Hearts by the numbers

What’s in a blood pressure number?

As I paged through the Parade magazine that arrived with my newspaper this past weekend, my attention was grabbed by Dr. Oz’s health column on page 7, specifically this statement about heart health:

Blood pressure is the largest driver of heart disease; ideally it should be 115/70.

I confess to doing a bit of a doubletake. 115 over 70? What happened to the standard yardstick of 120/80?

It’s not an idle question. High blood pressure is one of the most common cardiovascular conditions, so where the threshold is set is a matter of importance to millions of Americans.

As it turns out, the answer isn’t all that straightforward. Once upon a time, optimal blood pressure was determined by adding your age to a baseline of 100 – a method that wasn’t particularly evidence-based or useful. As researchers tracked large populations to see how they fared over the course of many years, a consensus emerged: People were less likely to have a stroke or heart attack if their blood pressure was maintained at 140/90 or  lower.

This became the goal to which patients and their doctors aspired. But with more research came more nuances. In 2003 the National Institutes of Health identified a new, and lower, “normal”: 120/80. The guidelines also created a category known as prehypertension, defined as systolic readings of 120 to 139 and diastolic readings of 80 to 89, a range previously considered “high normal” but now thought to elevate the risk of heart disease

As a result, 120/80 or lower became the gold standard for successfully managing high blood pressure.

(For an easy-to-read breakdown of the stages of hypertension, check out this chart from the American Heart Association, or this one from the Mayo Clinic.)

So where does 115/70 fit in? Has the threshold for risk been ratcheted down even further, and are we headed for trouble if we don’t achieve these numbers?

Maybe not. Nowhere does this appear to be a new official guideline – not by the American Heart Association, the American Society of Hypertension, the Heart, Lung and Blood Institute, nor the U.S. Preventive Services Task Force, which evaluates the scientific evidence and makes recommendations for clinical practice in everything from pain management for arthritis to the best use of antidepressants.

In fact, there appears to be no such thing as an “ideal” blood pressure value, although there’s certainly a range that’s considered optimal; 120/80 obviously is better for overall health than, say, 160/100. I had to do some online digging but finally came up with the apparent basis for the numbers cited by Dr. Oz: 115/70 appears to be the cut-off point at which researchers have seen no evidence of increased risk for cardiovascular disease.

Is this a number we all should strive for, then? Well, I don’t know. Most American adults – especially those middle-aged and older – are unlikely to achieve that target without serious lifestyle changes, prescription medications or both. What’s more, a too-aggressive approach to lowering blood pressure comes with risks of its own, such as increased likelihood of dizziness and falls, not to mention the increased costs of all those drugs.

To complicate the picture further, evidence has emerged that suggests even prehypertension doesn’t necessarily raise the risk of dying from a stroke or heart attack. A study published last year in the Journal of General Internal Medicine analyzed data from the National Health and Nutrition Examination Survey and concluded that people with prehypertension were no more likely to die prematurely of heart disease than those whose blood pressure was categorized as “normal.” What seemed to matter were the individual systolic and diastolic numbers and the person’s age. Systolic readings consistently over 140 were associated with higher risk among people 50 and older, whereas it was the diastolic number that was more predictive among those younger than 50.

This particular study looked only at mortality and did not attempt to quantify the risk of non-fatal heart attacks and strokes among people with elevated blood pressure. Meanwhile, the state of knowledge is continuing to evolve. The last time the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure revised its guidelines was back in 2003; an update is in the works and scheduled to be released this year, possibly refining our understanding of the picture even further.

It would probably be safe to say that there’s more to blood pressure management than achieving a simple, standard set of numbers. While Dr. Oz’s benchmark of 115/70 might not have been wrong, technically speaking, it’s not the whole story. We’d do well to ask ourselves what these numbers really mean and whether there’s all that much to be gained before adopting this as a new goal.

Frazzled for the holidays

I enjoy the holiday season as much as the next person, but guess what? It’s always a relief when Jan. 2 rolls around and life returns to normal.

Talk about irony: This is supposed to be a happy time of year, yet for many people it often ends up being incredibly stressful.

When the American Psychological Association conducted a survey some years ago, money problems led the list of top reasons for holiday-related stress. About 60 percent of the 1,000 people who took the survey said a lack of money caused the most stress for them during the holidays. The pressures of gift-giving, lack of time and credit card debt were close behind.

The survey also found that people worried about how holiday stress was affecting their health; about one in three reported turning to food or alcohol to help them cope.

List My 5, a website devoted to top-five lists of everything from must-read books to remedies for migraines, highlights the emotional baggage that often contributes to the Christmas crunch: families who fight or don’t get along with each other, pressure to pull off the perfect Christmas, and nostalgia for happier Christmases of the past.

The effect of all of this on people’s well-being is very real. They might develop headaches, difficulty sleeping or even full-blown depression, especially if they’re already susceptible to seasonal affective disorder, which is triggered by the shortened hours of daylight during the winter.

Here’s an eye-opening fact: Several years ago, researchers decided to track heart disease-related deaths across the year to determine whether there was a seasonal pattern. They were surprised to find that deaths from heart attacks and strokes were more frequent during the early winter months than the rest of the year – and cold weather, which is known to affect the circulatory system, did not seem to be an important factor.

In an article that appeared in the Circulation journal in 2004, Dr. Robert A. Kloner describes the findings:

When we plotted daily rates of death from ischemic heart disease in Los Angeles County during November, December, and January, we were struck by an increase in deaths starting around Thanksgiving, climbing through Christmas, peaking on New Year’s Day, and then falling, whereas daily minimum temperatures remained relatively flat during December and January.

The mechanism for this isn’t entirely clear, but there are several suspects: holiday foods that tend to be higher in salt and fat, excess alcohol consumption, and even increased exposure to potentially harmful particulates from wood-burning fireplaces.

Stress is an obvious culprit, Kloner writes. “During the holiday season, patients may feel stress from having to interact with relatives whom they may or may not want to encounter; having to absorb financial pressures such as purchasing gifts, traveling expenses, entertaining, and decorating; and having to travel, especially in the post-September 11, 2001, era.”

Hospitals that are more lightly staffed during the holiday season – and therefore not geared up as usual to care for cardiac patients – might be a factor as well, Kloner suggests.

The phenomenon of seasonal heart emergencies is recognized well enough to have earned its own name: the “Merry Christmas coronary” or the “Happy New Year heart attack.” (Related to this is “holiday heart syndrome,” or episodes of atrial fibrillation that are caused by alcohol consumption and that can lead to stroke.)

The message in all of this can be summed up in two words: Slow down. Kloner’s advice, especially to those who already have heart disease or have risk factors for heart disease, is to watch their intake of salt and alcohol, avoid overeating, get enough sleep and be prudent about physical exertion.

Curbing holiday stress is easier said than done, but the holiday season will probably be a lot happier for many folks if they can enjoy it without the burden of being overly frazzled.

Photo: Wikimedia Commons

We want fries with that

The results are in: French fries made without trans fats can still taste good.

Consumer Reports checked out the fries at three major fast-food chains that now make their french fries without trans fats. The verdict: Taste-testers found that the fries from Burger King, McDonald’s and Wendy’s taste "as good as the old fries that contained heart-unhealthy trans fats."

Wendy’s and McDonald’s rose to the top, both earning a "very good" rating. The critique for Wendy’s fries: "Big potato flavor; light, crispy surface; soft inside. A little more browning would make them even better."

Here’s what the taste-testers said about McDonald’s fries: "Very flavorful, with crisp texture, but could be more potato-y."

Burger King fries received a "good" rating. They were deemed "decent, but coating detracts from the quality and makes texture a little tough, not crispy." They also tasted "more of oil than potato."

On the calorie and fat scale, McDonald’s performed the best. A 4.1-ounce serving of its fries contains 380 calories and 19 grams of fat. Wendy’s came in second, with 420 calories and 20 grams of fat in a 5-ounce serving of fries. BK offered the most generous helping of fries – 5.6 ounces – and came in at 480 calories and 23 grams of fat.

The taste-testers each tried a medium serving of fries at three outlets for each chain.

Even when they’re made without trans fats, french fries still contain plenty of fat, not to mention calories - but at least it’s the less bad kind of fat.

What’s a good fat? Monounsatured fats and polyunsaturated fats are considered good because they’re believed to help lower the risk of heart disease when they’re consumed in moderation. They can be found naturally in nuts, avocados, olive oil, and certain kinds of fish, such as salmon, to name a few. So-called bad fats, on the other hand, have been implicated in higher risk of stroke, heart disease and high blood pressure. They include saturated fats, which occur in animal products, and trans fats, which are typically manufactured by food companies to preserve foods and enhance the texture and taste.

Take this online quiz, created by the American Heart Association, to check your good fat/bad fat IQ. The AHA also has an entire resource center on dietary fat and how to manage how much fat you consume.

Photo credit: HealthBeat photo by Anne Polta