Older patients resist talking with doctors about their life expectancy, study finds

Nancy Schoenborn, a geriatrician at Johns Hopkins University’s School of Medicine, noticed that doctors increasingly are being told by their professional organizations to treat patients in the last decade or so of life differently. Less aggressive control of blood sugar and blood pressure makes sense for people with fewer years to go, the guidelines suggest. Screening tests for certain cancers probably won’t be beneficial if a patient is unlikely to live at least an additional 10 years.

The emphasis on life span rather than age stems from the recognition that health varies widely in the last chapters of life, and age alone is a poor predictor of how a patient is doing. A sick 65-year-old and a healthy 80-year-old might each have nine years left.

These new rules, though, present doctors like Schoenborn with a problem. How exactly is she supposed to explain her treatment decisions to patients?

This question led her to start asking older Americans how they want to talk about mortality with their doctors. Her recent survey, published in Annals of Family Medicine, revealed some surprising results.

Full story at philly.com

Blood pressure better controlled with ‘MAP’ for doctors

A quality improvement program designed to better control hypertension in primary care practices notably improved hypertension control in six months, according to research presented today at the American Heart Association (AHA) Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions 2017, in San Francisco.

One in three American adults has high blood pressure. That number is steadily climbing, despite the fact that high blood pressure can be easily treated using evidence-based guidelines.

Based on the American Medical Association’s M.A.P. Framework, the AMA collaborated with Care Coordination Institute Labs, Greenville South Carolina, to create the M.A.P. hypertension improvement program using the latest science in blood pressure control. It stands for measuring blood pressure accurately; acting rapidly to manage uncontrolled blood pressure; and partnering with patients to promote blood pressure self-management.

Full story at Science Daily

Leisure activities lower blood pressure in Alzheimer’s caregivers

Going for a walk outside, reading, listening to music — these and other enjoyable activities can reduce blood pressure for elderly caregivers of spouses with Alzheimer’s disease, suggests a study in Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published by Wolters Kluwer.

“Greater engagement in pleasant leisure activities was associated with lowered caregivers’ blood pressure over time,” according to the report by Brent T. Mausbach, PhD, of University of California San Diego and colleagues. “Participation in pleasant leisure activities may have cardiovascular benefits for Alzheimer’s caregivers.”

The study included 126 caregivers enrolled in the UCSD Alzheimer’s Caregiver Study, a follow-up study evaluating associations between stress, coping, and cardiovascular risk in Alzheimer’s caregivers. The caregivers were 89 women and 37 men, average age 74 years, providing in-home care for a spouse with Alzheimer’s disease.

Full story of lowering blood pressure in Alzheimer’s caregivers at Science Daily

Are childhood stroke outcomes associated with BP, blood glucose, temperature?

Infarct (tissue damage) volume and hyperglycemia (high blood glucose) were associated with poor neurological outcomes after childhood stroke but hypertension and fever were not, according to an article published online by JAMA Neurology.

After pediatric patients experience an arterial ischemic stroke, there are no evidence-based guidelines available for the best management of blood pressure, blood glucose levels and temperature.

Lori C. Jordan, M.D., Ph.D., of the Vanderbilt University Medical Center, Nashville, and coauthors looked at the prevalence of abnormal blood pressure, blood glucose levels and temperature measures with neurological outcomes.

Full story of childhood strokes associated with BP at Science Daily

Blood pressure targets for individuals with kidney disease should consider patients’ age

New research indicates that higher systolic blood pressure is linked with poor outcomes in patients with kidney disease, although the association diminishes with advanced age. The findings, which come from a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), provide valuable information concerning patients who are often excluded from blood pressure-lowering clinical trials.

Hypertension is the most important treatable risk factor for cardiovascular disease, and while it is especially common in the elderly and in patients with chronic kidney disease (CKD), these are the least studied groups in randomized controlled trials examining the health effects of lowering blood pressure. Furthermore, the majority of patients with CKD are elderly; hence it is important to clarify the role of elevated blood pressure in these individuals.

To investigate, Csaba Kovesdy, MD (Memphis VA Medical Center and the University of Tennessee Health Science Center) and his colleagues examined information from the national VA research database and looked for associations between blood pressure and various clinical outcomes — coronary heart disease, stroke, kidney failure, and death — in more than 300,000 patients with CKD.

Full story of blood pressure and kidney disease at Science Daily

Recent Western blood pressure guidelines may boost stroke risk in Asian patients

European and North American blood pressure guidelines, issued last year, may actually boost the stroke risk if used for Asian patients, particularly the elderly, suggests an expert opinion published online in the journal Heart Asia.

High blood pressure is a key risk factor for stroke, but the link between the two is much stronger in Asians than it is in Europeans or North Americans, say the experts.

The global number of people with poorly controlled high blood pressure has risen from 600 million in 1980 to almost 1 billion in 2008, and predicted to rise a further 60% to 1.56 billion by 2025.

Full story of western blood pressure guidelines and stroke risk at Science Daily

New blood pressure guidelines may lead to under treatment of older adults

Approximately one-third of U.S. adults have hypertension (or high blood pressure). Treatment of this condition is essential to the prevention of cardiovascular disease (CVD), the #1 killer of both men and women in the country. In 2014, the Joint National Committee (JNC) released the eighth update to the blood pressure guidelines (JNC8P). These guidelines included a controversial decision to change the blood pressure goal for adults 60 years of age or older. The JNC8P guidelines set a less stringent goal blood pressure of < 150/90 mmHg for individuals 60 years of age or older compared to the previous <140/90 mmHg goal. The guidelines also encouraged a more lenient goal for those with chronic kidney disease (CKD) or diabetes of < 140/90 mmHg (the previous goal was < 130/90 mmHg).

Michael Miedema, MD of the Minneapolis Heart Institute Foundation and principal investigator in a recently published study said, “The concern surrounding less stringent guidelines is that under treatment of hypertension may lead to an increase in the risk for heart attacks and strokes. One of the main risk factors for CVD is age, so under treating older adults may lead to a significant increase in CVD events. This study has helped us understand the potential magnitude of the impact of these new guidelines.”

Full story of blood pressure guidelines at Science Daily

Diets high in fruit, vegetables, whole grains and nuts among factors to lower first-time stroke risk

Eating Mediterranean or DASH-style diets, regularly engaging in physical activity and keeping your blood pressure under control can lower your risk of a first-time stroke, according to updated AHA/ASA guideline published in the American Heart Association’s journal Stroke.

“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled — especially high blood pressure — account for 90 percent of strokes,” said James Meschia, M.D., lead author of the study and professor and chairman of neurology at the Mayo Clinic in Jacksonville, Florida.

Full story of low stroke risk diets at Science Daily

CPAP superior to supplemental oxygen for blood pressure reduction in obstructive sleep apnea

Continuous positive airway pressure (CPAP), the most widely prescribed therapy for treatment of obstructive sleep apnea, resulted in significantly lower blood pressure compared to either nocturnal supplemental oxygen or an educational control treatment, according to a new study from Brigham and Women’s Hospital (BWH).

The study is published in the June 12, 2014 issue of The New England Journal of Medicine.

“The effect of CPAP on blood pressure in this study is important for both physicians and their patients,” said Daniel Gottlieb, MD, MPH, lead study author and a physician-scientist in BWH’s Division of Sleep and Circadian Disorders. “Previous studies have demonstrated that a decrease in blood pressure of this magnitude is associated with up to a 20 percent reduction in mortality from stroke and a 15 percent reduction in cardiovascular mortality.”

Full story of CPAP for sleep apnea at Science Daily

Blood pressure control, lifestyle changes key to preventing subsequent strokes

Stroke survivors should control their blood pressure, cholesterol and weight and do moderate physical activity regularly to avoid having another stroke, according to an American Heart Association/American Stroke Association scientific statement.

They should also receive other evidence-based therapy specific to their individual health, which may include aspirin therapy or a surgical procedure to keep neck arteries open.