Ask the doctor
Q. I’ve been taking blood pressure pills for 20 years, but I just turned 75. Do I still benefit from taking them?
A. There is no doubt about the benefit of treating high blood pressure in people younger than 75. But some doctors have wondered if, in people older than 75, the benefits might be less and the chance of bad reactions to medicines might be greater. So, you’re asking a question that we doctors have asked ourselves.
A study published online on Aug. 26, 2021, by The Lancet is the best one I’ve seen on this question. It indicates that the value of blood pressure treatment continues in people over 75 years old. Scientists pooled the results of 51 randomized clinical trials involving 358,707 people, who ranged in age from 21 to 105 years old. Nearly 59,000 people were ages 75 or older. With so many people in the analysis, the results are more likely to be valid.
Randomized trials are the best type of study for judging the benefits and the risks of treatment. Such trials randomly assign some people to take a real blood pressure pill and others to take a placebo (inactive pill). Since the people in the two groups are very similar except for the kind of pill they are taking, any differences in their subsequent health are likely to be explained by whether they took the real medicine or the placebo. So, because of the large number of people in the analysis, and the fact they were all in randomized trials, we can trust the results of the analysis.
Angina is heart-related chest pain caused by an insufficient delivery of oxygen to the heart muscle. Angina is a symptom of a variety of disorders rather than a disease. Is your angina caused by high cholesterol?
It's a difficult question to answer. The answer appears to be no on the surface. High cholesterol is usually accompanied by no symptoms. When we dig a little deeper, we discover that having high cholesterol increases your likelihood of acquiring a condition that includes angina as a symptom. As a result, even though there is no direct link between high cholesterol and angina, it does contribute to it indirectly.
Cholesterol is a necessary component created by your liver and used as a building block throughout your body; however, it is not soluble in water and hence cannot flow through your bloodstream on its own. Depending on which way it's heading, it does, however, hitch a ride on one of two lipoproteins.
LDL, or low-density lipoprotein, transports cholesterol to where it's needed in your body, whereas HDL, or high-density lipoprotein, transports cholesterol back to your liver for elimination. This is a natural process that happens to everyone at some point in their lives. When the ratio of LDL to HDL tips in favor of the low-density lipoproteins, your cholesterol is deemed high. A bad diet, a sedentary lifestyle, smoking, diabetes, or heredity can all contribute to this.
When you consume a high-fat diet, your LDL — or "bad" cholesterol — levels might rise beyond what your HDL can remove, and something has to happen with that excess LDL. The development of fatty deposits in your bloodstream is that item. These deposits build up on the inside of your blood vessels' walls. These deposits build up over time, obstructing the flow of blood via your arteries, the blood vessels that carry oxygen throughout your body.
Atherosclerosis is the name for these blockages, which leads to coronary heart disease. The many forms of angina discomfort are caused by a restricted flow of oxygen to your heart. High cholesterol is one of the most common causes of coronary heart disease, but it isn't the only one. Other risk factors include high blood pressure and age.
It's a difficult question to answer. The answer appears to be no on the surface. High cholesterol is usually accompanied by no symptoms. When we dig a little deeper, we discover that having high cholesterol increases your likelihood of acquiring a condition that includes angina as a symptom. As a result, even though there is no direct link between high cholesterol and angina, it does contribute to it indirectly.
Understanding Cholesterol
Cholesterol is a necessary component created by your liver and used as a building block throughout your body; however, it is not soluble in water and hence cannot flow through your bloodstream on its own. Depending on which way it's heading, it does, however, hitch a ride on one of two lipoproteins.
LDL, or low-density lipoprotein, transports cholesterol to where it's needed in your body, whereas HDL, or high-density lipoprotein, transports cholesterol back to your liver for elimination. This is a natural process that happens to everyone at some point in their lives. When the ratio of LDL to HDL tips in favor of the low-density lipoproteins, your cholesterol is deemed high. A bad diet, a sedentary lifestyle, smoking, diabetes, or heredity can all contribute to this.
What happens when LDL levels are high
When you consume a high-fat diet, your LDL — or "bad" cholesterol — levels might rise beyond what your HDL can remove, and something has to happen with that excess LDL. The development of fatty deposits in your bloodstream is that item. These deposits build up on the inside of your blood vessels' walls. These deposits build up over time, obstructing the flow of blood via your arteries, the blood vessels that carry oxygen throughout your body.
Atherosclerosis is the name for these blockages, which leads to coronary heart disease. The many forms of angina discomfort are caused by a restricted flow of oxygen to your heart. High cholesterol is one of the most common causes of coronary heart disease, but it isn't the only one. Other risk factors include high blood pressure and age.
Changes in the seasons and blood pressure
Q. My blood pressure is usually within the normal range, except in the winter. Do Seasons have an effect on blood pressure?
A. Seasons does have an effect on blood pressure. During the winter, some patients with borderline hypertension experience elevated blood pressure readings. And their blood pressure can rise to dangerous levels, necessitating medication to maintain control. They may be able to lessen the dosage in the spring or discontinue the medicine entirely in the summer.
The predominant idea for increased blood pressure in colder temperatures is that it is caused by artery tension. When our bodies become chilly, blood vessels constrict to retain heat. This can result in an increase in blood pressure in certain individuals. However, additional things may contribute to your elevated winter blood pressure. For instance:
Plastics and personal care products contain a chemical that has been related to heart disease.
We are following this research.
A recent study reveals that exposure to chemicals called phthalates, which are found in many common plastics, may be associated with an increased risk of dying from cardiovascular disease.
Phthalates, often known as plasticizers, are used to make vinyl polymers soft and flexible. They are extensively utilized in industrial food processing, medical devices, and vinyl construction materials, as well as personal care products such as shampoos and lotions.
The study enrolled 5,303 persons (median age 57) who participated in a nationwide health survey and gave urine samples for phthalate exposure assessment. The researchers then tracked the participants' causes of death over the next decade. After adjusting for potential confounding variables, they discovered that exposure to phthalates was related to a slightly increased chance of dying from any cause, but particularly cardiovascular disease.
Types of aortic valve problems
Aortic stenosis occurs when the valve narrows and cannot fully open, hence restricting blood flow forward. Aortic regurgitation occurs when the valve fails not to close completely, allowing blood to leak back into the left ventricle. Both conditions can occur alone or together. The underlying reason may be present from birth (congenital) or acquired later in life.
Is it possible to have a silent stroke?
I've heard about silent heart attacks, but is it possible to suffer a stroke and be unaware of it as well?
Indeed, this is possible. According to a joint statement made by the American Stroke Association and the American Heart Association, up to a quarter of octogenarians may have had one or more strokes without experiencing symptoms. These episodes are frequently noticed only after a person has brain imaging for another reason.
Identifying and addressing underlying issues, as well as making lifestyle adjustments, will aid in recovery.
Many people develop hypertension as they age, and it can be difficult to regulate. This is referred to as resistant hypertension – blood pressure that remains above a predetermined target, such as 140/90 millimeters of mercury (mm Hg), despite the use of three distinct classes of blood pressure medications (including a diuretic) at the maximum tolerated doses. The disorder is a significant risk factor for stroke, heart disease, and dementia, among other complications. How can you bring it under control?
All drugs should be reviewed.
Bring a list of all the prescriptions you are currently taking to your doctor or a bag with all the medication bottles. Include OTC medications, vitamins, and supplements. The list, or bag, of medications, might assist your doctor in determining which medications or supplements may be increasing your blood pressure.
For instance, nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen (Motrin, Advil) might cause an increase in blood pressure. Decongestants (such as phenylephrine, which is present in a variety of cold medications), some antidepressants, and corticosteroids can also help. For instance, "alternative drugs or physical therapy can help minimize or eliminate the need for NSAIDs in some patients," according to Harvard cardiologist Dr. Deepak L. Bhatt, editor-in-chief of the Harvard Heart Letter.
Alternatively, the doctor may determine that your medications can be simplified: fewer pills overall or fewer pills that must be taken more than once a day.
Treat the underlying causes
Additionally, underlying disorders can contribute to persistently high blood pressure (see "What causes resistant hypertension?"). It is critical to bring them under control. However, determining whether or not you have one may necessitate some detective work as well as a comprehensive medical examination.
For instance, you may be unaware that you have a condition that increases blood pressure, such as sleep apnea – breathing pauses during sleep. Sleep apnea symptoms include chronic loud snoring, a momentary cessation of breathing (and possibly gasping for air), and excessive sleepiness during the day. A sleep study conducted in a laboratory or at home (with a portable device) can give information.
What factors contribute to resistant hypertension?
Resistant hypertension (high blood pressure that does not decrease despite various drug treatments) can have a variety of causes. The most common reasons include consuming too much salt, which can reduce the effectiveness of blood pressure drugs; and missing doses or modifying them on your own. Additional reasons include the following:
gaining weight
obstructive sleep apnea
excessive alcoholic consumption
chronic pain
atherosclerosis is a condition in which arterial walls become inflamed.
interactions between medications
Panic attacks
elevated aldosterone levels (which causes the body to hold on to sodium and water)
kidney issues
consuming licorice noir (which contains a compound that can increase blood pressure).
There is never a time when you are too young or too old to take care of your heart! The decisions you make now have an effect on how your heart feels in the future. You do not have to be at a high risk of developing heart disease to take preventative measures. Anyone, regardless of age, can benefit from maintaining a healthy heart! Here are some straightforward measures for preventing heart disease:
1. Eat a balanced diet
Simple changes in your unhealthy eating habits can have a significant effect on your heart. The trick is to consume fewer processed foods and a greater variety of fresh fruits and vegetables. Additionally, you should consume fiber-rich whole grains, seafood, nuts, and legumes. Consume less saturated fat, trans fat, and sodium-containing items, such as fried foods, chips, cookies, doughnuts, and fast food. Consume salmon, citrus fruits, avocado, and dark chocolate instead. Substitute almonds or blueberries for your midday snack! Not to mention the spinach! Use spinach in place of lettuce in sandwiches and salads. Simple substitutions of harmful items here and there will assist you in achieving a healthy diet.
2. Maintain an active lifestyle
This is one of the simplest tips to implement and one of the most effective. Exercise is critical for maintaining a healthy heart. Additionally, exercising does not have to be difficult. It might be as simple as strolling through your neighborhood or as strenuous as running a marathon. Set out an hour each evening after work to engage in some form of physical activity, whether it's going to the gym, participating in a sport, or simply going for a stroll. All you have to do is stay upright and active. If you're new to exercise, begin cautiously by spending 2.5 hours per week on moderate-intensity physical activity. Once exercise becomes ingrained in your daily routine, it will develop into a habit that you will find difficult to break!
A number of studies have suggested a connection between an increased risk of heart attack or other heart-related disorders and a diet heavy in calcium supplements. However, this association remains controversial. The National Osteoporosis Foundation and the American Society for Preventive Cardiology have identified no such association in more recent research.
According to other specialists, the association between calcium supplementation and cardiovascular disease may have been coincidental.
An abdominal aortic aneurysm is a condition in which the aorta swells abnormally. Smaller aneurysms are rarely a source of concern. However, they can enlarge over time, increasing the risk of rupture. This is potentially fatal.
The aorta is the largest artery in the body. It transports oxygen-rich blood from the heart to the body's smaller arteries.
An abdominal aneurysm occurs when a section of the abdominal aorta ruptures. The section of the aorta between the bottom of the chest and the pelvis is referred to as the ascending aorta.
The aorta is the largest artery in the body. It transports oxygen-rich blood from the heart to the body's smaller arteries.
An abdominal aneurysm occurs when a section of the abdominal aorta ruptures. The section of the aorta between the bottom of the chest and the pelvis is referred to as the ascending aorta.
The aorta is typically about an inch (2.5 centimeters) in diameter. The size gradually increases as people age. When the abdominal aorta balloons swelling is greater than 3 centimeters in diameter, this is referred to as an abdominal aortic aneurysm. The most common symptom of an abdominal aortic aneurysm is a balloon-like swelling. The aorta's wall bulges out.
The majority of aortic aneurysms are caused by atherosclerosis. Atherosclerosis is a condition in which fatty deposits accumulate on the inside walls of blood vessels.
Symptoms
The majority of aortic aneurysms are asymptomatic. They are frequently detected during routine physical examinations. Alternatively, they are discovered during routine X-rays for unrelated illnesses.
When symptoms manifest, they may include the following:
Individuals in pain:
Abdomen
Pain
Between the bottom of the ribs and the hips, the fleshy part of the sides
A sensation of fullness following a small meal
Vomiting and nausea
A pulsating mass in the abdomen
Floating blood clots form infrequently near the aneurysm. These clots may disintegrate. They can also obstruct blood vessels in other parts of the body.
Occasionally, an abdominal aneurysm that has not been discovered ruptures without warning. The patient collapses and dies as a result of massive abdominal bleeding.
Diagnosis
Your doctor will inquire about any family history of heart disease in your family. He or she will be interested in learning about any unexpected and possibly unexplained deaths in the family.
Your doctor will ask a few questions about whether you smoke. The doctor will perform tests to determine if you have high cholesterol, high blood pressure, or diabetes.
Based on the physical examination, your doctor may suspect an aortic aneurysm. Your physician may detect abnormal blood flow in your abdomen. Alternatively, your physician may notice and feel a pulsating mass in your abdomen.
In the majority of cases, an abdominal aortic aneurysm is discovered during an imaging study for another illness. Numerous imaging studies can detect aortic aneurysms. X-rays and ultrasound are examples of these.
Ultrasound is an extremely accurate method of detecting abdominal aortic aneurysms. Additionally, the patient is not exposed to radiation.
Once an abdominal aortic aneurysm forms, it is permanent. Most increase in size over time.
Androgen deprivation therapy (ADT) is a common treatment for prostate cancer that is used when the tumour has progressed or is likely to return after surgery or radiation. Doctors use ADT (also known as hormonal treatment) to block testosterone from fueling prostate cancer development. However, this type of therapy has possible adverse effects, including heart effects that should be properly watched, especially in men with cardiovascular disease or other cardiac risk factors. Every year, approximately one million men are diagnosed with prostate cancer throughout the world, and half of them will be prescribed ADT at some point in their lives.
Given this summer's record-breaking heat, you might want to know if it's safe to be outside. There's cause to be curious. Climate change induced by the usage of fossil fuels has rendered hazardous, often fatal, heat waves more prevalent across the world.
So, what temperatures should you avoid, especially if you have a chronic illness like asthma, heart disease, or diabetes? we need to invest in learning more so that we can give good advice on staying safe in the heat, especially for individuals with chronic health issues.
Most of us know someone vulnerable to excessive heat. Heat sickness is more likely among the elderly and those using medications that impair the body's capacity to hold onto water, such as diuretics. If you suffer from any of the conditions listed below, you should exercise caution on hot days.
Lung conditions
Even for people who spend most of their time indoors, heat can irritate the lungs, producing flare-ups in adults who smoke, have asthma, or have a chronic obstructive pulmonary disease (COPD). Heat also raises ozone levels in the air and increases the risk of dehydration, both of which can make breathing more difficult.
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