ALL ABOUT HYPERTENSION & HEART HEALTH

What is hypertension?

Hypertension is called a sustained elevation of blood pressure levels above normal values (systolic pressure over 160 mmHg, diastolic pressure over 90 mmHg).). Originally, influence both personal and environmental factors (age, food habits and lifestyle) and genetic: blood pressure tends to rise with age, is also appearing more frequently if the person is obese, a diet high salt and low potassium (low in vegetables, fruits and nuts, legumes, cereals), drink large quantities of alcohol, physical activity, or suffer from psychological stress. Almost 90% of cases hypertension is of unknown primary, and in less than 10%, secondary to other processes related to alterations of renal origin, cardiovascular or endocrine system.

Coffee and hypertension, a contradictory relationship

The coffee-health equation remains a mystery important research with implications for public health. Within the prevention of cardiovascular risk, a predominant factor is hypertension. The recommendations given to hypertensive patients to reduce their blood pressure is a proper diet, limit alcohol and salt, not smoking and exercising. What is unclear is whether those recommendations should be added to reduce the consumption of coffee. This is reminiscent of a recent work published in the Journal of Human Hypertension, signed by the British epidemiologist Mark Hamer.

The epidemiological work are contradictory. Some show that increased coffee consumption is associated with hypertension while other studies say the opposite. The contradictory results could be explained most probably by the involvement of other factors. 'Hypertensive status, genetic vulnerability, and interaction with smoking or stress can be important, "says Mark Hamer. An explanation of why coffee may affect some individuals more susceptible is in the genes. This has been proposed this year a team of researchers from the University of Toronto (Canada), which assessed whether caffeine could be involved in the development of cardiovascular disease in relation to the CYP1A2 gene.

This gene, which encodes an enzyme that helps break down and metabolize caffeine, is found in humans known in two versions, one of which, the CYP1A2 * 1F, metabolizes caffeine more slowly than the other. Researchers say people who carry the gene would be "poor metabolizers" and would take, therefore, more time in eliminating coffee and caffeine from your body. A 64% higher risk. Caffeine given in pills results in increased pressure four times that when you drink coffee to see what involvement could have coffee and this gene in cardiovascular health, the team conducted a study of more than 2,000 people who had suffered a heart attack and compared them using a questionnaire and a genetic analysis, with another 2,000 healthy individuals. According to the results, the slow metabolizers who drank three cups of coffee up to 250 milliliters per day are 36% more likely to suffer a heart attack than those who only drink a cup. The probability rises to 64% in carriers of the gene CYP1A2 * 1F taking four or more cups, and the risk is even greater in children under 60 years. In contrast, consumption of two to three cups seems to be protective in the case of holders of the other version of the gene, which makes them what can be termed extensive metabolizers.

"The results are clear and quite striking," says Ahmed El-Sohemy, a researcher at the University of Toronto who led the research, released last March. How do you know if slow or fast metabolizer? A genetic test would be the best way and, instead, the effects against the coffee is not always the best track. "One can not infer that it is simply because poor metabolizer feel restless after a cup of coffee," says Ahmed El-Sohemy. The stimulating effect of coffee is mainly determined by the way he acts in the central nervous system, not the time caffeine remains in the body. Either way, adds the researcher, the results of work are not sufficient to trigger the alarm and recommend to the carriers of the gene CYP1A2 * 1F reduction or withdrawal of coffee, since there may be other factors. For example, people who consume more coffee might be more stressed and less sleep because they are busy, why these people would be drinking more coffee as a remedy for their few hours of sleep, so the highest coffee consumption would not be causes but the effects of stressful life. Or maybe these people who consume more coffee stressed also eat worse. Scientists say that to confirm or refute the role of the CYP1A2 * 1F gene should repeat the experiment with other populations, ethnic, genetically distinct and different lifestyles, so that it can discriminate the effects of caffeine from other .
It's not just the caffeine

It is unclear how it can act on the human metabolism but preliminary indications suggest it may affect the flexibility of blood vessels. The question is to what extent it affects and whether the effects of the caffeine in coffee can not be buffered by other components of coffee. There is another obstacle to determine the negative effects of coffee on hypertension and cardiovascular health. It is estimated that coffee has up to 2,000 different compounds, of which the best known is precisely the caffeine, well known physiological effects. Something curious, Hamer recalls epidemiologist at work, that caffeine is given in pill form results in a pressure increase four times when drinking coffee. A paper published by researchers at Harvard University last year in the Journal of American Medical Association (JAMA), revealed a higher incidence of hypertension in users of caffeinated cola and coffee to consumers, so is believed that some components of coffee that interact with caffeine might be protective.

Coffee contains antioxidant compounds, flavonoids and polyphenols that can be beneficial but, in return, has also been a positive relationship between coffee drinking and some molecules that are indicators of the inflammatory process (suggesting that coffee might help or have relation to these inflammatory processes). However, there may be confounding factors in research. In the case of the JAMA research, another explanation could be that consumers have cola, possibly, worse diet and increased intake of calories than coffee drinkers.
There is no evidence, Hamer says, that there is a cause and effect relationship between increased coffee consumption and hypertension. "There is a trend that suggests some benefits of coffee consumption, but more experimental work is needed to fully understand the effect of the compounds in coffee and its interaction with other factors such as genetic risk, diet, lifestyle and smoking. The coffee-health equation, Hamer says, remains a mystery important research with implications for public health.

So far all the attention of coffee and their "evil" have been focused on caffeine. But with the two thousands of compounds that make up this drink, you can not say that there is sufficient candidates to be investigated in relation to hypertension. A good candidate is the hydroxy hydroquinone, a compound pro-oxidative coffee, have been found very interesting results. In 2006, Japanese researchers of the Laboratory of Biological Sciences, Kao Corporation eliminated coffee this compound pro-oxidative. We tested in hypertensive rats and found that it had beneficial effects in rodents. Other studies by the same group have shown that there is another compound in coffee with beneficial effects on blood pressure. It is a polyphenol, chlorogenic acid, which seems to improve cardiovascular health in rodents. Maybe from there may begin to think of a coffee is not caffeine-free and free but hydroxy hydroquinone. Or coffee formulas with higher concentrations of chlorogenic acid but, really, the experiments conducted so far have been in mice and is yet to see the same beneficial effects occur in humans.

Frequent exercise may decrease blood pressure in persons with hypertension?

Yes, recent studies have shown: 1) that in people with hypertension, after a session of physical exercise dynamic of moderate intensity (brisk walking, jogging, bike ride without hills, swimming, soft, ...) that extends for 30 to 45 minutes, there is a decrease from 10 to 20mmHg in systolic blood pressure during the 1 to 3 hours, and this response can take up to 9 hours, and 2) than in people with mild hypertension (140 - 180 / 90 - 105mmHg ) can be seen, after several weeks of physical training, an average decrease of 8 to 10mmHg in systolic and 5 to 8 mm Hg diastolic blood pressure at rest.

"This improvement in blood pressure observed in people with moderate arterial hypertension, occurs equally in people who have a normal stress or those with very high voltage? No. In general, lower blood pressure with exercise training is greater the higher the blood pressure of the subject. In other words, people who have severe hypertension improved more than those with moderate hypertension, while those with normal blood pressure decrease your blood pressure too little sleep, but avoid increasing the tension observed with age in sedentary people. If exercise training is a good treatment for hypertension, no need to take medication against stress when deciding to exercise, so often?

In the case of moderate hypertension (140 - 175 / 90-105 mmHg), the positive effects of the training program are similar to those produced by commonly prescribed medication that, with the difference that exercise training is accompanied by a improving other risk factors, as has been observed that treatment with anti-hypertensive medications can worsen other risk factors. For that reason it is preferable that people have a choice moderate hypertension treated with the physical training program instead of medication, especially since you are doubting whether or not to treat moderate hypertension drug. For people with severe hypertension (resting values at or above 180 / 110 mmHg), it is recommended to take medication against hypertension and also to make a fitness program tailored to your physical condition because in this case only, treatment by physical activity is not sufficient to lower blood pressure to normal values. When combined, these two treatments in severe hypertension, there has been a decrease in mortality and, eventually, a reduction in dose of medication.

ROLE OF EXERCISE IN THE PREVENTION OF HYPERTENSION

How can you prevent high blood pressure?

Everyone can reduce the chances of developing hypertension as follows:

1 Maintaining a proper body weight, or losing weight if overweight
2 Being more physically active.
3rd Choosing a lower-salt diet and sodium and
Drinking in moderation 4th

Being more physically active ... how much?: For the American Heart Association (AHA), physical inactivity is a risk factor for developing coronary heart disease and also contributes to other risk factors such as obesity, hypertension, low HDL cholesterol ( "good") cholesterol and diabetes. For this association, even a moderate-intensity physical activity such as brisk walking is beneficial when practiced for at least 30 minutes most days. If exercise lasts longer periods of time and includes more physical intensity, the benefits are also higher.

In this way, people who are physically active have a lower risk of developing hypertension (a risk of 20 to 50% lower) than their sedentary peers. "I have no 30 minutes to walk" Then we have to find two 15-minute periods or three 10 minutes, at least, each in a single day, because they produce the same beneficial effect. For example, you can get two periods of 15 minutes leaving the car at home and walk to work.

Vaccine for Hypertension?

A new vaccine to treat hypertension, to be administered every four months, opened a new door for treatment, according to Swiss researchers. Statistics show that 25% of the European adult population is hypertensive and in Spain the figure is around 12 million affected. The tension control, basic pillar in the prevention of cardiovascular disease, often goes by the daily intake of various drugs. Recently, news of the effectiveness of a vaccine for hypertension has opened a new prospect for treatment of this disease.

Researchers at the University Hospital of Lausanne (Switzerland) have achieved positive results in humans demonstrating the effectiveness of a vaccine for hypertension. The study was conducted in 72 patients with mild to moderate hypertension, which was injected 100 or 300 micrograms (mg) of the vaccine or placebo. The group consisted of 65 men and 7 women with a mean age of 51.5 years. The researchers made a vaccine (CYT006-AngQb) from non-infectious particles in the form of virus that were paired with angiotensin II, substance found in the blood with vasoconstrictor effect, which acts to regulate blood pressure, among other actions. Thus, the body itself recognized the "couple" undesirable element to be eliminated. In patients who received the vaccine was detected an antibody response against angiotensin II in the first week, at four and twelve below. The most intense response occurred in those who received higher doses.

Therapy achieved significant reductions in blood pressure: up to 5.6 millimeters of mercury (mm Hg) for systolic pressure (maximum) and 2.8 mm Hg for diastolic (minimum). The most significant reductions were achieved in the early morning hours, considered as the time zone of highest risk of a cardiovascular problem. Specifically, with the dose of 300 mg was found a decrease of 25 mm Hg in systolic and 13 mm Hg diastolic at 08:00 h in the morning. "The antibodies produced by the vaccine seem to function as a sponge that is emptied at night, when the production of angiotensin II is smaller, and so is able to absorb that occurs early in the morning," said Martin Bachmann study co-author and chief scientist of Cytos Biotechnology, the Swiss company responsible for developing the vaccine.

The vaccine is well tolerated, except for some local reaction, and its effect lasts almost four months. The aim of the vaccine to block the action of one of the mediators in hypertension, angiotensin. This molecule is part of the renin angiotensin aldosterone system (RAAS), one of the most potent vasoconstrictor systems in the body. The activity of the system begins with the release of renin from the kidney, which in turn activates the other components of the system.

Blocking angiotensin

Angiotensin is already the target of two treatment groups at our disposal for the treatment of hypertension: ACE inhibitors (inhibitors of angiotensin converting enzyme), which act by blocking the enzyme that facilitates the conversion from angiotensin I and angiotensin II and ARBs, which act on angiotensin receptors. An important fact is that the vaccine conferred protection for 24 hours, a goal that they can not all antihypertensive treatments. The vaccine is safe and well tolerated, with some local reaction to the jab and occasionally, headache. The effect lasts for about four months (depending on the patient), so three or four annual administrations would be sufficient. It is expected that in ten years the vaccine is already available for universal use. The findings were made public in recent Scientific Sessions of the American Heart Association (AHA, in the acronym) held recently in Orlando (USA).

Also recently appeared a new drug, aliskiren, which works by blocking the renin directly. The new drug has been approved by the European Union and is the only significant development that has appeared in the last ten years in the field of antihypertensive therapy. About 44 clinical trials involving over 7,800 participants support the efficacy and safety of the drug. About 70% of hypertensive patients never achieve optimal blood pressure control. One of the difficulties facing the treatment of any chronic illness is that of non-compliance. It is often hypertensive patients should eat different tablets of different medications to control their disease. Moreover, this must be added that hypertension is a silent disease, often without symptoms (the patient has no discomfort, unless the numbers are extreme), making compliance more difficult.

Swiss research offers a new vision and a totally different perspective in the treatment of chronic disease. The possibility of substituting the tablets administered daily by injection regularly improve adherence of millions of patients. Do not forget that hypertension is a condition that causes the medium to long term, major changes at the cardiovascular level, with important repercussions at the level of the microcirculation, especially in target organs: kidney, brain and heart. The prevalence of hypertension increases with age but is increasingly being detected younger hypertensive patients. The October 10 National Day was celebrated for Hypertension under the motto "Do not take risks, control your stress." The seminar, sponsored by the Hypertension Club of the Spanish Society of Hypertension-Spanish League for the Fight Against Hypertension, SEH-LELHA, was to sensitize the general population and health professionals about the importance of prevention and management of hypertension.