Health

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State Dashboard Shows Comsewogue HS With Two Positive Tests, But District Says Not to Worry

PJSD said the Edna Louise Spear Elementary School has been temporarily closed and all students moved online after on student was tested positive. Photo from Google maps

*Update* The night of Sept. 16, Port Jeff Superintendent Jessica Schmettan released a follow up letter about the student who was confirmed positive. She said the elementary school was “thoroughly” cleaned after the district received the news. The New York State Department of Health interviewed the family and district, and has since advised the district that classrooms are cleared to reopen, saying the student was not infectious while on school grounds.

Students who had close contact with the student have been contacted, and contact tracing is underway. 

“The situation today is a reminder about the importance of social distancing, the use of masks, and proper hygiene,” Schmettan said in the letter. “The community needs to remain vigilant in order to avoid closures in the future.”

Original story:

Parents in the Port Jefferson School District received a message Wednesday morning saying a student was tested positive for COVID-19 and that the Edna Louise Spear Elementary School would be closed for the meantime.

“This morning the Port Jefferson School District was notified that a student at the elementary school tested positive for COVID-19,” Superintendent Jessica Schmettan wrote in a message to district parents shared with TBR News Media. “Following our procedures and protocols and guidance from the [New York State] Department of Health, the elementary school is closed today for distance learning.”

The district added they will be conducting contact tracing and disinfecting the elementary school. Parents will be updated as the situation develops.

As of Sept. 15, Comsewogue High School has been listed by the New York State dashboard as having two positive cases in the Comsewogue High School. 

Comsewogue Superintendent Jennifer Quinn described the situation as two siblings who had tested positive for COVID in another country, though she said the name of the country was not released for fear of the students being outed to their peers. They were cleared by the New York State Department of Health to come back to school, though while in school another test taken in the states came back positive.

Quinn said the Department of Health was aware of the situation, and health officials told the district the two students were likely positive because of the viral load still in the body, though they were not infectious. Both students have volunteered to stay home in the mean time.

 

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Dr. Nick Fitterman said they wouldn't necessarily endorse a COVID-19 vaccine immediately without first getting all the information. Photo from Huntington Hospital

Huntington Hospital won’t automatically endorse a COVID-19 vaccine, even if it receives approval from the federal government.

The hospital plans to evaluate the data from the vaccine’s phase 3 trials to ensure that the vaccine is safe and effective.

“We’ll see if things are starting to uptick long before it’s more obvious to the public.”

— Nick Fitterman

“It’s part of our oath, ‘Do no harm,’” said Dr. Nick Fitterman, executive director at Huntington Hospital. “If we don’t think the safety is there, I will scream it from the rooftops. It has to be a combination of safety and efficacy.”

Fitterman said at least seven vaccines are in phase 3 trials, with over 250 experimental vaccines in the works in total.

Fitterman was pleased to see that nine vaccine makers signed a pledge to uphold medical standards and not succumb to governmental pressure for rapid approval.

At this point, Fitterman would only take a vaccine after publication of the evidence from the clinical trials.

Once he is convinced that a vaccine is safe and effective, he said he would feel an urgency to take it as a health care worker.

“If you take care of people who are high risk, you’re going to need to take it,” Fitterman said.

The hospital would likely have the same policy for a COVID vaccine that it does for a flu vaccination: if workers choose not to get a vaccine, they will be required to wear a mask.

For the flu, hospital workers with purple badges on their name tags have had a flu shot.

At this point, it is unclear how long a COVID-19 vaccination might provide potential protection. Like tetanus or mumps, no vaccine wards off infection indefinitely, which means people will likely require boosters.

“I’m more worried about people getting complacent because they have been vaccinated,” Fitterman said.

Years down the road, the virus could return.

Asked whether those people who have antibodies for the virus would need a vaccine, Fitterman highlighted a recent case in Hong Kong. Published in the journal Lancet, doctors shared the story of one patient who contracted COVID-19 and then tested positive again.

The virus currently has several strains, so a vaccine might provide greater protection than natural antibodies against a single type of COVID-19.

The man who contracted the virus twice had antibodies that “didn’t protect him from another infection,” but he did not have any symptoms during the second positive test.

An infection in which a person develops antibodies could “protect you from the disease, but it doesn’t [necessarily] protect you from getting infected again,” Fitterman said.

A health care worker in particular would benefit from a vaccine that prevented infection from numerous strains to prevent that worker from spreading a disease to which he or she would likely be exposed during the course of any increase in cases.

With the possibility of a second wave of COVID-19 overlapping with the flu, Fittterman strongly urged residents to get a flu shot, which would help prevent the virus from overwhelming a health care system that might again face an influx of hospitalizations from the coronavirus.

“It’s part of our oath, ‘Do no harm.'”

— Nick Fitterman

Huntington Hospital recently started making the flu vaccine available to frontline workers and urged people to get flu shots this month. He reminded people that the vaccine only works two weeks after an injection after the immune system has had a chance to recognize the virus.

Fitterman is encouraged by the range of current vaccines in trials for COVID-19, including those that use messenger RNA.

Fitterman said Huntington Hospital is prepared for a potential second wave of COVID-19. He monitors the data every day.

“We’ll see if things are starting to uptick long before it’s more obvious to the public,” Fitterman said.

As a part of Northwell Health, Huntington Hospital has stockpiled personal protective equipment. Northwell also gave Huntington $4 million to be prepared, which includes having more ventilators, dialysis machines, and negative pressure rooms ready. Huntington can handle 10% more than the number of patients who needed medical help in the spring.

“We are beyond ready [but we] hope we don’t have to exercise any of that,” Fitterman said.

Fitterman urged those people who need other hospital services, such as cancer screenings, to come to the hospital.

When the spring surge for COVID-19 occurred, the hospital told people who were dealing with nonemergency situations not to come to the hospital because they needed the beds, and not because they felt patients would be exposed to the virus.

Indeed, after the viral numbers declined, the hospital tested its staff for the presence of the antibodies. They found that 9% of the staff had antibodies to the virus, which is below the 14% for the surrounding community.

“What we did works,” Fitterman said, which included PPE and procedures to protect the staff. The hospital is a “safe place to be,” he said.

In monitoring the daily changes in infection in Suffolk County, Fitterman said positive tests have been rising and falling during the last few weeks. So far, he has not seen an increase in hospitalizations.

“Our numbers continue to go down,” Fitterman said, as the hospital had three people with COVID-19 as of Sept. 8.

Stock photo

The Visiting Nurse Service will administer annual flu shots by appointment in the Parish Outreach office of St. Anthony of Padua Church, 1025 Fifth Ave., East Northport on Wednesday, Sept. 16 from 10 a.m. to noon. Traditional Medicare (Part B) and Medicaid are accepted (not Medicare HMO or managed care Medicaid); others can pay $35 by cash or check. Private insurance is not accepted, but a consent form can be submitted to most insurers. Please bring your insurance card. Recipients will be required to wear masks and practice social distancing. Call 631-261-1695 to make an appointment.

Photo from Northwell Health

Empire Subaru of Huntington has once again selected Huntington Hospital as the recipient of Subaru’s Share the Love program. The dealership donated more than $50,000 to Huntington Hospital’s award-winning neurosurgery department. This is the second year the dealership has donated to the hospital. Pictured at the check presentation on Aug. 7, from left, are Dr. Robert Kerr; Empire Subaru Sales Manager Vinny Rizzo; Vice Chair of Huntington Hospital’s board Thomas Lederer; Empire Subaru General Manager Gary Farley; and Huntington Hospital’s Executive Director Dr. Nick Fitterman.

White fleshy fruits like apples, pears and bananas have shown to decrease ischemic stroke risk. Stock photo
Medications and lifestyle play important roles

By David Dunaief

Dr. David Dunaief

Stroke remains one of the top five causes of mortality and morbidity in the United States (1). While some risk factors are out of our control, like family history and age, many of our risks can be altered by making lifestyle changes and managing contributing diseases, like hypertension and diabetes.

We have a wealth of studies that inform us on the roles of medications and lifestyle in managing risk. Of particular importance are medication guidelines that balance the risks and benefits of different stroke prevention regimens.

Medications can be protective

Two medications have shown positive impacts on reducing stroke risk: statins and valsartan. Statins are used to lower cholesterol and inflammation, and valsartan is used to treat high blood pressure. Statins do have side effects, such as increased risks of diabetes, cognitive impairment and myopathy (muscle pain). However, used in the right setting, statins are very effective. Some studies have shown reduced mortality from stroke in patients who were on statins at the time of the event (2). Patients who were on a statin to treat high cholesterol had an almost six-fold reduction in mortality, compared to those with high cholesterol who were not on therapy.

There was also significant mortality reduction in those on a statin without high cholesterol, but with diabetes or heart disease. The authors surmise that this result might be from an anti-inflammatory effect of the statins. Of course, if you have side effects, you should contact your physician immediately.

Valsartan is an angiotensin II receptor blocker that works on the kidney to reduce blood pressure. However, in the post-hoc analysis (looking back at a completed trial) of the Kyoto Heart Study data, valsartan used as an add-on to other blood pressure medications showed a significant reduction, 41 percent, in the risk of stroke and other cardiovascular events for patients who have coronary artery disease (3).

It is important to recognize that high blood pressure and high cholesterol are two of the most significant risk factors for stroke. Fortunately, statins can reduce cholesterol, and valsartan may be a valuable add-on to prevent stroke in those patients with coronary artery disease.

Use caution with medication combinations

There are two anti-platelet medications that are sometimes given together in the hopes of reducing stroke recurrence — aspirin and Plavix (clopidogrel). The assumption is that these medications together will work better than either alone. However, in a randomized controlled trial, the gold standard of studies, this combination not only didn’t demonstrate efficacy improvement but significantly increased the risk of major bleed and death (4, 5).

Major bleeding risk was 2.1 percent with the combination versus 1.1 percent with aspirin alone, an almost twofold increase. In addition, there was a 50 percent increased risk of all-cause death with the combination, compared to aspirin alone. Patients were given 325 mg of aspirin and either a placebo or 75 mg of Plavix. The study was halted due to these deleterious effects. The American Heart Association recommends monotherapy for the prevention of recurrent stroke. If you are on this combination of drugs, please consult your physician.

Managing aspirin dosing

Greater hemorrhagic (bleed) risk is also a concern with daily aspirin regimens greater than 81 mg, which is the equivalent of a single baby aspirin. Aspirin’s effects are cumulative; therefore, a lower dose is better over the long term. Even 100 mg taken every other day was shown to be effective in trials. There are about 50 million patients who take aspirin chronically in the United States. If these patients all took 325 mg of aspirin per day, an adult dose, it would result in 900,000 major bleeding events per year (6). Do not take an aspirin regimen — even a low-dose aspirin regimen — for stroke prevention without consulting your physician.

Protection from fruits and vegetables

A prospective study of 20,000 participants showed that consuming white fleshy fruits — apples, pears, bananas, etc. — and vegetables — cauliflower, mushrooms, etc. — decreased ischemic stroke risk by 52 percent (7). Additionally, the Nurses’ Health Study showed that foods with flavanones, found mainly in citrus fruits, decreased the risk of ischemic stroke by 19 percent (8). The authors suggest that the reasons for the reduction may have to do with the ability of flavanones to reduce inflammation and/or improve blood vessel function. I mention both of these trials together because of the importance of fruits in prevention of ischemic (clot-based) stroke.

Fiber’s role

Fiber also plays a key role in reducing the risk of a hemorrhagic stroke. In a study involving over 78,000 women, those who consumed the most fiber had a total stroke risk reduction of 34 percent and a 49 percent risk reduction in hemorrhagic stroke. The type of fiber used in this study was cereal fiber, or fiber from whole grains.

Refined grains, however, increased the risk of hemorrhagic stroke twofold (9). When eating grains, it is important to have whole grains. Read labels carefully, since some products that claim to have whole grains contain unbleached or bleached wheat flour, which is refined.

Fortunately, there are many options to help reduce the risk or the recurrence of a stroke. Ideally, the best option would involve lifestyle modifications. Some patients may need to take statins, even with lifestyle modifications. However, statins’ side effect profile is dose-related. Therefore, if you need to take a statin, lifestyle changes may help lower your dose and avoid harsh side effects. Once you have had a stroke, it is likely that you will remain on at least one medication — typically low-dose aspirin — since the risk of a second stroke is high.

References:

(1) cdc.gov. (2) AAN conference: April 2012. (3) Am J Cardiol 2012; 109(9):1308-1314. (4) ISC 2012; Abstract LB 9-4504; (5) www.clinicaltrials.gov NCT00059306. (6) JAMA 2007;297:2018-2024. (7) Stroke. 2011; 42: 3190-3195. (8) J. Nutr. 2011;141(8):1552-1558. (9) Am J Epidemiol. 2005 Jan 15;161(2):161-169.

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.

Dr. Elena Maresca

Dr. Elena L. Maresca has been selected for inclusion in the forthcoming Trademark Top Doctors of America 2020 Honors Edition for demonstrating dedication, leadership and professional excellence. During the vetting process it was noted along with her exceptional reputation that she has also maintained a positive peer rating.“Representing the state of New York as one of the best is truly an honor,” said Dr. Maresca. “I am dedicated to providing my patients with the very best care and I am humbled by this selection.”

Dr. Maresca has been practicing audiology for 25 years. Prior to establishing a private practice in 2004 she was the Director of Audiology for Beverly Hospital in Massachusetts. In 2013, Dr. Maresca opened Hearing & Tinnitus Management in Stony Brook where she specializes in hearing healthcare, hearing aids, tinnitus and hyperacusis management.

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Stock photo

The Centers for Disease Control and Prevention has recommended that people wear cloth face coverings in public settings where social distancing measures are difficult to maintain. Even as the world begins to unpause, wearing masks seems likely to continue.

Masks are designed not to prevent the wearer from getting ill, but to protect other people from getting the virus. Masks protect others from your germs when you cough or sneeze. They’re also an effective way to help people to avoid touching their faces.

Masks are exposed to the elements and germs each time they are worn, meaning they will require cleaning. Even though Harvard Health suggests COVID-19 may live more readily on hard surfaces than fabric, the CDC urges people to give cloth face masks the same level of care as regular laundry. Masks should be washed and dried often. The CDC offers these tips on how to clean most cloth and fabric masks.

• Fabric face masks should be washed depending on the frequency of use. More frequent use necessitates more frequent washing.

• A washing machine should be adequate for properly washing a face covering. Choose a warm setting for water temperature. Place masks in the dryer afterward.

• More delicate, hand-sewn masks may be washed by hand, suggests The Good Housekeeping Institute Cleaning Lab. Lather masks with soap and scrub them for at least 20 seconds with warm or hot water before placing in the dryer.

• For additional sanitation, iron masks on the cotton or linen setting for a few minutes to kill remaining germs.

• If masks are fortified with a filter, such as a coffee or HVAC filter, keep in mind that these filters are designed for single use. Paper filters should be replaced after each use. HVAC filters are washable, but manufacturers warn that their effectiveness decreases with each wash. Medium weight nonwoven interface used as filter material is typically washable.

Various health agencies do not condone using steam or microwaves to clean cloth face masks, as these sanitizing techniques are not as effective as regular laundering. Also, never microwave non-fabric dust or N95 respirator masks if you are using them. They can catch fire or be rendered useless.

Many seniors are embracing digital technology in this new world of social distancing.

By Linda Kolakowski

Linda Kolakowski

In the wake of the pandemic, many people who had formerly expected to move to a life plan retirement community, assisted living or other type of senior residence now have questions about whether a senior living community is still the right choice for them.

While it’s natural to have a level of uncertainty, even in the best of times, getting educated about the various living options available, what precautions are permanently in place, and what it was like to live in these communities during shelter in place times will help in the decision making process.

People are aging for a much longer period than years ago. In 2030, the expectation is that there will be twice as many 85-year-olds and three times as many people over 100 years of age than there are today, and they’re more active than previous generations. Trends indicate that more people want to be in communities with their friends, who become more like family members, as relatives may live far away. Retirement communities help people hold on to the community relationships we need in order to thrive at every age. Will these trends continue as we cope with the likes of COVID-19?

The Need for Community

One common experience across generations during COVID has been the need to have a community of sorts. Whether they found it through regular Zoom or Facetime calls with family, friends or work colleagues, the majority moved quickly to fill the void from social distancing measures and embraced digital technology. As the weather warmed, outdoor socially distant gatherings — fitness and other classes, bring your own sandwich picnics and other no touch activities became the norm in senior living communities.

While this certainly happened at all manners of senior living communities, it was not necessarily the case for seniors living on their own. Some seniors were able to enjoy the company and comforts of living with family members or had more mobile neighbors and friends to shop for them and otherwise help out. Others who were already isolated had neither the equipment nor technical know-how to connect with family and friends digitally.

Fear of infection closed down many senior centers, limited ride services and at home visits, and made trips to the supermarket and drug store overwhelming, if not impossible. Home maintenance also became a significant issue.

Residents of senior living communities like Jefferson’s Ferry had to curtail their activities, just like the rest of the population, but because of the array of services that come with living in a retirement community, they were able to get takeout meals, groceries, household items, laundry service, and even cocktails to go on the premises. 

Staying Healthy

While there were health concerns, residents of many senior living communities also had ready access to the most up to date health information, as well as greater access to health care. Healthy residents overall remained healthy, thanks to senior living communities’ strict adherence to protocols and directives from local, state, and federal agencies that promote resident and employee safety and reduce the chance of exposure or transmission. 

Feeling Good by Giving Back

Senior community residents across Long Island also came together in the spirit of giving back to make the best of a difficult situation.  At Jefferson’s Ferry, the residents spearheaded fundraisers and made donations to provide free meals to the hardworking staff and otherwise demonstrated their gratitude with thank you notes and small gifts. Some residents made masks for their neighbors; others reached out to fellow residents with phone calls, or left treats and notes outside the doors of their neighbors to lift their spirits.

One Jefferson’s Ferry resident related her experience. “I can’t imagine having lived anywhere else during the ‘life during social distancing’ period. While most of my day is spent in my apartment, I converse regularly with friends by phone. I can have meals delivered, but often take the outdoor route to the Community Center. I’ll meet some masked neighbors along the way, pick up my mail and my takeout dinner in the café. If there is any kind of emergency or special need, I can just ‘push the button’ and a staff member will help me out.”

Another said, “It’s interesting and inspiring how Jefferson’s Ferry has continued to be a caring community, even in the midst of social distancing. We can still laugh at each other’s masks and hairdos, encourage one another when we get down, and remind each other that all the fun things we do together will resume someday.”

It’s Your Choice

At every stage of life, we all want to be able to exercise control and make choices.  Equally important is making sure that access to services and health care remains viable and affordable as needs change over time. Talk to your friends, visit the senior communities in your area and ask a lot of questions. There are many terrific options out there. You will find the one that’s right for you.  

Author Linda Kolakowski is the Vice President of Resident Life at Jefferson’s Ferry Life Plan Community in South Setauket.

Studies have shown that combined strength and endurance training may lower RHR in women. METRO photo
Certain types of exercise may lower RHR

By David Dunaief, M.D.

Dr. David Dunaief

How many of us regularly check our resting heart rate, or pulse, and what can we learn from it?

Resting heart rate is pretty important. In fact, it may play a role in longevity, heart disease — including heart failure, arrhythmias, heart attacks and sudden cardiac death — and even chronic kidney disease.

A “normal” resting heart rate is between 60 to 100 beats per minute (bpm). If your resting heart rate (RHR) is above 100 bpm, this is referred to as tachycardia, or a racing heartbeat, and it has potentially serious consequences. However, even normal RHRs can be stratified to identify risks for diseases. What I mean is that, even in the normal range, as your RHR increases, so do your potential risks. Actually, resting heart rate below approximately 70 bpm may be ideal.

The good news is that RHR is modifiable. Methods that may reduce your rate include medications, such as beta blockers, and lifestyle modifications, including meditation, dietary changes and exercise.

Impact on life span

Reducing RHR may be an important component in living a longer, healthier lifestyle. In the Copenhagen Male Study, a prospective study that followed 2,798 participants for 16 years, results showed that those with higher resting heart rates had a greater risk of death (1). There was a linear relationship between the risk of death and increasing RHR. Those who had a resting heart rate above 90 bpm were at a threefold greater risk of death, compared to those who had a RHR at or below 50 bpm. RHR was inversely related to the amount of physical activity.

Thus, the authors concluded that a “healthy” person with higher RHR may still have a shorter life span, with all other factors being equal, such as physical activity and blood pressure.

Predictor of Hypertension?

An analysis of 4,000 young adult participants in the 30-year CARDIA cohort study found that a 10 bpm higher RHR had a significant impact on future hypertension, or high blood pressure, experienced in middle age (2). This association was found with a 10 bpm increase in RHR among black and white men and white women. Interestingly, black women did not show the same association. The study authors hypothesize that this may suggest racial differences in sympathetic nervous activity impacts on hypertension among women. Of course, additional research will be necessary to delve deeper into this.

Heart disease mortality

In the Nord-Trondelag Health Study, a prospective observational study, those who had a higher RHR at the end of the study than they did at the beginning of the study 10 years prior were more likely to die from heart disease (3). In other words, as the RHR increased from less than 70 bpm to over 85 bpm, there was a 90 percent greater risk of heart disease, compared to those who maintained a RHR of less than 70 throughout the two measurements. This study involved 30,000 participants who were healthy volunteers at least 20 years old.

Heart attacks

In the Women’s Health Initiative, results showed a 26 percent decrease in the risk of cardiovascular events in those postmenopausal women who had a RHR below 62 bpm, compared to those who had a RHR above 76 bpm (4). Interestingly, these results were even more substantial in the subgroup of women who were newly postmenopausal, ranging in age from 50 to 64.

Effect on kidney function

I have written many times about chronic kidney disease. An interesting follow-up is resting heart rate and its impact on kidney function. In the Atherosclerosis Risk in Communities Study, results showed that the most severe form of chronic kidney disease, end-stage renal disease, was 98 percent more likely to occur in those with the highest RHR, compared to those with the lowest (5). There were approximately 13,000 participants in the study, with a 16-year follow-up.

The authors hypothesized that this negative effect on the kidney may be due to a loss of homeostasis in the autonomic (involuntary) nervous system, resulting in blood vessel dysfunction, such as increased inflammation and vasoconstriction (narrowing).

Lowering RHR

Studies have shown that combined strength and endurance training may lower RHR in women. METRO photo

A meta-analysis of controlled studies analyzed the effects of different types of exercise on RHR (6). Studies’ interventions included a range of exercises, such as high intensity interval training, including ball and team sports; endurance or strength training; yoga; qigong; and tai chi. Some studies’ participants were limited to one gender.

No surprise, analysis found that all interventions lowered RHR compared to control groups that did not exercise. The greatest results in lowering RHR were in endurance training, yoga, strength training (females only), and combined endurance and strength training (females only).

Can RHR be too low?

Is there a resting heart rate that is too low? Well, it depends on the context. If you are a marathoner or an athlete, then a RHR in the 40s may not be abnormal. For a healthy, physically active individual, it is not uncommon to have a resting heart rate in the 50s. However, if you are on medications that reduce your RHR and/or have a chronic disease, such as heart failure, it is probably not advisable to go much below 60 bpm.

Always ask your doctor about the appropriate resting heart rate for your particular situation.

Thus, resting heart rate is an easy and inexpensive biomarker to potentially determine risk stratification for disease and to increase longevity, even for those in the normal range. By monitoring and modifying RHR, we can use it as a tool for primary disease prevention.

References:

(1) Heart Journal 2013 Jun;99(12):882-887. (2) Hypertension. 2020 Sep;76(3):692-698. Epub 2020 Aug 12. (3) JAMA 2011; 306:2579-2587. (4) BMJ. 2009 Feb 3;338:b219. (5) J Am Soc Nephrol. 2010 Sept;21(9):1560-1570. (6) J Clin Med. 2018 Dec; 7(12): 503.

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.

Exercise plays a crucial role in lowering blood pressure. Stock photo
Nighttime pressure readings may better predict cardiovascular events

By David Dunaief, M.D.

Dr. David Dunaief

Roughly 45 percent of adults in the U.S. have hypertension, or high blood pressure. That’s almost one in two adults, or 108 million people, of which 82 million do not have their hypertension con-trolled. If that isn’t scary enough, the Centers for Disease Control and Prevention (CDC) reports that almost a half-million people died in the U.S. in 2017 from complications of hypertension in 2017 (1).

Speaking of scary, the probability of complications, such as cardiovascular events and mortality, may have their highest incidence during nighttime sleeping hours.

Unfortunately, as adults, it does not matter what age or what sex you are; we are all at increased risk of complications from high blood pressure. Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (2). At least some of the risk factors are probably familiar to you. These include being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (3).

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, some nonpharmacological approaches have benefits. These include lifestyle modifications with diet, exercise and potentially supplements.

Risk factors matter, but not equally

In an observational study involving 2,763 participants, results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (4). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²), which put participants at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk.

The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension.

Hypertension complications are felt across gender, age and race

While the data show that more men than women have hypertension, 47 percent vs. 43 percent, and the prevalence of high blood pressure varies by race, the consequences of hypertension are felt across the spectrum of age, gender and race (1).

One of the most feared complications of hypertension is cardiovascular disease. In a study, isolated systolic (top number) hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (5). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, it was very large and had a 31-year duration.

Nighttime concerns

Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (6).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration. Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).

There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (7). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (8). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

Eat your berries

Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (9).

This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase a substance called nitric oxide, which helps blood vessels relax, reducing blood pressure.

In conclusion, nighttime can be scary for high blood pressure and its cardiovascular complications, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

References:

(1) CDC.gov. (2) Diabetes Care 2011;34 Suppl 2:S308-312. (3) uptodate.com. (4) BMC Fam Pract 2015;16(26). (5) J Am Coll Cardiol 2015;65(4):327-335. (6) J Am Coll Cardiol 2015;65(4):327-335. (7) Eur Heart J 2015;35(46):3304-3312. (8) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (9) J Acad Nutr Diet 2015;115(3):369-377. (10) JAMA Pediatr online April 27, 2015.

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.