Saturday, May 16, 2015

Power Down in May for National High Blood Pressure Education Month

Photo: Doctor taking woman's blood pressureReducing high blood pressure can lower your risk for stroke and heart attack.

Less is better in some things, including in blood pressure. About 1 of 3 US adults—67 million people—have high blood pressure.1High blood pressure makes your heart work too hard and increases your risk of heart disease and stroke.

You can have high blood pressure and not know it. That is why it is called the silent killer. It is also why it is so important to have your blood pressure checked. If you know family or friends who haven't had their blood pressure checked recently, make it a point to ask them to do it in May, National High Blood Pressure Education Month.

It is easy to check blood pressure and it is painless. It can be checked by your doctor, and many pharmacies have free screenings.

Caution! Arteries Under Pressure

Photo: Senior man by swimming pool

Blood pressure is the force of blood on the walls of your blood vessels as blood flows through them. This pressure naturally rises and falls during the day, but when it is consistently too high, it is considered high blood pressure. The medical term is hypertension.

Like the pipes in your house, your arteries can fail if they are under too much pressure. The video, "High Blood Pressure Basics," illustrates the concept of high blood pressure.

More than 360,000 American deaths in 2010 included high blood pressure as a primary or contributing cause.2 That's 1,000 deaths each day.

Blood pressure has two numbers, systolic and diastolic, and is measured in millimeters of mercury (mmHg). Systolic pressure (the top number) is the force on the blood vessel walls when the heart beats and pumps blood out of the heart. Diastolic pressure (the bottom number) is the force that occurs when the heart relaxes in between beats.

If your blood pressure is less than 120 systolic and less than 80 diastolic, then your blood pressure is normal; between 120 and 139 systolic and 80–89 diastolic, you have prehypertension. Systolic of 140 or greater, or diastolic that is 90 or greater, is hypertension.

What Is Your Risk?

Men and women are about equally likely to develop high blood pressure over their lifetimes, but their risks vary at different ages. The condition affects more men than women before 64 years of age. For people aged 65 years or older, more women than men have high blood pressure.


Men (%)

Women (%)


Data in this table are from the 2014 AHA Statistical Update, using 2007-2010 NHANES

African Americans develop high blood pressure more often, and at an earlier age, than whites and Hispanics do. More black women than men have high blood pressure.3

Racial or Ethnic Group

Men (%)

Women (%)

Mexican Americans28.627.8

Data in this table are from Health US 2012, using 2007-2010 NHANES

African American men are disproportionately affected by cardiovascular disease (CVD). One of the reasons for this has to do with the rates of uncontrolled high blood pressure among African American men. Uncontrolled high blood pressure among African American men aged 20 years and older is 59.7%; compared to 47.0% of white men. Uncontrolled hypertension among African American women is 47.3% compared to 43.2% for white women.2

Eliminating health disparities among various segments of the population is a CDC priority and a Healthy People 2010 goal.

Keep It Down in There!

If you have high blood pressure, there are steps you can take to get it under control, including—

  • Ask your doctor what your blood pressure should be.Set a goal to lower your pressure with your doctor and then discuss how you can reach your goal. Work with your health care team to make sure you meet that goal.
  • Take your blood pressure medication as directed. If you are having trouble, ask your doctor what you can do to make it easier. For example, you may want to discuss your medication schedule with your doctor if you are taking multiple drugs at different times of the day. Or you may want to discuss side effects you are feeling, or the cost of your medicine.
  • Quit smoking—and if you don't smoke, don't start.You can find tips and resources at CDC's Smoking and Tobacco Web site or Be Tobacco Free Web site.
  • Reduce sodium. Most Americans consume too much sodium, and it raises blood pressure in most people. Learn about tips to reduce your sodium.

Photo: Two women riding bicyclesThere are other healthy habits, that can help keep your blood pressure under control—

  • Achieve and maintain a healthy body weight.
  • Participate in 30 minutes of moderate physical activity on most days of the week.
  • Eat a healthy diet that is high in fruits and vegetables and low in sodium, saturated fats, trans fat, and cholesterol.
  • Manage stress.
  • Limit the amount of alcohol you drink (no more than one drink each day for women and two for men).
  • If you have high blood pressure and are prescribed medication, take it as directed.
  • If you have a family member who has high blood pressure, you can help by taking many of the steps listed above with them. Go for walks together or cook meals with lower sodium. Make it a family affair!
  • Check your blood pressure regularly.


The Dietary Approaches to Stop Hypertension (DASH) can help control high blood pressure through a healthy diet.

"I can do it!" is the message of the My Blood Pressure Wallet Card that helps patients monitor their blood pressure readings, remember to take their medications, and keep up the lifestyle changes that will help lower their blood pressure.

Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes in the United States by 2017. Launched by the US Department of Health and Human Services (HHS), it aligns existing efforts and creates new programs to help Americans live longer, more productive lives. The CDC and Centers for Medicare and Medicaid Services, co-leaders of Million Hearts™ within HHS, are working alongside other federal agencies and private-sector organizations to make a long-lasting impact against cardiovascular disease.


  1. CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010. MMWR. 2012;61:703-9.
  2. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation.2014;129:e28-e292.
  3. CDC. Health, United States, 2012: With Special Feature on Emergency Care. Atlanta, GA: US Department of Health and Human Services; 2013.
  4. CDC. A Closer Look at African American Men and High Blood Pressure Control: A Review of Psychosocial Factors and Systems-Level Interventions. Atlanta, GA: US Department of Health and Human Services; 2010.

Tuesday, May 12, 2015

PE recurrence same with vena cava filter plus anticoagulation as anticoagulation alone

Adding an inferior vena cava filter did not reduce the risk of recurrent pulmonary embolism (PE) compared to anticoagulation alone, according to a recent study of French patients hospitalized with PE.

The open-label trial included patients who were hospitalized with acute, symptomatic PE associated with lower-limb venous thrombosis and who met at least 1 criterion for severity between 2006 and 2012. The patients were randomized to retrievable inferior vena cava filter implantation plus anticoagulation (n=200) or anticoagulation alone (n=199) and were followed for 6 months. Patients with a contraindication to anticoagulation therapy and those with recurrence despite adequate anticoagulation were excluded. Results were published in the April 28 Journal of the American Medical Association

Filters were successfully inserted in 193 patients, and they were retrieved, at 3 months after placement, in 153 of the 164 patients in whom retrieval was attempted. By 3 months, 6 patients in the filter group had a recurrent PE (3.0% of the group, all were fatal), compared to 3 patients in the anticoagulation-only group (1.5% of the group; 2 fatal; P=0.50 for PE recurrence). The groups also had similar rates of recurrence within 6 months, symptomatic deep venous thrombosis, major bleeding, and mortality within 3 or 6 months. Filter thrombosis occurred in 3 patients. One patient died of cardiac arrest during filter insertion.

Implantation of the filters did not reduce risk of symptomatic PE recurrence, and thus the study's results do not support use of inferior vena cava filters in PE patients who can be treated with anticoagulation, the study authors concluded. The rate of PE recurrence in the study was less than expected, but this shows that "modern management with full-dose anticoagulation is likely very effective even in patients usually considered to be at high risk for recurrence," the authors wrote.

The study was limited by its open-label design and its small size, and the results do not exclude the possibility of benefit from filters in certain subgroups of patients with venous thromboembolism, such as those with PE and hemodynamic instability. The study used the ALN brand of filter (provided by the manufacturer for the study), but given existing evidence of similarities among retrievable filter models, the results are probably applicable to other retrievable filters, the authors said.

Fecal transplants for recurrent C. diff may resolve symptoms with few adverse events

Low-strength evidence shows fecal microbiota transplantation (FMT) effectively treats recurrent Clostridium difficile infections (CDIs), with few short-term adverse events, a review found.


Researchers conducted a literature search to find 2 randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports (included only for reporting harms) assessing FMT. Results of their analysis, which was funded by the Department of Veterans Affairs, appeared in the May 5 Annals of Internal Medicine

Across all studies of FMT for recurrent CDI, symptom resolution was seen in 85% of cases. In the 2 RCTs, totaling 36 patients with recurrent CDI, 27 (75%) had resolution of CDI symptoms without recurrence. One RCT comparing FMT with 2 control groups reported resolution of symptoms in 81% of patients who received FMT, 31% of patients who received vancomycin, and 23% of patients who received vancomycin plus bowel lavage (P<0.001 for both control groups vs. FMT). An RCT comparing different FMT routes of administration for CDI recurrence reported no difference between groups (60% had their symptoms resolved in the nasogastric tube group, as did 80% in the colonoscopy group; P=0.63). Among the 480 patients in 21 case-series studies who received FMT for recurrent CDI, 85% had resolution of symptoms without recurrence.

There were 7 studies reporting on patients with refractory CDI treated with FMT, and they used various methods and did not compared FMT with standard therapy. Reported resolution of symptoms ranged widely (0% to 100%; overall resolution rate, 55%).

Case-series studies included 7 patients treated with FMT for initial CDI, with mixed results. Six cases were part of a series of 14 patients with refractory CDI, and 1 case was part of a series of 4 patients. Among the 6 cases, 1 was cured after FMT. The other, single case received FMT as initial treatment of an episode of postantibiotic-associated colitis and had symptom resolution within 48 hours.

"[L]ow-strength evidence supports FMT as having a substantial effect and few short-term adverse events for adults with recurrent CDI," the authors wrote. "There is insufficient evidence about FMT for patients with refractory CDI or for initial treatment of CDI. Evidence is insufficient about whether treatment effects vary by FMT donor, preparation, or delivery method."

The author of an accompanying editorial stated that FMT is effective, provides durable cures, and can result in a cost savings of $17,000 per patient in recurrent cases. Remaining issues include the need for regulations to standardize the treatment, which is currently considered a biologic by the FDA, and the potential effects of transplanting a microbiome from one patient to another.

"The excitement about FMT is justified given its high efficacy in treating recurrent CDI, relative availability and simplicity, and favorable cost profile compared with other therapies," the editorial stated.