UP TO 150,000 IRISH BLOOD PRESSURE PATIENTS MAY NOT NEED ADDITIONAL DRUG TREATMENT DESPITE NEW GUIDELINES

NEW IRISH-AUTHORED, JAMA-PUBLISHED MEDICAL PAPER CHALLENGES RECENT GUIDELINES DEFINING HIGH BLOOD PRESSURE

The findings of a major research study from The National Institute for Prevention and Cardiovascular Health (NIPC) and The National University of Ireland Galway (NUIG) call into question the validity of recent changes to treatment recommendations for a certain type of blood pressure patient.

The study has challenged an element of the new, lower, blood pressure thresholds recommended in recently released American medical guidelines for the diagnosis and treatment of high blood pressure (also termed hypertension).  These US guidelines changed the definition of hypertension from a blood pressure of 140/90 or more, to a blood pressure of 130/80 or more. Subsequently, guidelines from European clinical societies also recommended that most adults being treated for high blood pressure be treated to the new lower target of 130/80.

These high blood pressure guidelines are observed widely in Ireland and as a result, as many as 150,000 patients with a bottom blood pressure number of over 80, but a normal top blood pressure number below 130 are potentially at risk of being over-treated according to the NIPC/NUIG research. This is because the study found that this specific type of blood pressure pattern does not appear to be adversely affecting their health. Of note, blood pressure levels are denoted by two numbers, one above the other where, for example, a blood pressure level may be written as 130/80.  The top number is known as the systolic, and the bottom number is known as the diastolic reading.

The NIPC and NUIG investigation, led by Prof J William McEvoy, Medical and Research Director of the NIPC, was conducted in collaboration with US investigators and is today published in a leading international medical journal, the Journal of the American Medical Association (JAMA).

The JAMA published investigation looked specifically at the new (lower number) diastolic blood pressure threshold set at 80 for the diagnosis of elevated blood pressure, which was a reduction from a prior diastolic blood pressure of 90. The recommendation to lower the diastolic threshold for hypertension from 90 to 80 was based on expert opinion (which is a relatively weak type of evidence), not on results from clinical trials (with the latter considered to be the strongest type of medical evidence). 

A specific group of patients is now eligible to be diagnosed with high blood pressure as a result of this changed threshold.  These patients suffer from Isolated Diastolic Hypertension, characterised by a normal systolic (top) number (i.e., below 130 according to new guidelines) but a higher diastolic (bottom) number (i.e., greater than or equal to 80 according to new guidelines).

The report states that approximately 5% of the US adult population are newly diagnosed with high blood pressure (or hypertension) based on the definition for isolated diastolic hypertension contained in the new guidelines. This translates into approximately 12 million adults in the US being newly diagnosed with this condition.

“Though there are differences between American and European guidelines in how high blood pressure is defined, in general both sets of guidelines recommend that a target blood pressure of 130/80 be achieved for those who are receiving treatment to lower their blood pressure”. 

Professor McEvoy, Medical and Research Director, the NIPC

He continued: “The findings from this NIPC/NUIG study have implications for Irish adults since approximately 600,000 are already on treatment for high blood pressure and as many as 150,000 of these may now be eligible for increases in their treatment doses or number of medications.  Their clinicians could now be aiming to get the diastolic (lower) number to less than 80 despite the patient having a normal systolic (top) blood pressure of below 130”. 

He concluded: “This is a concern, because our team found no adverse health outcomes from a diagnosis of Isolated Diastolic Hypertension when the new guideline criteria are used. The absence of negative health outcomes in this group challenges the need to intensify the blood pressure treatment of these adults with higher diastolic blood pressure. Instead the main focus should be on getting the top number (or systolic blood pressure) under control”.

A tried and tested prescription to prevent and treat advancing age!

By Maria Kearney, Croí’s Physical Activity Specialist

There is a steady decline in muscle and bone strength from the age of 40 that accelerates after the age of 65 or post-menopause in women. This can make everyday activities seem much more difficult and can also increase the risk of fracture and likelihood of future disability.

Exercise is an established and effective therapy for the maintenance of good health and quality of life throughout the lifespan. One of the most popular forms of exercise is going for a walk with the renowned Salthill Prom “wall kick” a great example of such an activity. Whilst walking is recognised as a medicine to be taken to help reduce our risk of several chronic diseases including cardiovascular disease, diabetes and cancer, it has limited impact on the age-related deterioration in our muscles and bones.

We need to start thinking about exercise as a collection of different medicines that can be taken in different doses to bring about specific effects. For example you would not take a blood pressure medicine to lower your cholesterol and vice versa. Likewise if you want to combat the loss of muscle and bone strength your walking “medicine” is not enough. In order to address this specific need you need to start considering lifting weights or to call it by its official name; resistance training. Let me guess, a picture of Arnold Schwarzenegger popped in to your head and you have already decided that this is not for you. I urge you to read on and see if maybe your mind can be changed!

So what is resistance training? It involves performing a series of exercises where you lift a weight that you are unaccustomed to for a set amount of repetitions. It challenges the body in a very different way than aerobic exercise, like walking. Unlike walking, resistance training is a powerful stimulator of muscle, bone and nerve growth and development. It also improves balance, coordination and mobility. These are all important factors in healthy successful ageing and essential in combatting the age-associated decline in physical function.

One of the most common barriers to starting a resistance training programme centres on safety and fear of injury. However according to a large scale study of over 121 trials involving in excess of 6,700 participants, it was concluded that resistance training is both a safe and appropriate activity for older adults. Another common misconception is that age is a barrier to starting a resistance training programme. Again research is on our side here, with several studies reporting significant positive gains in both muscle size and strength in adults aged 80 and over. Furthermore the American College of Sports Medicine states that while resistance training is important through the lifespan it becomes even more so as we approach middle-age and beyond. Finally, as with all medicine, we do need to talk about the side effects of resistance training. As well as gains in muscle and bone strength, expect increases in vitality, psychological well-being, quality of life, and healthy life expectancy. These are much less unwanted side effects compared to swollen ankles and an annoying cough!

Hopefully your mind has been changed, or at least opened to the possibility that resistance training might be for you. Your next question might then be how do I get started?

Here at Croí we are running a resistance training programme specifically designed for the older adult (> 50 years of age) called Nifty Lifters. Participants on this programme are initially taught the fundamentals of resistance training including breathing, posture, alignment and technique. They are then encouraged to lift weights that are within their limits but still challenge their neuromuscular systems to adapt and develop. Expert guidance is on-hand at all times so participants feel fully supported throughout the process of learning this new skill of resistance training.

One of our current Nifty Lifters participants says, “I would not have been brave enough to go in to a gym and lift weights, but the supervision and instruction is fantastic on the Nifty Lifters programme. My confidence in my abilities has increased significantly and my posture has never been better.” Another Nifty Lifters participant commented that it is a class where he has felt “the benefits for days afterwards.”

Contact us now on 091-544310 for a full list of our Nifty Lifters classes or see www.croi.ie/classes and let’s get you started lifting your way to a healthier happier future!

Croí’s new classes will get you moving!

Improving your cardiovascular fitness is one of the most positive New Year’s resolutions you can make in 2020. To give you a helping hand, the heart health experts at Croí Centre have developed a new class timetable with offerings to get the blood pumping! Classes include Zumba, Nifty Lifters, Yoga, Pilates, Fit@Fifty+ and our popular and enjoyable Walking Football and Back to Fitness classes.

Being physically active prevents and helps control a multitude of health problems, especially heart disease, stroke, diabetes and obesity. Croí’s classes are ideally suited to anyone trying to reduce weight or improve their overall health and wellbeing, and include both aerobic and weight-lifting offerings.

“We are delighted to launch our new timetable for 2020. Our classes are so beneficial for participants, helping people to improve their fitness, decrease their risk of heart disease, stroke and diabetes, and overall live healthier lives,” says Croí’s Specialist Cardiac Physiotherapist, Denise Dunne.

Prior to enrolling in the classes individuals will be assessed to ascertain current fitness levels and exercise will be prescribed based on this assessment. Croí offers an opportunity for those with diabetes, heart disease, pulmonary disease and other long-term health conditions to commence safe and beneficial exercise led by trained professionals. “The social interaction and group inclusion is also another vital part of the benefits of our classes. Over the last few years it has been a pleasure to see the many friendships develop between class members,” says Dunne.

Classes start back on January 6, 2020 in Croí Centre with some new offerings also available locally in Oranmore. See the new class timetable at www.croi.ie/classes and call Croí on 091-544310 to book your place.