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Want to avoid stroke? Watch your blood pressure

We all know that diet and lifestyle can have a profound effect on wellbeing, but which aspects matter most? Is smoking more dangerous than drinking? And how do both compare with being overweight or stressed? Questions that an international team of researchers have just answered in relation to one of the biggest threats to our health: strokes.

Whether caused by a brain haemorrhage or a blood clot, strokes vie with cancer and heart disease as the biggest killers — and disablers — in the western world. And it is not just the elderly who are at risk. Every year in the UK there are 10,000 strokes in people under 55.

The Interstroke study, published in the this edition of The Lancet, identifies the ten most important modifiable risk factors for stroke and ranks them in importance (see below). The factors themselves won’t raise too many eyebrows among Times readers (I hope), but their relative importance might.

Blood pressure is also the easiest risk factor on the list to miss

high blood pressure headlines with medical instruments

High blood pressure tops the list by some margin, having nearly double the impact of physical inactivity, which is second in the ranking, and nearly ten times that of stress, which sits close to the bottom of the list. To put it another way, if you want to take one sensible precaution against an early stroke it should be to keep an eye on your blood pressure.

Blood pressure is also the easiest risk factor on the list to miss. Contrary to pub lore it rarely gives you a red face or constant headaches. It tends to be silent and pernicious, and the longer it remains undiagnosed the greater the damage to the delicate lining of the blood vessels resulting in the changes responsible for most strokes.

High blood pressure can develop at any age but is most common in the over-forties, affecting at least one in five adults in the UK to some degree at some time. The only reliable way to pick it up is to monitor it regularly — at least every five years from the age of 35 and annually if it’s found to be borderline.

But what is normal? It depends where the reading is taken. In your GP surgery you are likely to be told you have high blood pressure if your readings are consistently above 140/90. Yet in the more relaxed environment of your home the upper limit of “normality” is thought to be lower at 130/80-85.

Simple blood pressure chart showing systolic (top) and diastolic (bottom) reading

Simple blood pressure chart showing systolic (top) and diastolic (bottom) reading

Once a series of higher than ideal readings has been recorded the next step is to do something about it. This is where many people go wrong. It is not all about taking a pill to correct the numbers, although that will be an essential part of therapy for many people. Rather your first step should be to look at the risk factors identified by Interstroke and mitigate as many as you can. This can lower your blood pressure and have myriad other benefits too.

The next question is how low should you go? Up until now doctors have generally been content to see their patients’ blood pressure readings drop just below the upper limit of normal, but there is evidence that lowering it further offers protection. Recent American research suggests that aiming for 120/80 could reduce cardiovascular complications such as stroke, heart attack and heart failure by nearly a third more than the current targets.

However, there is a downside to having too low a pressure. It can make you feel lightheaded, particularly on standing or getting out of a warm bed or bath, and that carries a risk of falls, particularly in the elderly. And the type and dose of the more aggressive medication needed to achieve these lower targets tends to have more side-effects, including kidney problems. It is a matter of balance.

Fortunately, lifestyle interventions — such as taking up exercise, losing weight, eating a Mediterranean, low-salt diet, etc — have few if any worrying side-effects. So start with self-help measures and use medication as an adjunct, not a substitute. Treat your whole body and not just the numbers.

MODIFIABLE RISK FACTORS FOR STROKE IN ORDER OF IMPACT

  • High blood pressure, physical inactivity, abnormal blood fats (not just high cholesterol), poor diet and obesity are the top five accounting for most strokes
  • Smoking and underlying heart issues (such as atrial fibrillation) sit in the middle of the ranking with alcohol, stress and diabetes at the bottom
  • For an overview of the UK guidance on measuring and diagnosing high blood pressure visit Nice for guidelines

Triple the risk of high blood pressure? Eat late!

People have been warned not to eat late at night after a study found it tripled the risk of high blood pressure.

Dinner should be eaten no later than two hours before bedtime, advise scientists, who insist that when we eat could be as important as what we eat.

Healthy eating to lower blood pressure

Previous research has emphasised the importance of a good breakfast in staying healthy, and the latest findings underline that eating is best done early in the day.

Almost 10 million people in Britain have high blood pressure, which increases their risk of conditions such as heart attacks and strokes. Blood pressure usually drops at night, but in many patients this does not happen and these people are particularly prone to further heart problems.

“If blood pressure doesn’t drop by more than 10 per cent at night this increases cardiovascular risk and these patients have more [heart attacks and strokes] and more chronic disease,” said Ebru Özpelit of Dokuz Eylul University, Turkey, who led the study.

In the first study of its kind, her team found that “non-dipping” high blood pressure was much more likely in people who regularly eat within two hours of going to bed. They studied 721 patients with high blood pressure, half of whom had the non-dipping kind.

After adjusting for age, weight and other risks, they found that people who reported eating late at night were 2.8 times as likely to suffer from the condition, they told the European Society of Cardiology’s congress in Rome. Dr Özpelit said that late-night eaters were not bingeing on junk food but simply delaying dinner or snacking on nuts and fruit.

Although the study could not prove a link, she said that animal studies have suggested that eating at night interferes with the body clock and stimulates the production of hormones such as adrenaline which affect blood pressure. She emphasised that dinner should be eaten no later than 7pm.

“If we eat late at night, the body essentially remains on high alert as during the day, rather than relaxing for sleep, and stress hormones are secreted causing blood pressure not to decrease during sleep,” she said.

She said that mealtimes were a key factor. “We must define the ideal frequency and timing of meals because how we eat may be as important as what we eat,” she said.

“It is not as important as obesity and it is not as important as diabetes, but we found it was more important than salt consumption in our analysis.”

COMMENTS

This is a retrospective observational study.  It is based on what people with a condition (hypertension) recall in terms of their lifestyle and previous habits.  At best it may demonstrate association, not causation.  For that you need a prospective RCT (randomised controlled trial) where patients are divided into two similar groups before they have developed the condition, with one group eating late and one eating at a normal time, with all other confounding factors potentially controlled for.   Retrospective observational studies are low down on the scale of evidence quality and mean very little.  Must a be slow news day in terms of health.  I know the Times isn’t a medical journal but it could do without publishing such tosh with misleading headlines.

AND

According to this blood pressure must be very high in Cyprus and other European countries bordering the Mediterranean where it is normal to eat late.

yes….I agree, The southern Mediterranean diet is often cited as one reason for the longer life expectancy of people from the region.  Yet they routinely eat at 9.00 pm or an even more preposterous later time.

Managing your blood pressure when travelling abroad

How to keep blood pressure low whilst travelling

If you suffer from high blood pressure, follow our top tips to stay safe on your travels this summer.

According to the NHS, around 30% of people in Britain suffer from high blood pressure. However, if you are amongst this 30%, you should not be deterred from globe-trotting! There is plenty of advice you can follow to help manage your condition whilst travelling, ensuring that you stay safe in the sun.

Planning and Research

Careful planning is key! Before going abroad, consult your doctor if your blood pressure is especially high. It’s always sensible to get medical advice before embarking on a big adventure. Your doctor will be able to ensure you have all the advice and medication you need.

If you are on medication, then make sure you leave with a generous supply. Take extra in case you lose a packet, and don’t pack all of the tablets in the same place; if you lose your suitcase and all of your medication with it, you could be in trouble!

travel health

What to pack

It’s not just medication that’s important. If you suffer from high blood pressure, then the following essentials will help to manage your condition abroad.

  • Flight socks – These will help to keep your circulation healthy and reduce the risk of DVT in the air.
  • Blood pressure monitor – A compact blood pressure monitor will allow you to keep an eye on your blood pressure whilst away.
  • Emergency list – write down your medication and the contact numbers for your doctor and next of kin. Should there be an emergency, all of your information can be made known to the medical team.
  • European Health Insurance Card (EHIC) – Don’t forget this card, which entitles you to free healthcare within the EU. In the event of an emergency, this will mean you can get medical care quickly and easily, without risking a payment. Keep your card tucked into your passport, so you never forget to take it abroad with you.
  • Health insurance documents – Make sure you have copies of your insurance documents to hand, in case of emergency. Specialist insurance for travellers with high blood pressure is available, so make sure you research the best policy for you.

Reduce stress at the airport

Airports can be notoriously stressful: long queues, screaming children and missed flights will only exacerbate high blood pressure.

If you plan ahead, however, this stress can be minimised. Consider booking an airport hotel before a flight, to save an early morning rush to the airport. In addition, try to pre-book your seats, so that you don’t have to worry about rushing onto the plane as soon as the gate opens.

An aisle seat is also a good idea, so you are able to easily move around on the plane. It’s a good idea to pack some snacks, too, as aeroplane food can be very salty and could potentially affect your blood pressure.

Relax!

Once you have taken care of these precautions, you can relax in the knowledge that you’re safe in the sun! And relaxing is especially important for those with high blood, as stress will only exacerbate the condition.