Health Topics – Johns Hopkins Medicine Podcasts

Home blood pressure measurements help confirm a diagnosis of high blood pressure, a federal task force states. Greg Prokopowicz, a blood pressure expert at Johns Hopkins, says a number of such measurements are needed for a couple of reasons.

Prokopowicz: It’s worth pointing out that to really measure blood pressure properly in the office, you’re supposed to have the patient sit down and relax for five minutes before you even check the blood pressure but very few clinics can actually implement that because the workflow is such that you just don’t have the time to do that, so we’re really not measuring blood pressure entirely correctly in most clinics. So that heightens the need to get additional data outside of the clinic. And that would imply maybe ten or twenty home readings.  :31

Prokopowicz says having a large number of blood pressure readings taken at different times of day helps develop the most accurate picture of whether someone really has high blood pressure and needs treatment. At Johns Hopkins, I’m Elizabeth Tracey.

You’ve been told you have high blood pressure and now need confirmation. Can you accomplish that goal with a home blood pressure monitor? Greg Prokopowicz, a blood pressure expert at Johns Hopkins, says the latest guidelines say you can.

Prokopowicz: There’s been a greater acknowledgement that home blood pressure monitoring is probably going to be where we should focus our energy. The current guidelines recommend getting an office reading and then confirming it with home readings, so that’s a sensible recommendation, because there are a lot of people who will have a high reading in the office due to the stress of the environment, maybe they’re not given an adequate chance to relax before their blood pressure is measured, and their home readings would be completely normal. And we don’t want to put those people on medications, so it is really important to do that.  :32

Prokopowicz says a home monitor also helps make sure your medicines are working to keep blood pressure under control. At Johns Hopkins, I’m Elizabeth Tracey.

Many people have elevated blood pressure when they visit their doctor’s office, so if you’ve been told your blood pressure is high that needs to be confirmed before you are put on any medicines to lower it. That’s according to new guidelines from the US Preventive Services Task Force. Greg Prokopowicz, a blood pressure expert at Johns Hopkins, explains.

Prokopowicz: A single office blood pressure measurement doesn’t tell the whole story. So you want to confirm that with some sort of out of office blood pressure monitoring. And in previous guidelines they’ve often emphasized ambulatory blood pressure monitoring, which is where you wear a monitor and walk around with it for 24 hours and it takes a blood pressure reading every twenty to thirty minutes. That set of measurements is the best way to get a sense of where you stand with respect to blood pressure it terms of your risk for future problems related to your blood pressure meaning heart attack, stroke, and kidney disease. :32

At Johns Hopkins, I’m Elizabeth Tracey.

The United States Preventive Services Task Force has just updated their guidelines on managing blood pressure. Greg Prokopowicz, a blood pressure expert at Johns Hopkins, says managing your blood pressure starts with getting it measured.

Prokopowicz: Starting at age 18, you should have your blood pressure checked. Another question is how often should you have it checked? So if you’re under 40 and your blood pressure is quote unquote normal, which by current guidelines would actually be under 120 over 80, so that would mean your blood pressure would have to been in the one-teens over 70s or lower. If your blood pressure is normal then they say check it every several years maybe every three years but if it’s in the high normal range, in the 120s over 70s, then you’d probably want to monitor it approximately yearly.   :33

Prokopowicz says some people may need to measure their blood pressure much more often, in particular when they’ve had a number of readings that indicate it is high. He says your provider can tell you if this is a necessary step for you. At Johns Hopkins, I’m Elizabeth Tracey.

Consumption of sugar sweetened beverages may explain part of the increase in colorectal cancer before the age of 50 we’re seeing nationally, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains the data.

Nelson: Out of this group of 95,000 women they could find 109 women who got colorectal cancer at this young age group, less than 50. The women who reported drinking two sugar sweetened beverages a day had twice the increased risk of this early onset colorectal cancer as women who didn’t and there was basically a 16% increased risk for each sugar sweetened beverage beyond that, that appeared especially significant when they were aged 13 to 18.  :30

Nelson notes that the United States Preventive Services Task Force has now recommended screening for colorectal cancer beginning at age 45 because of this increased incidence, and says people should be mindful of their own family history also. At Johns Hopkins, I’m Elizabeth Tracey.

There are a wide range of choices when it comes to medicines to manage diabetes. Rita Kalyani, a diabetes expert and author of a recent review paper in the New England Journal of Medicine, says if you have additional health conditions such as heart or kidney disease, there are medicines that may help both.

Kalyani: Over the past three to four years, cardiovascular outcome trials have actually shown superiority of some agents in their cardiovascular benefits. Also renal benefits of these glucose lowering drugs. In the SGL2 inhibitor class and the GLP1 receptor agonist class we now have multiple agents that are not only approved for their glucose lowering mechanism but also for their benefit in reducing recurrent heart attacks, stroke, or reducing mortality, or also for reducing the progression of chronic kidney disease.  :33

Kalyani says talk with your provider, and make sure to revisit this issue periodically to see if there’s a better drug for you. At Johns Hopkins, I’m Elizabeth Tracey.

The longer someone has had diabetes the greater the chance they’ll develop dementia, a recent study of thousands over 30 years of follow up has shown. Rita Kalyani, a diabetes expert at Johns Hopkins, says while associations between diabetes and many conditions is known, it’s unclear why.

Kalyani: We’ve tried to look at this for various geriatric conditions whether its frailty, muscle loss, falls, it’s really hard to tease out these associations between say it’s insulin and these outcomes, which we know is more related to hypoglycemia. That should also be noted, there is good literature that reports hypoglycemia as related to cognitive decline and dementia too, and so it’s both sides. High blood glucose and low blood glucose that likely contribute to the risk. :29

Kalyani says another big question is whether good blood sugar control attenuates the risk of both high and low blood sugar, and only additional long term studies with many people will help answer that question. At Johns Hopkins, I’m Elizabeth Tracey.

People who’ve had diabetes longer are at greater risk to develop dementia than those who’ve had diabetes for shorter periods of time, a large UK study following people for an average of 30 years has found. Rita Kalyani, a diabetes expert at Johns Hopkins, interprets the findings.

Kalyani: What they found in this very interesting study is that among more than 10,000 participants that they followed those who went on the develop dementia had a relatively earlier age of onset of diabetes and so this study in particular was very informative. It suggested that those at greatest risk of developing cognitive decline or dementia were those that were diagnosed with diabetes at an earlier age.   :26

Kalyani notes that studies like this clearly point to the need to control risk factors for diabetes, such as obesity and sedentary lifestyle, and says some researchers already refer to Alzheimer’s disease as type 3 diabetes since the link has been observed for some time. At Johns Hopkins, I’m Elizabeth Tracey.

Even people with some advanced cancers can benefit from genetic analysis of their tumors, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the contribution of genetics to overall risk for developing cancer.

Nelson: There have been studies that look at inherited tendencies, environmental exposures, and just the error prone aspects of the way cells divide. There’s a significant inherited contribution to cancer that’s on the order of 30-40%. If you look at the environmental exposure logic, it’s 80% or more of all cancers are caused by environmental influences, and the propensity for one cell to divide into two and make some mistakes that ultimately would lead to cancers, that’s also at an estimate that comes in at roughly 40%.   :32

Nelson says the reason this adds up to more than 100% is because of the overlap between factors, and notes that risk can clearly be impacted by individual choices. At Johns Hopkins, I’m Elizabeth Tracey.

Lung cancers are declining in the US as fewer people smoke cigarettes, but a recent look at cancer incidence worldwide finds that others are rising. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, looks at the domestic data.

Nelson: The ones that we have our eye on here in the US are cancers of the liver, cancers of the pancreas, they are definitely rising. Liver cancer rise in the US seems to be related to the obesity epidemic.  :13

Does this data indicate where we should be directing research? Not necessarily, Nelson says.

Nelson: Some of the ones for which the global disease burden is greater I’m not sure randomized clinical trials are the answer. So cervical cancer I’m not sure we need randomized clinical trials for advanced disease, we need to stop cervical cancer by vaccinating people against HPV. Liver cancer the global burden is caused by a virus that we need to vaccinate away.  :17

At Johns Hopkins, I’m Elizabeth Tracey.