Health

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Photo from Deposit Photos

One of the larger centers for the Novavax vaccine trials, Stony Brook University Hospital recruited 376 patients for a potential fourth vaccine against COVID-19 .

Benjamin Luft

The Gaithersburg, Maryland-based company announced earlier this week that its vaccine was effective in 90.4% of the participants in its phase 3 trials, which is typically the last clinical hurdle before approval from the Food and Drug Administration. The trials occurred in the United States and Mexico.

With 30,000 people participating in the clinical study, the Stony Brook participants accounted for about 1.25% of the total study group.

“The quality of our data is among the highest,” said Benjamin Luft, chief investigator of the Novavax trial and director and principal investigator of the Stony Brook WTC Wellness Program.

At its peak, the Novavax trials, which began on Dec. 28, involved 10 to 12 full-time staff at Stony Brook to prepare and administer the vaccines.

“The staff worked extremely hard,” Luft said. “I think everybody takes a great deal of satisfaction in being a small part of this great machine that ultimately produced these vaccines that we all benefit from.”

Novavax reportedly plans to produce as many as 100 million doses of the vaccine per month starting in the third quarter and as many as 150 million per month in the fourth quarter.

The Novavax vaccine, which received $1.6 billion from Operation Warp Speed in 2020, differs from the other three approved vaccines. Pfizer/BioNtech and Moderna use messenger RNA and the Johnson & Johnson vaccine uses a combination of the gene for the spike protein with an altered adenovirus, which causes the common cold.

Novavax, by contrast, uses a piece of the spike protein from COVID-19 to train the immune system to recognize the foreign invader.

Vaccine providers can store the Novavax vaccine, which requires two doses, at typical refrigerator temperatures, unlike the mRNA vaccines, which require ultra cold storage. The Novavax vaccines are usable for up to three months after they are stored.

Luft said the vaccine might have a real benefit in places that don’t have these cold storage facilities.

Earlier one morning this week, Luft received several emails from colleagues in South America who had heard about the trial and knew he was involved.

“They are so excited for their countries that they could get access to such a vaccine,” Luft said.

The clinical trials for Novavax occurred at a time when the original Wuhan strain, which formed the basis for the vaccine, wasn’t the only COVID-19 threat.

“The variants that were in the community were different” during the Novavax trial, Luft said. The vaccine was not retooled for the new variant, which is what made the results so encouraging.

Like the other vaccines, the Novavax vaccine had some side effects, which included fever, head aches and soreness at the site of the injection that went away over the course of a day or two.

At this point, Novavax plans to submit its data for potential approval to the Food and Drug Administration by the end of the third quarter.

Luft expressed his appreciation for the opportunity Stony Brook and the residents in the area who participated in the study had to contribute to this effort.

“I was just so delighted” with the results, Luft added. “It was just so gratifying to be a part of the cog in the great wheel” for a process that proved effective.

Photo from PJCC

Insight Healing Ministries in Port Jefferson was treated to a ribbon cutting ceremony by the Greater Port Jefferson Chamber of Commerce on May 20. Owner Marianne Hennigar received a Certificate of Congratulations from Town of Brookhaven aide Zachary Baum on behalf of Councilmember Jonathan Kornreich. 

Located at 156 E. Main Street, in Port Jefferson, Insight Healing Ministries uses the concept of Psycho-emotive Anatomy, a body based approach, for physical and emotional healing.

Pictured from left, chamber members Stuart Vincent, Pat Kennedy, Mary Joy Pipe, and Raquel Fernandez; owner Marianne Hennigar with husband Dr. Randy Hennigar; and Zachary Baum, Town of Brookhaven Aide for Councilmember Jonathan Kornreich. For more information, visit insighthealingministries.com.

Image from FDA
Much of our sodium comes from processed foods, including breads and sauces

By David Dunaief, M.D.

Dr. David Dunaief

When you hear someone tell you that you should lower your salt intake, how do you respond? Typically, I hear responses like, “I don’t use salt,” “I use very little,” or “I don’t have high blood pressure, so I don’t have to worry.”

Unfortunately, these are rarely true. All of us should be concerned about salt or, more specifically, our sodium intake. Also, approximately 90 percent of Americans consume too much sodium (1).

Why do we care?

We most often hear that excessive sodium in our diets increases the risk of high blood pressure (hypertension), which has consequences like stroke and heart disease.

Now comes the interesting part. Sodium also has a nefarious effect on the kidneys. In the Nurses’ Health Study, approximately 3,200 women were evaluated in terms of kidney function, looking at the estimated glomerular filtration rate (GFR) as related to sodium intake (2). Over 14 years, those with a sodium intake of 2,300 mg had a much greater chance of an at least 30 percent reduction in kidney function, compared to those who consumed 1,700 mg per day.

Why is this study important? Kidneys are one of our main systems for removing toxins and waste. The kidneys are where many initial high blood pressure medications work, including ACE inhibitors, such as lisinopril; ARBs, such as Diovan or Cozaar; and diuretics (water pills). If the kidney loses function, it can be harder to treat high blood pressure. Worse, it could lead to chronic kidney disease and dialysis. Once someone has reached dialysis, most blood pressure medications are not very effective.

How much is too much?

Ironically, the current recommended maximum sodium intake is 2,300 mg per day, or one teaspoon, the same level that led to negative effects in the study. However, Americans’ mean intake is twice that level.

If we reduced our consumption by even a modest 20 percent, we could reduce the incidence of heart disease dramatically. Current recommendations from the American Heart Association indicate an upper limit of 2,300 mg per day, with an “ideal” limit of no more than 1,500 mg per day (3).

Where does sodium hide?

If the salt shaker is not the problem, what is? Most of our sodium comes from processed foods, packaged foods and restaurants. There is nothing wrong with eating out or ordering in on occasion, but you can’t control how much salt goes into your food. My wife is a great barometer of restaurant salt use. If food from the night before was salty, she complains of her clothes and rings being tight.

Do you want to lose 5 to 10 pounds quickly? Decreasing your salt intake will allow you to achieve this. Excess sodium causes the body to retain fluids.

One approach is to choose products that have 200 mg or fewer per serving indicated on the label. Foods labeled “low sodium” have fewer than 140 mg of sodium, but foods labeled “reduced sodium” have 25 percent less than the full-sodium version, which doesn’t necessarily mean much. 

Soy sauce has 1,000 mg of sodium per tablespoon, but low-sodium soy sauce still has about 600 mg per tablespoon. Salad dressings and other condiments, where serving sizes are small, add up very quickly. Mustard has 120 mg per teaspoon. Most of us use far more than one teaspoon of mustard. 

Caveat emptor: Make sure to read labels on all packaged foods very carefully.

Breads and rolls are another hidden source. Most contain a decent amount of sodium. I have seen a single slice of whole wheat bread include up to 200 mg. of sodium.

If you are working to decrease your sodium intake, become an avid label reader. Sodium hides in all kinds of foods that don’t necessarily taste salty, such as breads, soups, cheeses and salad dressings. I also recommend getting all sauces on the side, so you can control how much — if any — you choose to use.

What about sea salt?

Are fancy sea salts better than table salt? High amounts of salt are harmful, and the type is not important. The only difference between them is slight taste and texture variation. I recommend not buying either. In addition to the health issues, salt tends to dampen your taste buds, masking the flavors of food.

As you reduce your sodium intake, you might be surprised at how quickly your taste buds adjust. In just a few weeks, foods you previously thought didn’t taste salty will seem overwhelmingly so, and you will notice new flavors in unsalted foods.

If you have a salt shaker and don’t know what to do with all the excess salt, don’t despair. There are several uses for salt that are actually beneficial. According to the Mayo Clinic, gargling with ¼ to ½ teaspoon of salt in eight ounces of warm water significantly reduces symptoms of a sore throat from infectious disease, such as mononucleosis, strep throat and the common cold. Having had mono, I can attest that this works.

Remember, if you want to season your food at a meal, you are much better off asking for the pepper than the salt.

References:

(1) cdc.gov. (2) Clin J Am Soc Nephrol. 2010;5:836-843. (3) heart.org.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

Adrian Popp

Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health and associate professor of medicine at Hofstra School of Medicine, spoke with TBR Newspapers to discuss the current state of vaccinations in Suffolk County, the return to school in the fall, workplace issues, and tic-borne challenges for residents. Please find below an abridged version of the interview below. If you’d like to listen to the entire interview, view the video above.

COVID-19

TBR: How close are we to the 70% threshold for herd immunity to COVID-19?

Popp: We were hoping vaccination would start rolling out pretty fast and actually that happened. Over the last several months, more and more people got vaccinated. Right now, it’s open more or less like just show up and you can get a vaccine. You don’t even need an appointment anymore. The number of people vaccinated in Suffolk County is, percentage-wise, around 55% of eligible persons.

TBR: What about the rates at which people are seeking the vaccines? Has that slowed?

Popp: The number getting vaccinated has somewhat plateaued. The most eager people who wanted to get vaccinated did. Now, we’re seeing people who are actually still willing to get vaccinated and doing it and also some of people who are on the fence getting more information and speaking with other people who actually received the vaccine. More and more people are getting confident that the vaccine is safe, efficacious, and I hope this trend will continue.

TBR: What about schools in the fall? Will students return without masks and at full capacity?

Popp: At this point, the rate of coronavirus in Suffolk County is very low and has been decreasing since March steadily and is at almost a minimum even compared to last year. The question is, what will happen down the road? What will happen in the fall? We know that coronavirus has a propensity to be more active in cold environment. It’s hard to predict, because of these variants coming from different parts of the world. We should be hopeful that the fall will look good as long as more and more people get vaccinated. Hopefully, by September, we’ll reach about 70%, then going back to school will be easier.

TBR: As offices reopen and people return to work, how should companies handle rules, especially if some people aren’t vaccinated?

Popp: Offices vary in size, the number of people, how many are sitting in one room, close to one another. One has to make a decision on a case-by-case basis. Ideally, everyone working in one office should be vaccinated. It’s a difficult situation, mandating people to get vaccinated. It’s a fine line between your personal liberties and public policies.

TBR: When might a booster be necessary?

Popp: The need for the booster is being debated [as] the efficacy of the vaccine, the immunogenicity of the vaccine is probably higher than what I expected to see. From the early stages of December, we do find that they hold their antibodies quite well. The expectation is that this could last maybe two years or so. We don’t know that yet. One has to give it time and really find out.

TBR: What about weddings?

Popp: The wedding situation is quite a big situation. A lot of people have postponed the wedding in the hopes of having a real thing later on. The approach people have taken varied from A to Z. There is no cookie-cutter way to say this is the right thing to do and that’s the wrong thing to do. A friend of mine getting married is asking every person to be vaccinated. If you’re not vaccinated, you’re not allowed in the wedding. This is the decision of the groom and bride. Other venues are obviously more open, and they invite everybody and so forth. In the end, you have to be comfortable with the decision you make and you’re going there to have fun, you can’t have fun and celebrate if you’re truly nervous.

Tick-borne diseases

TBR: What about tick-borne diseases? Is there messaging people should keep in mind?

Popp: In the last three years, I have seen more tick-related diseases than before. We’re not talking only Lyme disease, could be also babesiosis, ehrlichiosis, and Rocky Mountain Spotted fever. Rocky Mountain Spotted fever used to be very unusual on Long Island. Now, we do see cases. I have already seen cases this year. When you go somewhere walking or hiking in some woods or meadows that may have ticks that may be around there, what you do at the end of the day when you come home, you get your shower, do a body check. Have someone else look at areas you can’t see well on your back, back of your legs.

Stock photo

By Matthew Kearns, DVM

I can’t tell you how many pet owners arrive at my clinic saying, “both myself and Fluffy suffer from the COVID 15”, with the “COVID 15” referring to weight gain during the pandemic. Remember, it is important to realize that weight gain in pets is as dangerous as weight gain in humans. Here are a few of the diseases associated with obesity in pets: 

Growth abnormalities and arthritis: There is a documented link between overfeeding and growth abnormalities. One study was able to prove that by feeding a group of growing dogs less calories than the control group, the risk of hip dysplasia was reduced by 25%. We are not talking about starving dogs, just not overfeeding. Additionally, the added weight is a burden on already arthritic joints, especially in older pets.

Respiratory Disorders: Severe obesity will lead to respiratory problems in any pedigree or mixed breed. However, brachycephalic breeds (breeds with flat faces) such as Pugs, Boston Terriers, Shih Tzus, Lhasa Apso, English Bulldogs, Pekingese, etc) and cat breeds such as Persians are at a higher risk.  

Pancreatitis and diabetes: Pancreatitis is a serious disease, sometimes life threatening, in dogs and cats just as it is in people and risk increases with obesity. Pancreatitis can damage the insulin- producing cells in the pancreas but experts conclude that insulin resistance is more common in obese pets similar to insulin resistance in obese humans.

Anesthetic risk: Recent studies have shown a 20 to 40% increase in mortality associated with general anesthesia in obese patients. The added fat increases blood pressure and makes it more difficult for the anesthetized patient to breathe on their own under general anesthesia.

Heart failure: Although obesity does not have a direct effect on the development of heart disease or failure, obesity in a pet with a pre-existing heart condition will hasten the progression to heart failure. 

How do we reverse the trend of obesity in our pets? Same as ourselves: eat less, exercise more. However, before radically reducing your pet’s food intake or taking them on a 10-mile run, it would be better to make an appointment with your veterinarian to examine your pet. This way both you and your veterinarian can identify obesity and make sure there is no underlying disease that should be addressed first. Older pets that suffer from obesity could also have an underactive thyroid gland, arthritis, etc. 

If your veterinarian feels that your pet is healthy, then you can identify obesity and set realistic goals. Eliminating all the extras (table scraps, extra cookies, treats, rawhides, pig’s ears, etc) are a good start.  These are all empty calories. If that is not working then you may need to cut back on the amount of food, or consider a weight-reducing diet. These diets are available both commercially and through your veterinarian.  

Controlled exercise (short walks at first) not only burns calories but enhances the bond between our pets and ourselves. Cats, especially indoor only cats, can’t go on walks but there are toys that you can play with them. Make sure these toys are not made of material that could be chewed off or fray and potentially form an obstruction.    

So, remember to have your pets eat right and exercise. That is the best way to keep them happy and healthy.  

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. 

Photo from PJCC

The Greater Port Jefferson Chamber of Commerce hosted a ribbon cutting for iV Bars of Port Jefferson on April 28. Town of Brookhaven Councilmember Jonathan Kornreich and the chamber presented owner Aaron Roberts with Certificates of Congratulations and wished him best of luck in his new venture.

Located at 5400 Nesconset Hwy, Port Jefferson Station, the franchise offers numerous types of intravenous fluids, vitamins and medicines to provide patients with vitamins and supplements to help treat the symptoms of hangovers, boost energy levels, hydrate the body, relieve chronic fatigue, and more.

Pictured from left, Lisa Castellano, iV administrator; chamber members Stuart Vincent and Matthew Fernandez; Town of Brookhaven Councilmember Jonathan Kornreich; Caleb Laues, iV manager; Aaron Roberts, iV owner; and chamber member Raquel Fernandez.

Hours of operation are noon to 6 p.m. Monday to Friday, 10 a.m. to 4 p.m. Saturday and Sunday. For more information, call 631-828-2692 or visit www.ivbars.com.

Stony Brook University Hospital Diabetes Program team members celebrate 2019 Pinnacle Award for Quality and Patient Safety. Photo from Stony Brook Medicine

Stony Brook University Hospital has received a two-year Advanced Inpatient Diabetes certification from The Joint Commission after a comprehensive review of its diabetes program.

Stony Brook becomes the seventh hospital in New York State and the first hospital in Suffolk County to achieve advanced certification. Only 66 hospitals nationally have achieved this distinction after a rigorous three-day review by Joint Commission surveyors.

Certification demonstrates continuous compliance with The Joint Commission’s performance standards. As the Joint Commission’s “Gold Seal of Approval®” for Advanced Inpatient Diabetes, it reflects a healthcare organization’s commitment to providing safe and quality patient care.

“This achievement demonstrates the outstanding quality of care that our faculty and staff provide for patients with diabetes,” said Carol Gomes, MS, FACHE, CPHQ, Chief Executive Officer of Stony Brook University Hospital. “Our entire diabetes team is uniquely equipped and qualified to help our patients address the daily challenges they face in managing their disease.”

“I am overjoyed that the Stony Brook Medicine Diabetes Program has been recognized for excellence by The Joint Commission and am honored to be among only a handful of hospitals nationwide with this certification,” said Joshua D. Miller, MD, MPH, Medical Director of Diabetes Care for Stony Brook Medicine, Assistant Dean and Associate Professor of Medicine for Endocrinology and Metabolism at the Renaissance School of Medicine at Stony Brook University. “This achievement acknowledges the dedication of our team to patients living with diabetes and showcases our shared commitment to providing the highest quality care to the community here on Long Island.”

Joshua D. Miller, MD, MPH. Photo from Stony Brook Medicine

Dr. Miller in particular acknowledged the contributions of Danielle Kelly, MS, ANP-C, RN, CDCES, lead inpatient diabetes nurse practitioner; Paul Murphy, BS, CSSBB, Assistant Supervisor of Quality; Sue Robbins, MS, RN, CPPS; and Nancy Cohen, MA, RN, in the Department of Regulatory Affairs; inpatient diabetes educators Patty Skala, RN, MA, MSN, CDECS, BC-ADM, and Mary Rieff, RN, CDECS; and members of the Diabetes Advisory Committee. He also cited Eileen Gilmartin, Michael Kaufman, Anthony D’Aulerio and team from Stony Brook Medicine’s Information Technology Department for their efforts to transform Stony Brook Medicine into the region’s leader in diabetes care.

Stony Brook’s diabetes team is among the best in the nation,” Dr. Miller said. “As a person living with type 1 diabetes for over 21 years, I have tremendous pride in the care Stony Brook Medicine provides to patients living with the disease and consider myself privileged to work alongside individuals so dedicated to improving the lives of those we serve.”

Since Dr. Miller joined Stony Brook in 2013, the hospital has made a significant commitment to diabetes treatment and education, building the first comprehensive diabetescenter in the region. In 2019, the program received the Healthcare Association of New York State (HANYS) 2019 Pinnacle Award for Quality and Patient Safety.

To achieve Joint Commission certification, a team of reviewers evaluated Stony Brook’s compliance with related standards, including program management and delivering and facilitating clinical care. Certification recognizes healthcare organizations that provide clinical programs across the full range of care for patients with diabetes. The review process evaluates how organizations use clinical outcomes and performance measures to identify opportunities to improve care, as well as to educate and prepare patients and their caregivers for discharge.

“Advanced Inpatient Diabetes Certification recognizes healthcare organizations committed to fostering continuous quality improvement in patient safety and quality of care,” says Mark Pelletier, RN, MS, Chief Operating Officer, Accreditation and Certification Operations, and Chief Nursing Executive, The Joint Commission. “We commend StonyBrook for using certification to reduce variation in its clinical processes and to strengthen its program structure and management framework for diabetes patients.”

“Our teamwork has powered a transformational journey for patients with diabetes at Stony Brook,” Gomes said. “By focusing on specific opportunities for improvement, we are enhancing quality of care and clinical outcomes.”

For more information about the Stony Brook Diabetes Center, visit https://www.stonybrookmedicine.edu/patientcare/diabetes.

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Animal overpopulation is a concern that affects the well-being of pets. The ASPCA says letting animals reproduce unchecked can lead to pet homelessness that results in millions of healthy cats and dogs being euthanized in the United States each year.

In addition to helping to control homelessness, spaying and neutering companion animals may have medical and behavioral benefits. As valuable as spaying and neutering can be, the procedures are not without potential complications. Responsible pet owners must weight the pros and cons of spaying and neutering with a qualified animal professional.

The ASPCA says it is generally considered safe for kittens as young as eight weeks old to be spayed or neutered. Doing so can help avoid the start of urine spraying and eliminate the chances for cats to go into heat and become pregnant. 

Did you know that female kittens can enter their first heat as young as four months? Or that most do so by the time they reach six months old? A domestic cat can live around 12 to 15 years. A cat that has an average of four kittens per litter, three times per year for 15 years can produce a total of 180 kittens over a lifetime. Spaying a cat early on can prevent overpopulation and offer other benefits. 

Spaying and neutering has been shown to reduce risk for testicular cancer and some prostate problems. Sterilization also can protect against uterine infections and breast tumors in many female pets. These procedures may also help prevent animals from roaming to find mates or reduce aggression problems.

Many veterinarians now recommend female and male dogs be spayed or neutered between the ages of six to nine months. Some vets say puppies can be neutered as young as eight weeks old as long as they are healthy. In fact, it has become the norm for rescue puppies to be neutered prior to being placed with adoptive families. Those who would like to follow the American Animal Hospital Association Canine Life Stage Guidelines should have small-breed dogs (under 45 pounds projected adult body weight) neutered or spayed at six months of age or prior to the first heat. Large-breed dogs should be sterilized after growth stops, which is usually between nine and 15 months of age. 

Some research has pointed out that early neutering may lead to certain medical conditions that may be preventable by waiting until a pup or kitten is a little older before having him or her go under the knife. Researchers at the University of California, Davis, conducted a study on golden retrievers in 2013 that found early neutering and spaying appeared to increase the risk of diseases, such as cranial cruciate ligament rupture, hemangiosarcoma, mast cell tumors, lymphosarcoma, and hip dysplasia.

Working with a veterinarian can help pet owners make informed decisions about the appropriate age for a pet’s sterilization.

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METRO photo

Nutrition is a popular topic of conversation, particularly among those embarking on a weight loss or maintenance plan. Individuals carefully study food macros and pore over various diets to get the most out of the foods they eat. When the end goal is simply looking good, it may be easy to forget about the other benefits of nutritious diets, including their link to overall health. 

A close relationship exists between nutritional status and health. Experts at Tufts Health Plan recognize that good nutrition can help reduce the risk of developing many diseases, including heart disease, stroke, diabetes, and some cancers. The notion of “you are what you eat” still rings true.

The World Health Organization indicates better nutrition means stronger immune systems, fewer illnesses and better overall health. However, according to the National Resource Center on Nutrition, Physical Activity, and Aging, one in four older Americans suffers from poor nutrition. And this situation is not exclusive to the elderly. A report examining the global burden of chronic disease published in The Lancet found poor diet contributed to 11 million deaths worldwide — roughly 22 percent of deaths among adults — and poor quality of life. 

Low intake of fruits and whole grains and high intake of sodium are the leading risk factors for illness in many countries. Common nutrition problems can arise when one favors convenience and routine over balanced meals that truly fuel the body. 

Improving nutrition

Guidelines regarding how many servings of each food group a person should have each day may vary slightly by country, but they share many similarities. The U.S. Department of Agriculture once followed a “food pyramid” guide, but has since switched to the MyPlate resource, which emphasizes how much of each food group should cover a standard 9-inch dinner plate. 

Food groups include fruits, vegetables, grains, proteins, and dairy. The USDA dietary guidelines were updated for its 2020-2025 guide. Recommendations vary based on age and activity levels, but a person eating 2,000 calories a day should eat 2 cups of whole fruits; 2 1⁄2 cups of colorful vegetables; 6 ounces of grains, with half of them being whole grains; 5 1⁄2 ounces of protein, with a focus on lean proteins; and 3 cups of low-fat dairy. 

People should limit their intake of sodium, added sugars and saturated fats. As a person ages he or she generally needs fewer calories because of less activity. Children may need more calories because they are still growing and tend to be very active.

Those who are interested in preventing illness and significantly reducing premature mortality from leading diseases should carefully evaluate the foods they eat, choosing well-balanced, low-fat, nutritionally dense options that keep saturated fat and sodium intake to a minimum.

Switching to a Mediterranean diet will help treat elevated blood pressure. Metro Photo
Treating early with lifestyle changes can improve your long-term outcomes

By David Dunaief, M.D.

Dr. David Dunaief

We have focused a large amount of effort on the treatment and prevention of hypertension (high blood pressure) in the U.S, where it’s pervasive: it affects approximately 45 percent of adults over 18 in the U.S. (1).

Since 2017, this insidious disorder’s severity has been categorized into three stages, each with its recommended treatment regimen. One of the most interesting shifts with this recategorization was the recategorization of what we used to call “prehypertension” into what we now call “elevated” blood pressure and “hypertension stage 1.” 

Elevated blood pressure is defined as systolic blood pressure (the top number) of 120-129 mmHg and diastolic blood pressure (the bottom number) of less than 80 mmHg, while Stage 1 includes systolic blood pressure of 130-139 mmHg or diastolic blood pressure of less than 80-89 mmHg (2).

The consequences of both are significant, even though there are often no symptoms. For example, they increase the risk of cardiovascular disease and heart attack dramatically. In an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (3). This is why it’s crucial to treat it in these early stages, even before it reaches the more severe levels of hypertension.

Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (4).

This may or may not impact mortality, but it certainly does impact quality of life, which can be dramatically reduced with heart disease, heart attack and hypertension.

Elevated blood pressure treatment

In my view, it would be foolish not to treat elevated blood pressure. Updated recommendations for treatment, according to the Joint National Commission (JNC) 8, the association responsible for guidelines on the treatment of hypertension, are lifestyle modifications (5).

Lifestyle changes include a Mediterranean-type diet or the DASH (Dietary Approaches to Stop Hypertension) diet. It’s important to focus on fruits, vegetables, reduction in sodium to a maximum of 1500 mg (2/3 of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis) (6). Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (7). 

Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.

The danger in treating elevated blood pressure comes only when medication is used, due to side effects. For example, the Trial of Preventing Hypertension (TROPHY), suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (8)(9). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Still, the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, the makers of the drug. 

In an editorial, Jay I. Meltze, M.D., a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (10). 

Elevated blood pressure is an asymptomatic disorder that has been shown to respond well to lifestyle changes — why create symptoms with medication? Therefore, I don’t recommend treating elevated blood pressure patients with medication. Thankfully, the JNC8 agrees.

However, it should be treated — and treated with lifestyle modifications. The side effects from this approach are only better overall health.

References:

(1) cdc.gov. (2) heart.org. (3) Stroke 2005; 36: 1859–1863. (4) Hypertension 2006;47:410-414. (5) Am Fam Physician. 2014 Oct 1;90(7):503-504. (6) J Am Coll Cardiol. 2018 May, 71 (19) 2176–2198. (7) Archives of Internal Medicine 2001;161:589-593. (8) N Engl J Med. 2006;354:1685-1697. (9) J Am Soc Hypertens. Jan-Feb 2008;2(1):39-43. (10) Am J Hypertens. 2006;19:1098-1100.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.