Blood Pressure Differences Between Arms Could Signal Heart Risk “People whose systolic blood pressure -- the upper number in their reading -- is different in their left and right arms may be suffering from a vascular disease that could increase their risk of death, British researchers report. The arteries under the collarbone supply blood to the arms, legs and brain. Blockage can lead to stroke and other problems, the researchers noted, and measuring blood pressure in both arms should be routine.”

Blood Pressure Response During Treadmill Testing as a Risk Factor for New-Onset Hypertension (Circulation. 1999) “In normotensive men and women, an exaggerated diastolic BP response to exercise was associated with a 2- to 4-fold risk for new-onset hypertension. A diminished recovery systolic BP response was also predictive of hypertension in men. Although previous work has shown exercise-induced hypertension to be predictive of incident hypertension,4 6 10 this is the first prospective population-based study to examine the exercise BP response during treadmill testing as a predictor of new-onset hypertension separately in middle-aged men and women. … Several definitions of exaggerated BP response have been reported, including some based solely on systolic BP and others on systolic and diastolic BP together.4 5 6 7 8 9 10 Scant information is available regarding the examination of each separately. In this study, the exercise diastolic response was predictive of the development of hypertension and was the strongest exercise predictor of hypertension in both men and women. This finding is consistent with an earlier report describing diastolic BP changes with exercise in borderline hypertensives who subsequently went on to develop hypertension.10 … suggesting that exercise systolic response was a weaker predictor of hypertension than the diastolic response. This finding is at odds with several other studies that have reported exercise systolic BP as a strong predictor of hypertension.5 6 10 23 Those studies included small numbers of female subjects, did not adjust for confounding variables, and used different cutoff points for exaggerated BP responses. The CARDIA study, which observed a weak association between exercise systolic BP response and hypertension, was restricted to younger subjects and did not separately examine the diastolic BP or recovery-phase responses.4 … We observed a stronger association between resting BP and risk for subsequent hypertension than with exercise BP. Although this finding is supported by some studies,4 19 several others have suggested that BP during exercise is a better predictor of hypertension than resting BP.6 10 29 This discrepancy probably arises from differences in methodology, characteristics of the study sample, and clinical covariates considered in the analyses. In this study, we have shown the additional value of exercise and recovery BP responses as predictors of hypertension after adjustment for baseline systolic and diastolic BP. In a subset analysis of subjects with high-normal resting BP (subjects at high risk of developing hypertension), we have shown the additional and incremental value of exercise systolic and diastolic BP responses above resting measurements. Subjects with high-normal resting BP who exhibit an exercise BP response in the top quartile are more likely to develop resting hypertension in the future.”

How Does Exercise & Position Affect Blood Pressure?

Normal Blood Pressure Increase During Treadmill Tests “Under normal circumstances, you can expect systolic blood pressure to increase to about 200 at the peak of the test and diastolic blood pressure to remain steady or fall only slightly. Heart disease is a likely if your systolic pressure does not rise above 120, if it falls, or if your diastolic pressure rises above 90 to 100. … During the test, says HeartSite.com, an unblocked coronary artery will dilate, or become larger to provide increased blood flow to your heart. Blood pressure will rise as your heart begins pumping faster to accommodate the muscles need for additional blood. If, however, your arteries cannot dilate enough to accommodate this increased need for blood due to coronary artery blockage, blood pressure will not increase sufficiently and your heart, as well as your muscles will not get the extra blood they require. If the test continues, reduced blood flow to muscles can cause symptoms such as chest pain or extreme shortness of breath.”

The exercise treadmill test: Estimating cardiovascular prognosis (Cleveland Clinic Journal of Medicine 2008) “Of the prognostic factors, exercise duration is the one most strongly associated with risk of coronary events and death, independent of age, sex, or known presence and severity of coronary artery disease. A decrease in blood pressure with exercise can reflect severe coronary artery disease or left ventricular systolic dysfunction. A heart rate that does not increase adequately during exercise or does not recover rapidly after exercise is associated with an increased risk of death. Exercise training may help to improve the prognosis of patients with an abnormal hemodynamic response to exercise caused by poor general health.”

Treadmill Stress Test

Treadmill Stress Testing

A Regenerative Antioxidant Protocol of Vitamin E and a-Lipoic Acid Ameliorates Cardiovascular and Metabolic Changes in Fructose-Fed Rats. (Evid Based Complement Alternat Med. 2011) “Type 2 diabetes is a major cause of cardiovascular disease. … These results suggest that adequate antioxidant therapy can both prevent and reverse the metabolic and cardiovascular damage in type 2 diabetes.”

A Visual Guide to High Blood Pressure (slides)

Effects of Low-Sodium Diet vs. High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol, and Triglyceride (Cochrane Review) (American Journal of Hypertension (2012))

High-Normal Blood Pressure Raises Heart Risks in Men ““Having high blood pressure in middle age is a major risk factor for developing atrial fibrillation later in life, and now new research links high-normal-range blood pressure with an increase in risk. More than 2 million mostly older Americans have the heart rhythm disorder known as atrial fibrillation, which greatly increases their risk for stroke, heart failure, and death. Researchers followed about 2,000 Norwegian men for an average of 30 years, during which time 270 developed atrial fibrillation. Men whose systolic blood pressure (the upper number) was in the high-normal range at the start of the study were 50% more likely than men with normal blood pressure to develop the heart rhythm condition. An earlier study in women who were followed for an average of 14 years also showed high-normal blood pressure to be associated with a higher risk for atrial fibrillation. … Prehypertension is common in people with metabolic syndrome, which is a group of risk factors associated with an elevated risk for heart disease, stroke, and type 2 diabetes. “This study is another example of a metabolic syndrome trait being associated with higher [heart disease and stroke] risk,” says AHA spokesman Roger Blumenthal, MD, who directs the Johns Hopkins Ciccarone Preventive Cardiology Center. Blumenthal says the findings should serve as a wake-up call for those with blood pressure readings in the high-normal range, adding that people with systolic blood pressure readings in the 130s and diastolic readings in the 80s should be counseled to make lifestyle changes that can improve the numbers. “That means revving up your diet and exercise schedule and losing weight if you are overweight,” he says.

NGC - Medical management of adults with hypertension. (2011)

Non-pharmacological aspects of blood pressure management: what are the data? (Kidney Int. 2011)

Resistant Hypertension? Ask About Snoring

Salt (slides)

Taurine prevents hypertension and increases exercise capacity in rats with fructose-induced hypertension. (Am J Hypertens. 2011)

[Vascular aging, arterial hypertension and physical activity]. (Dtsch Med Wochenschr. 2011)

Can vitamin D deficiency cause diabetes and cardiovascular diseases? Present evidence and future perspectives. (Nutr Metab Cardiovasc Dis. 2012)

Dietary Fructose and Elevated Levels of Blood Pressure (JASN 2010) “Although the mechanism to explain the relationship between dietary fructose and sugar-sweetened beverages and elevated levels of BP remains unknown, what is clear is that modifying their intake may have profound effects on the future risks for cardiovascular disease in our aging population that is already struggling with an epidemic of obesity.”

Dietary fructose and risk of metabolic syndrome in adults: Tehran Lipid and Glucose study. (Nutr Metab (Lond). 2011) “Higher consumption of dietary fructose may have adverse metabolic effects.”

Dietary fructose, salt absorption and hypertension in metabolic syndrome: towards a new paradigm. (Acta Physiol (Oxf). 2011)

Fruit and Vegetable Intake and the Risk of Hypertension in Middle-Aged and Older Women (American Journal of Hypertension (2012)) “Many known nutrients rich in fruits and vegetables, such as fiber, potassium, magnesium, folate, and vitamin C, are postulated to lower BP. Trials that tested the BP-lowering effects of these nutrients in the form of dietary supplements have shown inconsistent results,30,31 suggesting that other components in fruits and vegetables or potential interactions among multiple nutrients may be responsible for the benefits. When we examined individual and subgroups of fruit and vegetable, a stronger inverse association was observed for green-leafy vegetables, dark-yellow vegetables, apples, oranges, and raisins. Dark-green and orange vegetables have been emphasized in the dietary recommendations by the US Department of Agriculture27 and Harvard healthy eating guidelines.32 It is possible that the nutrient components in these food subgroups have particularly strong effects on BP, but this hypothesis needs to be further investigated. Elimination of the associations after adjustment for BMI supports a concept that maintaining normal body weight could be one important pathway through which fruit and vegetable consumption may contribute to BP regulation.”

Fructose and cardiometabolic disorders: the controversy will, and must, continue. (Clinics (Sao Paulo). 2010)

Fructose diet treatment in mice induces fundamental disturbance of cardiomyocyte Ca2+ handling and myofilament responsiveness. (Am J Physiol Heart Circ Physiol. 2011) “These findings demonstrate that fructose diet-associated myocardial insulin resistance induces profound disturbance of cardiomyocyte Ca(2+) handling and responsiveness, in the absence of altered systemic loading conditions.”

Fructose impairs glucose-induced hepatic triglyceride synthesis (Lipids Health Dis. 2011) “Metabolism of fructose occurs primarily in the liver and high fructose flux leads to enhanced hepatic triglyceride accumulation (hepatic steatosis). This results in impaired glucose and lipid metabolism and increased proinflammatory cytokine expression. Here we demonstrate that fructose alters glucose-stimulated expression of activated acetyl CoA carboxylase (ACC), pSer hormone sensitive lipase (pSerHSL) and adipose triglyceride lipase (ATGL) in hepatic HepG2 or primary hepatic cell cultures in vitro. This was associated with increased de novo triglyceride synthesis in vitro and hepatic steatosis in vivo in fructose- versus glucose-fed and standard-diet fed mice. These studies provide novel insight into the mechanisms involved in fructose-mediated hepatic hypertriglyceridemia and identify fructose-uptake as a new potential therapeutic target for lipid-associated diseases.”

Fructose: a highly lipogenic nutrient implicated in insulin resistance, hepatic steatosis, and the metabolic syndrome. (Am J Physiol Endocrinol Metab. 2010)

High-carbohydrate, high-fat diet-induced metabolic syndrome and cardiovascular remodeling in rats. (J Cardiovasc Pharmacol. 2011)

Increased Fructose Associates with Elevated Blood Pressure (J Am Soc Nephrol. 2010)

Salt consumption and cardiovascular, renal, and hypertensive diseases: clinical and mechanistic aspects (Current Opinion in Lipidology 2011) “It is now generally accepted that there is a direct positive correlation between dietary salt and arterial pressure. Thus, the beneficial effects of dietary salt reduction are, at least in part, due to a decrease in arterial pressure. Furthermore, the beneficial, pressure-independent effects of sodium restriction on the heart, blood vessels, and kidneys are being increasingly recognized, but not generally appreciated.”

The Impact of Fructose on Renal Function and Blood Pressure (Int J Nephrol. 2011)

The Role of Salt in the Pathogenesis of Fructose-Induced Hypertension (Int J Nephrol. 2011) “Recent studies in rodents demonstrate that increased dietary fructose intake stimulates salt absorption in the small intestine and kidney tubules, resulting in a state of salt overload, thus setting in motion a cascade of events that will lead to hypertension. These studies point to a novel interaction between the fructose-absorbing transporter, Glut5, and the salt transporters, NHE3 and PAT1, in the intestine and kidney proximal tubule. This paper will focus on synergistic roles of fructose and salt in the pathogenesis of hypertension resulting from salt overload.”

The Western-style diet: a major risk factor for impaired kidney function and chronic kidney disease. (Am J Physiol Renal Physiol. 2011)

Vital Signs: Food Categories Contributing the Most to Sodium Consumption — United States, 2007–2008 (MMWR 2012) “Mean daily sodium consumption was 3,266 mg. Approximately 44% of sodium consumption came from foods in the following 10 categories: bread and rolls (7.4%), cold cuts/cured meats (5.1%), pizza (4.9%), fresh and processed poultry (4.5%), soups (4.3%), sandwiches like cheeseburgers (4.0%),†† cheese (3.8%), pasta mixed dishes (e.g., spaghetti with meat sauce) (3.3%), meat mixed dishes (e.g., meat loaf with tomato sauce) (3.2%), and savory snacks (e.g., chips and pretzels) (3.1%) (Table 1). Whether analyzed by age group, sex, or racial-ethnic population, the five leading food categories contributing to sodium consumption almost always were among the top 10 ranked categories (Table 1 and Table 2). Exceptions included frankfurters and sausages, which were the third highest contributor among children aged 2–5 years (5.4% of sodium consumption) and the fifth highest among non-Hispanic blacks (5.0%). Among Mexican-Americans, burritos, tacos, and tamales were the top contributor (6.8%), and tortillas were the fifth contributor (4.7%). Most sodium consumed (65.2%) came from foods obtained from a store (e.g., supermarket or convenience store). Restaurants were the source of 24.8% of the sodium consumed, including 13.6% from restaurants with fast food/pizza and 11.2% from restaurants with service by a waiter/waitress. The remaining 10.0% was from other specific sources (Table 3). Among children aged 2–19 years, 8.1% of sodium consumed came from foods obtained from school cafeterias or child care centers. Among both persons aged 2–19 years and =20 years, mean sodium density was significantly greater for foods and beverages obtained from fast food/pizza or other restaurants versus stores (Table 3).”

Diet and exercise training reduce blood pressure and improve autonomic modulation in women with prehypertension. (Eur J Appl Physiol. 2012)

High Blood Pressure and the DASH Diet “One step to lower high blood pressure: Incorporate the DASH diet into your lifestyle. Doctors recommend: Eating more fruits, vegetables, and low-fat dairy foods Cutting back on foods that are high in saturated fat, cholesterol, and total fat Eating more whole grain products, fish, poultry, and nuts Eating less red meat and sweets Eating foods that are rich in magnesium, potassium, and calcium The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is an example of such an eating plan. In studies, patients who were on the DASH diet reduced their blood pressure within two weeks. Another diet -- DASH-Sodium -- calls for reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon). Studies of patients on the DASH-Sodium plan significantly lowered their blood pressure. … Here are some tips to get you started on the DASH diet: Add a serving of vegetables at lunch and at dinner. Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use. Use only half the butter, margarine, or salad dressing, and use low-fat or fat-free condiments. Drink low-fat or skim dairy products three times a day. Limit meat to six ounces a day. Try eating some vegetarian meals. Add more vegetables, rice, pasta, and dry beans to your diet. Instead of typical snacks (chips, etc.), eat unsalted pretzels or nuts, raisins, graham crackers, low-fat and fat-free yogurt and frozen yogurt; unsalted plain popcorn with no butter, and raw vegetables. Read food labels carefully to choose products that are lower in sodium.”

Low-fructose diet lowers blood pressure and inflammation in patients with chronic kidney disease. (Nephrol Dial Transplant. 2011) “Low-fructose diet in subjects with CKD can reduce inflammation with some potential benefits on BP. This pilot study needs to be confirmed by a larger clinical trial to determine the long-term benefit of a low-fructose diet compared to other diets in subjects with CKD.”

Physical Activity in the Prevention of Chronic Kidney Disease. (Cardiorenal Med. 2011)

Role of nitric oxide and prostanoids in the regulation of leg blood flow and blood pressure in humans with essential hypertension: effect of high-intensity aerobic training. (J Physiol. 2012)

Swimming lowers older adults' blood pressure “On average, the swimmers started the study with a systolic blood pressure of 131 millimeters of mercury (mm Hg). Three months later, it was 122 mm Hg. Normal blood pressure is defined as an average reading no higher than 120/80 mm Hg. Readings of 140/90 or higher are considered high blood pressure, and anything in between is considered "pre-hypertension." Swimming is often promoted as a good way for older people to exercise, since it's easy on the joints and it's not likely to cause overheating. And many follow that advice: after walking, swimming is the second-most popular form of exercise among the older set.”