Hypertension Guideline Update

 

Hypertension represents a major modifiable risk factor for coronary artery disease, heart failure, stroke, chronic kidney disease and dementia. Two well-established clinical practice guidelines on hypertension include the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults and the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension.

The ESH recommends a threshold of >140/90 mm Hg (Grade 1) for the diagnosis of hypertension, whereas the ACC/AHA guideline recommends a lower threshold of >130/80 mm Hg (Stage 1). Systolic blood pressure (SBP) ranging between 130 and 139 mm Hg or diastolic blood pressure (DBP) ranging between 80 and 89 mm Hg represent Stage 1 hypertension in the ACC/AHA guideline, whereas the ESH guidelines classify these ranges as "normal" or "high-normal" (130-139/85-89 mm Hg). Whereas the ACC/AHA guideline categorizes BP ≥140/90 mm Hg as Stage 2 hypertension, the ESH guidelines subdivide BP levels ≥140/90 mm Hg into Grades 1, 2, and 3 hypertension.

                     * Target <130/80 if tolerated

With increasing age, blood pressure rises as a consequence of arterial stiffness, caused by the biological process of ageing and arteries becoming clogged with fatty substances, otherwise known as arteriosclerosis.

Since arterial hypertension (high blood pressure in the arteries) is the most important preventable cause of cardiovascular disease, lowering blood pressure can lower the risk of heart attacks, stroke, and all-cause mortality, even in people over 80.

However, for mental abilities, age seems to play an important role. At old age, low blood pressure is associated with worse cognitive function and increased mortality than people with higher blood pressure especially when they are frail.

Thus doctors thinking about prescribing blood pressure lowering therapy in older patients should consider the specific patients. A more individual approach instead of “one size fits all” seems most appropriate and is also more patient-centered. This is especially important for very old and frail patients not just to follow the guidelines.

The Effects of Apple Cider Vinegar on Weight Loss and Diabetes

 

Apple cider vinegar is a popular home remedy. People have used it for centuries in cooking and natural medicine.

It is made by combining apples with yeast to create alcohol, which is then fermented into acetic acid by added bacteria. Apple cider vinegar also contains water, vitamins, minerals and trace amounts of other acids.

Research suggests that apple cider vinegar may have beneficial health properties, including antimicrobial and antioxidant effects:

1. May aid weight loss

Some evidence suggests that apple cider vinegar may help with weight and fat loss when combined with a calorie-restricted diet. This is because vinegar slows digestion and suppresses appetite, at least in the short term. Long-term studies have found no effect of vinegar on appetite.

Several human studies show that vinegar can increase feelings of fullness. This can lead to eating fewer calories and losing weight.

In short-term studies when participants consumed apple cider vinegar with a meal containing solid foods, they experienced appetite suppression for 120 minutes after the meal. They also snacked less for 3-24 hours after consuming the apple cider vinegar.

Another 2024 randomized control trial study showed significant reductions in weight (6-8 kg), body fat ratio, waist and hip circumferences, body mass index (BMI), blood sugar, as well as fats and cholesterol in the blood after daily consumption of 3 doses of apple cider vinegar (15 milliliters per tablespoon (mL/tbsp)) for 12 weeks. 

2. May help lower blood sugar levels and manage diabetes

Research suggests that consuming apple cider vinegar can slow the emptying of the stomach and hence prevent large spikes in blood sugar.

A 2019 clinical trial suggests apple vinegar consumption may have beneficial effects on the glycemic index and oxidative stress in individuals with diabetes and dyslipidemia. A 2021 review of clinical trials also found that its consumption may benefit glycemic status in adults.

In a 2023 study of adults with type 2 diabetes, the group that received 30 milliliters of apple cider vinegar a day showed greater improvement in hemoglobin A1c levels than the control group.

People without diabetes can also benefit from keeping their blood sugar levels in the typical range, as some researchers believe that high blood sugar levels are a major cause of aging and various chronic diseases.

But if you are taking blood-sugar-lowering medications, talk with a doctor before increasing your vinegar intake.

3. May improve heart health

A 2020 review of studies in both humans and animals noted that apple cider vinegar may potentially benefit levels of high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol.

A 2021 review of research in humans also found that apple cider vinegar may benefit total cholesterol levels.

However, it is necessary to do more studies before reaching any strong conclusions.

4. Can help kill harmful bacteria

Apple cider vinegar may have antibacterial and antifungal properties. This is mostly attributed to its main ingredient, acetic acid.

A test-tube study found that apple cider vinegar was effective in treating Candida albicans fungus and Escherichia coli, which can cause severe intestinal infections, as well as Staphylococcus aureus, which can cause skin infections.

In fact, people have traditionally used vinegar for cleaning and disinfecting, treating nail fungus, lice, warts and ear infections.

5. May boost skin health

Some people use apple cider vinegar as a common remedy for skin conditions like dry skin and eczema.

The skin is naturally slightly acidic. Using diluted topical apple cider vinegar topically may help rebalance the skin’s natural pH, improving the protective skin barrier.

However, in some cases, especially people with skin conditions like eczema, apple cider vinegar may irritate the skin. Thus it is better to talk with a doctor before trying new remedies, especially on damaged skin. Avoid applying undiluted vinegar to the skin, as it can cause burns.

Potential downsides

May cause nausea and indigestion

Apple cider vinegar has a pH level of 4.2. Acidic foods can cause indigestion and acid reflux in some people, especially when consumed before lying down.

Can damage tooth enamel

Regularly drinking any vinegar and eating acidic foods has been shown to erode tooth enamel.

Other side effects

May lower potassium, cause skin and throat burns or interact with certain medications such as diuretics and some diabetes drugs.

It is best to start with small doses and avoid taking large amounts. Too much vinegar can cause harmful side effects. Here are a few ways to consume apple cider vinegar that may minimize side effects and offer the most benefits:

• Dilute it: Mix 1–2 tablespoons (tbsp) or (15–30 ml) of apple cider vinegar with 1 cup (237 ml) of water. Ingesting undiluted vinegar of any kind can damage the throat and esophagus.
• Consume it earlier in the day: Drinking apple cider vinegar about 2-3 hours before bed may lower the risk of indigestion or acid reflux after lying down.
• The best way to incorporate apple cider vinegar into the diet is to use it in cooking. It is a simple addition to foods like salad dressings and homemade mayonnaise.
• Some people also like to dilute it in water and drink it as a beverage. Standard dosages range from 1–2 teaspoons (5–10 mL) to 1–2 tablespoons (15–30 mL) per day mixed in a large glass of water.

The health effects of two herbs – Juniper berry and Catnip

 

Juniper Berry

The juniper tree, Juniperus communis, is an evergreen shrub that grows in many parts of the world, including North America, Europe and Asia. It produces seed cones that are commonly known as juniper berries.

People have used these small berries for culinary and medicinal purposes since ancient times, and current research suggests that they may offer various health benefits:

1. High in nutrients and powerful plant compounds

Like many other berries, they contain vitamin C, which is essential for immune health, collagen synthesis and blood vessel function. It also acts as an antioxidant, protecting the cells from damage caused by unstable molecules called free radicals.

Juniper berries contain plant compounds like flavonoid antioxidants, volatile oils and coumarins.

The volatile oils in juniper berries contain substances known as monoterpenes. Research has shown these to have anti-inflammatory, antifungal, antioxidant and antibacterial properties.

The volatile oils also increase hydrochloric acid in the stomach. This is needed to relieve gas in the digestive system, help with good digestion and reduce bloating.

2. Provide anti-inflammatory and antioxidant effects

Juniper berries, being rich in volatile oils and flavonoids, besides functioning as potent antioxidants, may also help reduce inflammation.

One study detected over 70 compounds in juniper berry volatile oil, with the monoterpenes alpha-pinene, beta-pinene, myrcene, limonene, and sabinene making up the majority. The study found that the oil reduced cellular damage in yeast cells by increasing the activity of certain enzymes.

Another test-tube study showed that juniper berry volatile oil significantly reduced inflammation in human skin cells. The researchers attributed this to the oil’s high concentration of monoterpenes.

Juniper berries are effective diuretic, and useful for eliminating excess water from the body. They are used in the digestive system and are popular and effective ingredient in many weight loss supplements.

Juniper berries are also helpful for those who suffer from joint pain, nerve and muscle disorders and rheumatoid arthritis.

3. May have antidiabetic properties

People used juniper berries in traditional medicine practices to treat diabetes. More recent studies confirm that they may have antidiabetic properties.

Researchers believe these antidiabetic effects are due to the berries’ high concentration of antioxidants. One study on mice found that they helped reduce body weight as mentioned above and improve blood lipid profiles.

4. Could promote heart health

Juniper berries may promote heart health by increasing HDL (good) cholesterol and reducing LDL (bad) cholesterol.

A 2007 study on rats with diabetes demonstrated that treatment with juniper berry extract reduced total cholesterol and triglyceride levels by 57% and 37%, respectively.

Though human studies are lacking, research shows that eating berries may reduce heart disease risk factors.

5. Antibacterial and antifungal activity

Test-tube and animal studies show that juniper berries have powerful antibacterial and antifungal properties.

One test-tube study found that juniper berry volatile oil significantly inhibited the activity of three bacteria that can cause serious infections in humans — M. gordonae, M. avium and M. intracellulare.

Nonetheless, considering the lack of human research on juniper berry supplements, it may be best to speak with a doctor before trying or using as home remedy.

Catnip

Catnip is a strong-smelling herb. It is native to Central Europe, though it can now be found in most of Canada and the Northeast United States.

Catnip has long been thought to have medicinal properties. Its dried leaves and white flowers are traditionally used for this purpose. Both can be used to make tea, which is sometimes used to treat conditions like insomnia, anxiety and headaches. In some cases, the roots of catnip can be used. However, these act as a stimulant instead of a relaxing agent.

Catnip is effective alone or in herbal remedies for colds, flu, fevers, upset stomach and insomnia. Catnip is particularly good for children with upset stomachs in a very mild infusion. Catnip has been used for prevention of nightmares, and has a mild anti-spasmodic effect and is used to alleviate symptoms such as stress, menstrual cramps and gut cramps.

Historically, catnip was used for diarrhea, gas and stomach cramps. It is said to relieve muscle spasms in the intestinal tract. Drinking catnip tea may soothe the digestive system.

Catnip is believed to have sedative properties that can remedy nervous disorders and migraine headache. Many groups of people have traditionally used catnip tea to relieve infants' colic and help babies to sleep at night.

As carminative with anti-spasmodic properties, catnip is antiflatulent. Its sedative action on the nerves adds to its genera.

Catnip is astringent, and can be applied externally to cuts and scrapes to stop bleeding and promote healing. The leaves of catnip have traditionally been chewed as a remedy for alleviating toothache. The dried leaves can also be used to make a pillow that can be slipped into a pillowcase to promote sleep.