Study: Brand


By Patrick SauerTUESDAY, Dec. 2, 2008 ( — People who are taking a generic drug to lower blood pressure or ward off stroke and heart troubles can rest easy. Those low-cost alternatives are just as good as more expensive, brand-name drugs, according to Harvard researchers who published a large new analysis of the available data in the Journal of the American Medical Association.

“We found no evidence that brand-name drugs are superior to generic drugs in terms of the clinical outcomes,” says the review’s lead author, Aaron S. Kesselheim, MD, of Brigham and Women’s Hospital and Harvard Medical School. “Doctors should consider generic drugs where appropriate for their patients with cardiovascular disease.”

The researchers looked at 47 studies—with 9 different types of cardiovascular-disease drugs—conducted between 1984–2008. The majority of the studies, which included more than 800 patients, looked at four drug types: beta-blockers, which treat high blood pressure and heart arrhythmias; calcium channel blockers, which also lower blood pressure; diuretics, which reduce strain on the heart by boosting fluid output; and warfarin, which prevents clots. When the results were combined, they found no evidence that brand-name drugs were superior to generic versions.

The researchers looked at data from 1984 through the present. In ’84, the Hatch-Waxman Act authorized the U.S. Food and Drug Administration to approve generic drugs that are the “bioequivalent” of the brand-name counterparts.

Although that was almost 25 years ago, the perception still exists that generic drugs are inferior to the brand-name version, the authors say. It’s a costly assumption, particularly for cardiovascular drugs. As a group, they make up the largest chunk of money spent on outpatient prescriptions.

As prescription-drug costs rise and incomes decline in a weak economy, generic drugs are an increasingly important way to keep costs down—and keep patients taking their medications.

“There is clear evidence that when we treat patients with less expensive medicines that they can afford, they better adhere to them and that’s what we want,” says coauthor William Shrank, MD, of Brigham and Women’s Hospital and Harvard Medical School. “We want patients to take the medications we prescribe.”

People should feel comfortable taking a generic drug, says Steven Nissen, MD, chairman of cardiovascular medicine at the Cleveland Clinic. He always prescribes the generic equivalent and points out that many states have laws that mandate the same approach.

“In this economy, there’s a lot of people out of work, but what are you going to do if you have hypertension and can’t afford expensive drugs?” says Dr. Nissen. “I can now give out at least three classes of cheap drugs that are generically available that you can get at Wal-Mart for a few dollars a month. That is a fantastic thing for making sure people who most need medicines can get them.”

Dr. Nissen, who has been an outspoken critic of the pharmaceutical industry, notes that on rare occasions, generic drugs have had quality-control problems. He advises patients to get the generic versions, but to be vigilant and talk to your doctor if there is any reason to believe that the drug is not relieving your symptoms.

Generics are more widely available than ever before, but it can be hard to convince both doctors and patients to use them, particularly if there’s a perception that “more expensive” equals “better.” For example, volunteers in a 2008 study reported more pain relief after taking a $2.50-priced placebo pill compared to a 10-cent placebo pill, even though both were equally ineffective.

“[The news] is certainly reassuring, but only if you allow yourself to be reassured. That’s the challenge here,” says Jeffrey Goldberger, MD, director of cardio electrophysiology at Northwestern Memorial Hospital in Chicago. “Patients have strong biases and it can be difficult to reverse them.”

Dr. Kesselheim says that the review’s basic findings weren’t unexpected, but the authors were surprised that roughly half of the 47 studies’ accompanying editorials and commentaries (which are written by experts) had a negative view of generic substitutions. “The evidence doesn’t support that level of caution,” he says.

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Coffee, Exercise May Raise Stroke Risk for Some

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By Matt McMillenTHURSDAY, May 5, 2011 ( — Having sex, drinking coffee, working out—these and other everyday activities that cause blood pressure to spike may briefly raise the risk of a burst aneurysm in the brains of certain vulnerable people, a new study suggests.

Roughly 2% of the population is believed to have an aneurysm, a balloon-like swelling in a brain artery that results from a weak spot in the artery wall. Aneurysms are usually too small to cause symptoms or problems, but if they grow large they can burst and cause a stroke, leading to permanent brain damage or death.

The overall risk of rupture is small. However, even brief activities that raise blood pressure can temporarily boost the risk, according to the study, which appears in the journal Stroke. For instance, the risk appears to nearly double in the hour after drinking a cup of coffee, the researchers found.

“We investigated those factors that were known to cause a short-lasting sudden increase in blood pressure,” says the lead author of the study, Monique Vlak, MD, a neurologist at the University Medical Center, in Utrecht, the Netherlands. “Other researchers have already described that sexual activity or physical exercise are often reported by patients to precede rupture, but these potential risk factors were never quantified.”

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To do just that, Dr. Vlak and her colleagues asked 250 patients who had survived a rupture if they had been exposed to any of 30 potential triggers in the past year, how frequently, and whether any such exposures had occurred immediately before their rupture.

Coffee and vigorous exercise were the most commonly noted triggers, followed by nose blowing, sex, straining to defecate, drinking cola, being startled, and anger. Coffee was linked to nearly 11% of the ruptures in the study participants and vigorous exercise to roughly 8%. The remaining risk factors each accounted for approximately 5% or less of the ruptures.

This doesn’t mean that people with aneurysms need to quit drinking coffee, says Stanley Barnwell, MD, a neurosurgeon and stroke specialist at Oregon Health and Science University, in Portland.

“I’m not worried about coffee or cola,” says Dr. Barnwell, who was not involved in the research. “There’s not enough evidence here to get people upset about drinking coffee. There was a relatively small number of patients involved to make a strong conclusion.”

Aneurysms are most common after age 40. High blood pressure, genes, smoking, and drug abuse are among the many factors that are believed to contribute to their development. They can also be caused by head injuries and infections.

Most people who have small aneurysms don’t know it because they don’t have symptoms. These cases are usually discovered by accident—when a brain scan is performed following a head injury, for example—and regular checkups to monitor the aneurysm’s growth are generally all that’s needed.

People with larger aneurysms tend to undergo surgery or another treatment within one to three weeks of their diagnosis, so there’s no real need for them to give up coffee or make other lifestyle changes, says Neil Martin, MD, the codirector of the UCLA Stroke Center, who was not involved in the study.

But some people aren’t healthy enough for surgery and must live with the risk of rupture. These patients should quit smoking and lower their blood pressure, Dr. Martin says, and it might also be advisable for them to quit drinking coffee and take a stool softener if needed, as the study authors suggest.

“We don’t tell patients to stop having sex or having bowel movements or exercising,” he says.

Too Little Deep Sleep May Fuel Hypertension

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By Anne Harding

MONDAY, August 29, 2011 ( — Missing out on deep sleep can leave you feeling slow-witted and irritable in the morning, but the consequences don’t necessarily end there. Over time, too little deep sleep may also take a toll on your heart by contributing to high blood pressure, a new study suggests.

Healthy young and middle-aged adults spend about 20% to 25% of their sleeping hours in the stages known as slow-wave sleep (so called because of the brain waves associated with it). This sleep phase is considered restorative and has been shown to be important for memory and mental performance.

The new study, which included 784 men over the age of 65, adds to the growing evidence that slow-wave sleep is also essential to our metabolism and heart health. Compared to men who spent at least 17% of their sleep time in the slow-wave phase, those who spent less than 4% in this restful state had 83% higher odds of developing high blood pressure (hypertension) years later, the study found.

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The research should be considered “exploratory,” the authors say, and it doesn’t prove a direct link between sleep patterns and hypertension. But it suggests that “an important aspect of successful aging is the preservation of good sleep quality,” says Eve Van Cauter, PhD, the director of the Sleep, Metabolism, and Health Center at the University of Chicago.

Older people tend to get less slow-wave sleep as they age, and fighting this natural decline—through healthy sleep habits, for instance—could be an “extraordinarily important strategy” for heading off hypertension, adds Van Cauter, who wasn’t involved in the new research.

Sleep problems have been linked to high blood pressure before. Sleep apnea, a chronic disorder in which a person wakes up struggling for breath several times during the night, is strongly linked to hypertension, although it’s not clear whether the disorder causes high blood pressure or vice versa—or whether the two conditions feed each other.

Untangling the relationship has been tricky in part because obesity increases the risk of both high blood pressure and sleep apnea. Obesity could play a role in the link between slow-wave sleep and hypertension as well; in a previous analysis, the authors of the current research found that insufficient slow-wave sleep was related to obesity.

In the new study, published today in the American Heart Association journal Hypertension, researchers at the University of California–San Diego and Harvard University assessed the sleep quality of the participants using polysomnography, a technique in which electrodes are used to track brain activity.

All of the men had normal blood pressure when they underwent the test, which was performed on a single night in their own beds (as opposed to in a sleep lab). When the researchers followed up with the men an average of 3.5 years later, roughly 31% of the study participants had developed hypertension.

Next page: Good “sleep hygiene” may help

Once the researchers took age, body mass index, and race into account, they found that time spent in slow-wave sleep was the only measure of sleep quality associated with hypertension risk. Forty-one percent of the men who got the least slow-wave sleep went on to develop hypertension, compared to 26% of the men who got the most slow-wave sleep.

Susan Redline, MD, one of the study authors and a professor of sleep medicine at Harvard Medical School, in Boston, says that going to bed and waking up at the same time each day, avoiding alcohol and tobacco before bedtime, and other good “sleep hygiene” can help people sleep longer, and probably more deeply.

But, to maximize slow-wave sleep, she adds, “Probably the most important thing is to make sure that there is not a sleep disorder like sleep apnea or periodic leg movement that is causing disruptions.”

The study had some key limitations. The researchers tracked the men’s sleep on a single night, for instance, and they likewise measured blood pressure just once or twice. More research will be needed to address these shortcomings and also to rule out factors besides sleep quality (such as diet or medical conditions) that may independently contribute to hypertension, the study notes.

Nor is it clear whether habitual sleep deprivation—an increasingly common problem—has long-term effects on overall sleep quality and slow-wave sleep, Van Cauter says.

“It’s a possibility,” she says. “In the sixties, the average American was reporting sleeping 8.5 hours a night. Now most studies are showing six to seven hours. That’s a huge change.”

Rare Disorder Causes Severe Head Rushes

Nine years after being diagnosed with an extremely rare neurological disorder, Megan Kenny completed her first Olympic-length

By Amanda Gardner

When Megan Kenny was five years old, she began to exhibit a strange and troubling symptom: Every time she stood up for more than two minutes, she collapsed.

The episodes were particularly bad after Megan had been sitting or lying down for prolonged stretches, such as when she woke up in the morning or walked between classes at school.

“Church was always a disaster,” recalls Mary Kenny, Megan’s mother. After sitting or kneeling for a time, Megan would stand up with the congregation and invariably fall down.

As Megan got older, other worrisome signs emerged. Her eyelids began to droop. She continued to wet the bed and suffered from constant bladder infections. And, about once a week, she experienced extreme hypoglycemic episodes—a sudden drop in blood sugar levels—that left her shaking and unable to function for the rest of the day.

The Kennys visited a parade of doctors and specialists who considered, and ultimately ruled out, a grab bag of diagnoses: epilepsy, diabetes, cancer, liver failure, kidney failure. One time, after testing Megan for epilepsy, a neurologist observed that she appeared to have a severe form of orthostatic hypotension, a not-unusual condition in which a person’s blood pressure drops suddenly upon standing or sitting up, causing the sensation known as a head rush.

The doctor was only half right. Megan did have orthostatic hypotension, but the underlying cause was a far more exotic condition that wouldn’t be diagnosed until she was an adult. In the meantime, she had to cope with having blood pressure that could dive from a relatively normal 110/70 when she was lying down to 50/30 upon standing.

“I’ve seen dead people with higher blood pressure,” one nurse told her.

Next page: A family affair

A family affairIt was clear from the first minute of her life that Megan wasn’t in good health. She was a small baby, barely five pounds, in a family that had a history of strapping, nine-pound newborns, and she immediately required oxygen for respiratory distress. “She was literally blue,” Mary remembers.

Later, as an infant, Megan’s sucking reflux was so poor that her mother wasn’t able to nurse her. Orthopedists said her motor coordination was below average and referred her for physical therapy.

When Megan was eight years old her brother, Brendan, was born. As he grew up, he too would develop symptoms similar to hers, suggesting the mysterious condition had a genetic component. Megan’s parents continued visiting doctors, seeking explanations for what ailed the two siblings.

While some people get the occasional head rush or dizzy spell, Megan and Brendan experienced the sensation almost constantly. “Mostly it was a feeling as if you’re going to black out, like walking through life with permanent black spots,” Megan says.

Megan learned how to compensate for the strange spells. At school, if she had to climb a flight of stairs to get to a class, she’d sit on the landing to regain her composure or lean over and pretend to tie her shoes. She even played softball throughout high school, although she needed a teammate to run the bases for her.

Megan and her brother lived like this for years. Finally, after Megan had graduated from college and was living on her own in San Francisco, a psychiatrist at the University of Connecticut began to unravel the mystery.

After hearing a description of the Kenny children, the psychiatrist said some of their symptoms resembled those of a rare disorder he was researching: dopamine beta hydroxylase deficiency (DBHD).

As the name suggests, people with DBHD lack dopamine beta hydroxylase, an enzyme needed to convert the neurotransmitter dopamine into norepinephrine and epinephrine (also known as adrenaline), hormones that are critical to maintaining normal blood pressure.

The psychiatrist suggested the Kennys fly Brendan, who was still in high school and living at the family home in Connecticut, to see a specialist at Vanderbilt University, in Nashville, Tenn.

“It was like winning the lottery,” Megan says.

Next page: An “extraordinarily rare” condition

An “extraordinarily rare” conditionDavid Robertson, M.D., a neurologist at Vanderbilt’s Institute for Clinical and Translational Research, is the country’s leading DBHD expert. In 1986, he was the first person to identify the disorder, in a 33-year-old woman who hadn’t opened her eyes for the first five days of her life—a common feature of DBHD.

After performing blood work and numerous other tests on the woman, Robertson and his colleagues recognized that her abnormally low norepinephrine levels were caused by a genetic defect in dopamine beta hydroxylase.

It was thought that no one could survive for long without norepinephrine, but that woman lived to be 62. If people with DBHD are in a situation where they’re unable to sit or fall down safely, the resulting loss of blood flow to the brain can be fatal, but most people with the condition learn how to compensate and can live a relatively long life, Robertson says.

Robertson confirmed the suspicions of the UConn psychiatrist and diagnosed 15-year-old Brendan with DBHD. The diagnosis put Brendan in very exclusive company.

“DBHD is extraordinarily rare,” says Robertson, who is also the principal investigator of the Autonomic Rare Disease Consortium at the National Institutes of Health. It is so rare, in fact, that the 10 patients Robertson personally has seen represent the lion’s share of the documented cases worldwide. Another eight patients have been identified in Europe and Australia, though Robertson says there could be thousands more still undiagnosed.

A night and day treatmentIn the late 1980s, Robertson began to formulate a drug to treat the norepinephrine deficiency associated with DBHD, but he soon learned that such a drug was already being marketed in Japan. Droxidopa, also known as L-DOPS, was being used in that country for Parkinson’s disease, a movement disorder characterized by dopamine deficiency.

Roberston’s first patient responded immediately to droxidopa. “The drug allowed us to replace the norepinephrine not only in the blood, but even in the nerve cells of the body,” Robertson says.

Brendan, too, responded to droxidopa within days. Two years later, he ran a victory lap of sorts across the Golden Gate Bridge in San Francisco, while his sister watched.

Megan had visited Vanderbilt soon after Brendan. Not surprisingly, Robertson diagnosed her with DBHD, but due to a protocol change in the clinical trial he was leading, Megan had to wait three years before she could take droxidopa herself. When she finally did the results were just as dramatic.

“I felt different immediately,” Megan says. “This feeling of strength—being able to walk up a hill in San Francisco at the same pace as my friends, or actually [being] able to do it without sitting down—was incredible.”

Megan herself took a sprint across the Golden Gate Bridge as part of her training for the New Orleans Marathon. She finished that race in a little over six hours in the winter of 2005.

In 2010, she completed an Olympic-length triathlon: a 1,500-meter swim, 40-kilometer bike ride, and 10K run. “For me it was like checking this off the list,” Megan says. “I was so grateful for my new physicality.”

Megan takes 300 milligrams of droxidopa three times a day, and even now, a decade after her diagnosis, feels lightheaded if she misses a dose. She no longer runs marathons but climbs San Francisco’s steep hills with ease.

“It’s such a small thing in the grand scheme of things, being able to walk a block up the hill,” she says. “People take it for granted. I was like, ‘This is incredible.'”

The Subtle Stroke Warning Sign My Family Missed

Do you know all the symptoms of a stroke? I thought I did—until my dad had a devastating stroke and we missed an early warning sign.

Fourth of July weekend, two months before his massive stroke, my father complained about his vision being funny in one eye. “It looks like a film negative,” he said.

A couple of days later, my parents visited his eye doctor, who assured him he had surprisingly good vision for a 75-year-old with diabetes, and sent him on his way.

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What that specialist didn’t say: A sudden change in vision, particularly in only one eye, can signal a lack of bloodflow to the eye, suggesting a pre-stroke, or Transient Ischemic Attack (TIA), which is often a sign of an impending stroke. Other people have described the vision change that my father compared to photography, a lifelong hobby of his, as suddenly seeing through a window shade.

“It’s difficult to know all the symptoms of stroke, because there are at least 30 possible symptoms and they’re not all specific to stroke,” says Koto Ishida, MD, Director of the Comprehensive Stroke Care Center at NYU Langone Medical Center.

Alarmingly, many of us don’t even know the classic signs of a stroke: one recent study found that most people under 45 would not rush to the ER if they had telltale symptoms such as limb weakness and slurred speech.

But strokes can happen at any age. And they’re on the rise in younger adults: The rate of women 35 to 40 being hospitalized for clot-related, or ischemic stroke (by far the most common kind), shot up by 30 percent between 1995 and 2008; experts blame rising rates of health conditions such as high blood pressure and diabetes.

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If it’s a stroke, there’s zero time to waste. You need to get to the ER within four and a half hours of an ischemic stroke to get the emergency clot-busting drug called tPA that can greatly improve your odds of a good recovery. And if it’s a hemorrhagic stroke—caused by bleeding in the brain—you may need surgery, stat.

“For every minute that goes by, two million brain cells are irreversibly dead,” warns Dr. Ishida. “We’re trying to save your remaining brain.”

Interestingly, the one symptom you won’t have with an ischemic stroke is pain—and that’s too bad, say experts like Dr. Ishida: “Pain is the best motivator to get someone to go to the emergency room in the middle of the night.”





Turns Out You Could Have High Blood Pressure Even If Your Doctor's Office Readings Are Normal

Health experts often assume that blood pressure measured in a medical office or hospital may be higher than usual, thanks to the anxiety brought on from being in a doctor’s office (a phenomenon known as white-coat hypertension). As a result, physicians may not take borderline- too seriously in otherwise healthy adults.

A new study suggests that white-coat hypertension is actually less common than its exact opposite: a condition known as masked hypertension, in which blood pressure measurements at the doctor’s office are actually lower than those taken at other times of the day. Doctors may be missing a significant percentage of people who should be monitored (and potentially treated) for high blood pressure, the authors say, especially among young, normal-weight patients.

For the new study, published yesterday in the journal Circulation, researchers from Stony Brook University and Columbia University recruited 888 healthy men and women with an average age of 45. They asked participants to wear a portable blood pressure cuff for 24 hours as they went about their daily activities to monitor their ambulatory (around-the-clock) blood pressure. Multiple blood pressure readings were also taken during three separate visits to a clinic to represent measurements taken in a doctor’s-office setting.

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When the researchers compared those numbers, they found that ambulatory blood pressure—an average of all measurements taking while they were awake—tended to be higher than their in-office averages, not lower. On average, ambulatory systolic readings were 7 points higher than those taken in clinical settings, while diastolic readings were 2 points higher. 

About 16% percent of patients who had normal in-office readings turned out to have high blood pressure the rest of the day. Overall, masked hypertension affected about 15% of all study participants, while white-coat hypertension affected only 1%.

Masked hypertension was more common in men than in women, and in younger adults who were not overweight. As participants grew older and heavier, the gap between their in-office and ambulatory blood pressure narrowed and, in some cases, disappeared or reversed.  

“These findings debunk the widely held belief that ambulatory blood pressure is usually lower than clinic blood pressure,” said lead author Joseph E. Schwartz, PhD, professor of psychiatry and sociology at Stony Brook University, in a press release. “It is important for healthcare providers to know that there is a systematic tendency for ambulatory blood pressure to exceed clinic blood pressure in healthy, untreated individuals evaluated for hypertension during well-patient visits.”

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The findings were true among white, African American, and Hispanic participants, although the authors say they should be confirmed in more diverse study populations. (The majority of patients in this study were white.) They also note that this trend may not apply for people who have previously been diagnosed with, or are currently being treated for, high blood pressure.

Ambulatory blood pressure is generally recognized as a better predictor of future cardiovascular disease than in-office blood pressure readings; previous research has shown that elevated blood pressure throughout the day significantly increases the risk of cardiovascular events, compared to consistently “normal” readings. Unless doctors recognize a potential problem during an office visit, though, most patients are never given ambulatory tests.  

The study authors suggest that many adults—especially young and normal-weight people whose in-office readings put them in the prehypertension category—would likely benefit from completing a 24-hour monitoring. (The closer a person’s in-office reading is to high blood pressure, the more likely that person is to have masked hypertension, they say, so people on the low end of normal probably aren’t at risk.)

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When seeing patients for routine physicals or other reasons not related to heart health, “physicians should probably be more concerned that the clinic [blood pressure] underestimates, rather than overestimates, the patient’s average daytime [blood pressure],” the authors wrote. 

They hope that their findings will encourage doctors to recommend this next step for more people, and that future research will determine if and how people with high ambulatory blood pressure should be treated. 

Yoga May Help Lower Blood Pressure

If you’ve been warned by your doctor about borderline , you may want to give yoga a try. According to a small new study, people with prehypertension who practiced yoga for an hour a day for three months lowered both their average diastolic and arterial pressure.

The study was presented at the Cardiological Society of India’s annual conference. (It has not yet been published in a peer-reviewed medical journal.) The study authors say the results are promising, and that adopting a daily yoga habit could potentially protect those with prehypertension from the damaging effects of high blood pressure.

“Both prehypertension and high blood pressure increase the risk of heart attack, and heart failure,” said lead author Ashutosh Angrish, MD, a cardiologist at Sir Gangaram Hospital in Delhi, India.

Prehypertension is defined as a systolic reading (the first number in a blood pressure reading) of 120 to 139 mm Hg or a diastolic reading (the second number) of 80 to 89 mm Hg, while full-blown hypertension requires a systolic reading greater than 140 mm Hg or diastolic reading greater than 90 mm Hg. People who have prehypertension will likely develop hypertension “unless they improve their lifestyle,” Dr. Angrish says. 

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Dr. Angrish wanted to investigate the impact of Hatha yoga—a traditional branch of yoga that combines stretching poses, controlled breathing, and meditation—on people who’d been diagnosed with prehypertension but were otherwise healthy. So he and his colleagues recruited 60 such patients, average age 54, and prescribed all of them lifestyle strategies for lowering blood pressure. These included moderate aerobic exercise, a healthy diet, and quitting smoking. 

Half of those patients also received a month of daily yoga lessons, taught by an instructor. After the first month, this group was told to practice on their own for an hour a day.

At the beginning and end of the three-month study period, participants had their blood pressure measured over a 24-hour period. During that time, there were no changes in the group that was assigned lifestyle changes only.

In the yoga group, however, both 24-hour diastolic blood pressure and nighttime diastolic blood pressure decreased by approximately 4.5 mmHg. Average arterial pressure decreased as well, by about 4.9 mmHg.

“Although the reduction in blood pressure was modest, it could be clinically very meaningful,” Dr. Angrish said in a press release. Even a 2 mm Hg decrease in diastolic blood pressure has the potential to decrease the risk of coronary heart disease by 6%, and the risk of stroke by 15%, he added.

The reasons why yoga has these effects aren’t clear from this research, but other studies have suggested that yoga may calm the sympathetic nervous system, which plays a role in regulating blood pressure.

“The findings suggest that a combination of all three components of yoga (asanas, pranayama, and meditation) is helpful, but our study is unable to pinpoint their individual contribution,” said Dr. Angrish.

Shirish Hiremath, MD, president-elect of the Cardiological Society of India, said in a press release that yoga—a traditional part of Indian culture—has shown clear benefit in cases of prehypertension. Plus, he added, it’s easy to learn and inexpensive to practice.

“Yoga can turn out to be just the correct answer for people at risk,” he said, noting that a large number of young Indians are affected by hypertension. (A 2014 review found that 29% of India’s population, or one in three people, has high blood pressure; current estimates for the United States are similar.)

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Roberto Ferrari, MD, course director of the European Society of Cardiology program in India, agreed that yoga can be an important part of a heart-healthy strategy—but stresses that it’s just one component. “Cardiovascular disease can be prevented by adopting a healthy lifestyle and controlling blood pressure and cholesterol,” he said. “Exercise, including yoga, a good quality diet, and not smoking are all steps in the right direction.”

Dr. Angrish’s findings should be considered preliminary. Even so, he said, there’s little reason not to advise people worried about their blood pressure (and who are otherwise healthy) to start a daily yoga practice. “It may prevent the development of hypertension,” he said, “and in addition give a sense of well-being.”

Blood Pressure: Salt's Affect on the Body

It’s one of the first things people are told to do when they’re diagnosed with high blood pressure: Cut back on salt. But not enough Americans are taking that advice, a new study shows. Researchers found that between 1999 and 2012, daily sodium intake increased by more than 14% in people with high blood pressure. 

The study, which will be presented at the American College of Cardiology’s annual scientific session, revealed that people with high blood pressure consumed more than twice their recommended daily amount in 2012—a whopping 3,350 milligrams per day on average.

According to United States dietary guidelines, people who have or are at high risk for high blood pressure should have no more than 1,500 milligrams a day. That’s significantly less than the 2,300-milligram daily limit set for most people with normal blood pressure (the amount in one teaspoon of table salt), because studies have shown that sodium and are inextricably, and dangerously, linked. 

The exact mechanism for this link is unknown, says study author Elena Dolmatova, MD, a resident at Rutgers New Jersey Medical School. But scientists do have a few theories. One is that salt attracts water to the blood stream, increasing blood volume and therefore increasing pressure within the blood vessels. This increased pressure then creates strain on the heart and the entire cardiovascular system.

A few studies have also linked sodium consumption with secretion of a hormone called endogenous ouabain, which exhibits a “vasotonic effect” and causes blood vessels to contract, says Dr. Dolmatova.

Still other research has implicated a hormone called angiotensin II, which also constricts blood vessels. In people with normally functioning hormone systems, the body decreases its levels of angiotensin II in response to increased sodium consumption. But it’s believed that for people with certain genetic alterations, this doesn’t happen the way it should.

Regardless of how sodium contributes to high blood pressure, the important thing is that it does. And because people with high blood pressure already have a higher risk of developing cardiovascular problems, lowering sodium intake is especially important for them.

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In fact, the people with the lowest sodium intake in the new study tended to be the same ones who’d had a heart attack or , were taking blood pressure medications, or who had diabetes, , or heart failure. In other words, it took a drug prescription or a serious health issue—not just a diagnosis of high blood pressure—to get people to take the dangers of sodium seriously.

That shouldn’t be the case, says Dr. Dolmatova, because often this simple dietary change can help people avoid complications or medications with unwanted side effects. “People shouldn’t wait until they have a heart attack before taking action to limit sodium,” she says.

Dr. Dolmatova says it’s possible that some doctors are quick to prescribe medications before promoting lifestyle modifications, which may explain part of the increased rise in sodium intake. It’s also likely that increased access to restaurant and processed food plays a role. “People tend to pay more attention to calorie content of the food that they buy, and usually disregard sodium content,” she says.

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But the truth is that most Americans (with the exception of people with rare low­–blood pressure disorders) should be paying attention to their sodium intake, says Dr. Dolmatova—especially because most of us exceed even the higher maximum amount recommended for healthy people.

And even though salt is ubiquitous in American diets today, cutting back can be relatively simple: Eat less processed food, buy low-sodium or sodium-free products like soups and condiments, avoid the obviously salty restaurant items (hello, cheese fries), and use less salt when cooking your own meals at home. Watch out for these sneaky sources of sodium, too.