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How everyday life affects blood pressure

ESC Congress News 2015 - London

Primary care
Hypertension
Prevention
Cardiovascular Nursing


A study presented by Manolis Kallistratos, left, found lower systolic BP in those who took a one-hour daily siesta. Toru Shirakawa raised concerns of pulmonary embolism in those watching more than five hours TV a day.There have been many reminders here in London of the role played by lifestyle in the aetiology and management of hyptertension. Indeed, one widely reported study from Greece presented in a Poster Session on Saturday found that naps taken at midday - a habit favoured in some Mediterranean countries and the Far East but now in decline - are directly associated with reduced blood pressure and prescription of fewer antihypertensive medications. Manolis Kallistratos, a cardiologist at Asklepieion Voula General Hospital in Athens, thus asked if midday sleep is a habit, a privilege (because of the nine-to-five working culture) or an exercise for good health.

The study included 386 middle-aged patients with arterial hypertension whose midday sleep time (in minutes), 24-hour ambulatory BP, pulse wave velocity, lifestyle habits, BMI and left atrial size were measured. After adjustments, midday sleepers were found to have 5% lower average 24-hour ambulatory systolic BP (6 mmHg) than those who did not take a midday siesta. The duration of midday sleep was associated with arterial hypertension measures such that those who slept for 60 minutes at midday had 4 mmHg lower average 24-hour systolic BP readings. ‘The longer the midday sleep, the lower the systolic BP levels and probably fewer drugs needed to lower BP,’ said Kallistratos.

However, a long-term study described in the same Poster Session found that coffee-drinking (maybe as a pick-up after a short-term nap) was associated with an increased risk of cardiovascular events (mainly AMI) in young adults with mild untreated hypertension. The 12-year study in more than 1200 patients found that heavy coffee drinkers had a four-fold increased risk while moderate drinkers tripled their risk.

The study, said investigator Lucio Mos from the Hospital of San Daniele del Friuli in Udine, Italy, adds a little more to the controversial role of coffee consumption in the management of hyptertension. This study, which measured consumption as none (0), moderate (1–3 cups) and heavy (4 or more) in 1201 non-diabetic patients aged 18-45 years, found a linear relationship between coffee and risk of hypertension needing treatment. The association reached statistical significance for heavy coffee drinkers.

Because type-2 diabetes often develops in hypertensive patients at a later stage, the study also examined the long-term effect of coffee drinking on the risk of prediabetes. Again, a linear relationship was found, with a 100% (30-210%) increased risk of prediabetes in the heavy coffee drinkers.

Multivariable analyses over the 12-year showed that both coffee categories were independent predictors of cardiovascular events in these young adults, with hazard ratios of 4.3 (1.3-13.9) for heavy coffee drinkers and 2.9 (1.04-8.2) for moderate drinkers.

There was also a higher risk of fatal pulmonary embolism found in those who spent long hours in front of the television. Toru Shirakawa, a public health research fellow in the Department of Social Medicine at Osaka University in Japan, found that those watching TV for an average of five or more hours a day had twice the risk of fatal pulmonary embolism than those watching less than 2.5 hours daily. The findings come from the Japanese Collaborative Cohort (JACC) Study, a long-term investigation of how individual lifestyle affects disease mortality and cancer morbidity, and is the first prospective assessment of the link between prolonged TV watching and fatal pulmonary embolism. The results, presented in a Poster Session on Sunday, were derived from a study of 86,024 men and women aged 40-79 years who were followed-up for a median of 18.4 years until 2009.

The risk was most prominent in people under 60 watching TV for more than five hours a day - a six-fold greater risk of fatal pulmonary embolism than in those watching less than 2.5 hours (HR 6.49). ‘Leg immobility during television viewing may in part explain the finding,’ said Shirakawa. ‘To prevent the occurrence, we recommend the same preventive behaviour used against economy class syndrome. That is, take a break, stand up, and walk around during the television viewing. Drinking water for preventing dehydration is also important.’