reject drugs designed to get troublesome children to do well in school and to behave at home and  look for the root cause of a child’s behavioral or emotional problem and decide to fix it without resorting to the drugs of the day. With one parent and one child at a time, we can stop the ADHD epidemic by not being so quick to diagnose ADHD and medicate as if it were a panacea in every case.
Postscript: The central issues causing Justin’s behavior were not biological, but rather stemmed from the friction and animosity between his parents. As they worked on their problems and showed a more unified front with regard to Justin, the boy’s behavior gradually improved. No Adderall or Ritalin needed. Justin’s parents and grandparents credit A Disease Called Childhood for inspiring them to look into alternatives to stimulant drugs to help Justin.