Health Tip: Taking a Daily Aspirin

(HealthDay News) -- A daily low-dose aspirin can help reduce the risk of heart attack in people with higher-risk conditions such as high blood pressure or diabetes.

While aspirin is generally safe, there are some people who shouldn't take it, since the drug can irritate the stomach lining.

The American Diabetes Association says the following people should talk to their doctor before beginning daily aspirin therapy:

• People younger than age 21.
• People who bleed often or easily.
• People who are allergic to aspirin.
• People who have had recent bleeding in the digestive tract.
• People with current liver disease.

Many Doctors Don't Know Blood Pressure Guidelines

(HealthDay News) -- Too many family doctors don't start treatment of middle-aged men with high blood pressure when they should, a new study indicates.

The men in the study happened to be black, but the same is probably true for men in general, said Dr. Joseph Ravenell, who was expected to report the findings Friday at the American Heart Association's Council for High Blood Pressure Research annual meeting, in Atlanta.

Traditionally, most of the emphasis has been on patient behavior, such as noncompliance with medication and access to care, said Ravenell, who did the study while at the University of Texas Southwestern Medical Center at Dallas; he is now an assistant professor of medicine at New York University. But there is increasing evidence that the problem of poor hypertension control is not just about patients.

Ravenell and his Texas colleagues interviewed 891 black men in Dallas County, most of them being treated by primary-care physicians. The researchers also interviewed 22 community doctors, asking whether they would start drug treatment for a 45-year-old black man with an office blood pressure of 145/92 and an out-of-office pressure of 154/95, both well above the recommended 120/80 level.

Only 36 percent of the doctors said they would start treatment, Ravenell reported. And none of the 22 said they were familiar with the national guidelines calling for treatment of blood pressure at such levels.

The results are somewhat surprising but are consistent with other results in the literature which suggest that the guidelines aren't adhered to by physicians nearly as well as the guideline creators would like, Ravenell said.

How different the results might have been if the men were not black is uncertain, he said. Evidence does not suggest that blacks suffer more from poor guideline adherence by physicians, but that is still an open question, Ravenell said. It would be an interesting study to see if the same scenario with white men produced the same results, he added.

There is a lesson in the study for doctors, he said. The particular lesson is that physicians need to take a very good look at their own practices to make sure they are appropriately applying the guidelines to all patients, but particularly to black men, who are at high risk of death from hypertension, Ravenell said.

One lesson for people who are seen by the doctors is that people need to be aware of the guidelines, said Dr. Daniel Jones, vice chancellor for health affairs at the University of Mississippi, and a past president of the American Heart Association.

Another lesson is that they should know their blood pressure numbers and should speak up if the readings indicate high blood pressure, he said. Patients can influence doctors' choices by initiating discussions, Jones said.

National health surveys show that Americans are becoming more aware of the dangers of high blood pressure, a major risk factor for heart attack and stroke, and that it can be controlled by drug therapy, Jones said.

More information
Learn about high blood pressure and its treatment from the U.S. National Heart, Lung, and Blood Institute.

Exercise Reduces Blood Pressure...

(HealthDay News) -- For people with high blood pressure, exercise can be the most important lifestyle change they can make, researchers say.

Yet two-thirds of doctors don't take the time to tell their patients with high blood pressure about the importance of exercise and physical activity, a new study finds.

"Patients do follow physician recommendations to exercise when instructed to, and patients who follow exercise recommendations tend to have lower systolic blood pressures than those who do not," said lead researcher Dr. Josiah Halm, a hypertension specialist at the University of Wisconsin School of Medicine and Public Health.

The findings are published in the summer issue of Ethnicity & Disease.

For the study, Halm's team collected data on 17,474 people who participated in the Third National Health and Nutrition Examination Survey. Among these people, 4,686 reported having high blood pressure.

The researchers found that only slightly more than one-third of the people with high blood pressure said their doctor had told them to increase physical activity as a way of bringing down their blood pressure.

Yet, 71 percent of patients with high blood pressure saw a drop in their blood pressure when they increased their physical activity, which means that they listened when doctors told them to exercise more, according to the report.

"Non-pharmacological methods such as exercising are important in improving blood pressure control on a population level as this study looked at the cross-section of the U.S. population," Halm said.

Studies have shown that small changes in blood pressure -- 2 to 3 mmHg -- could result in a 25 percent to 50 percent decrease in the incidence of high blood pressure, also known as hypertension, Halm said. "That would result in an annual reduction of stroke, coronary heart disease and all-cause mortality by 6 percent, 4 percent and 3 percent, respectively," he said.

Exercise -- as part of a comprehensive lifestyle-modification program including weight loss, low-salt diet, diets rich in fruits and vegetables and low in saturated fats -- has beneficial effects on blood pressure, Halm said.

"It is thus appropriate to recommend exercise as most patients will follow their physician recommendations and this is associated with improved blood pressure control and likely a reduction in the morbidity and mortality associated with uncontrolled blood pressure," he said.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, thinks more needs to be done to get patients to make lifestyle changes that will reduce their blood pressure.

"Despite clinical trial evidence and national guideline recommendations for exercise counseling to be provided for patients with high blood pressure, this study demonstrates that only one-third of these eligible patients received exercise counseling," he said.

"Much more needs to be done to ensure that patients with high blood pressure receive appropriate counseling on lifestyle change -- including counseling on the importance of regular aerobic exercise -- from their physicians," Fonarow said.

More information

For more on high blood pressure, visit the American Heart Association.

Sleep Apnea Linked to Night Heart Attacks

(HealthDay News) -- A study links night-time heart attacks with the breathing disorder sleep apnea, which makes people gasp for breath every few minutes.

The link is not fully established, but it seems logical, said Dr. Virend Somers, a cardiologist from the Mayo Clinic who is lead author of the report in the July 29 issue of the Journal of the American College of Cardiology.

Most heart attacks occur in the day, generally between 6 a.m. and noon, Somers said. Having one during the night, when the heart should be most at rest, means that something unusual happened, he said. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame.

Their studies have looked at the most common form, obstructive sleep apnea, in which the tube carrying air to the lungs, collapses periodically, blocking the flow. "About 10 years ago, we showed that obstructive sleep apnea has a powerful effect on the sympathetic nervous system, causing an acute increase in adrenaline flow, high blood pressure and lack of oxygen," Somers said.

That study was followed by another showing that sudden death at night is more common for people with sleep apnea. An obvious cause of sudden death is a heart attack, so in this latest study, Somers and his colleagues studied the breathing patterns of 92 people admitted to the hospital after heart attacks.

"For those who had heart attacks at night, the vast majority had undiagnosed sleep apnea," Somers said. "So, perhaps sleep apnea is acting as a trigger for night-time heart attacks."

The "perhaps" is there because it is an observational study, not the kind of carefully controlled study that is the gold standard of medical research. Prospects for such a study, in which people with and without sleep apnea would be followed for months or years to determine their risk of night-time heart attacks, are dim, Somers acknowledged.

Several studies have shown a link between sleep apnea and cardiac problems, said Dr. Allan Pack, director of the sleep center at the University of Pennsylvania. The largest, done several years ago, followed thousands of individuals. "It showed that people with sleep apnea who refused treatment had a three- to fourfold increased risk of cardiac events," Pack said.

What the new study adds is "a relative difference in the timing of cardiac events," he said. In clinical practice, if someone has a heart attack in the night, "you would strongly suspect sleep apnea," Pack said.

If tests detect sleep apnea, there is an effective treatment available that can reduce the risk of future cardiac events, he said. Continuous positive air pressure (CPAP) keeps airways open continuously by pushing air into the lungs through a face mask.

"It might be cumbersome, but it is effective," Pack said.

More information
Learn about the symptoms and treatment of sleep apnea from the American Sleep Apnea Association.