Eating the right diet and getting regular exercise are effective strategies to lower elevated blood pressure.
Clinical trials have found this to be true in people with hypertension (high blood pressure) who don’t take blood-pressure-lowering drugs, as well as those who are treated with one or two medications.
Yet among people with high blood pressure that doesn’t respond to drug therapy, called resistant hypertension, studies investigating the potential benefit of diet and exercise have been almost non-existent.
A randomized controlled trial from Duke University School of Medicine in Durham, N.C., demonstrated that the combination of diet, reducing sodium intake and exercise led to significant blood-pressure-lowering effects in people with resistant hypertension.
What is resistant hypertension?
Hypertension, affecting almost one in four Canadians, is a leading preventable risk factor for heart disease, heart attack and stroke. Up to 30 per cent of people diagnosed with hypertension have resistant hypertension, defined as having a blood pressure reading that remains above target despite taking three or more blood-pressure-lowering drugs at optimal doses.
Over time, uncontrolled blood pressure is associated with a 50-per-cent greater risk of heart attack, stroke and cardiovascular death compared to controlled blood pressure.
About the new research
The TRIUMPH study, published on Sept. 27 in the American Heart Association’s journal Circulation, was the first to test the effect of comprehensive lifestyle modification on resistant hypertension. (TRIUMPH stands for Treating Resistant Hypertension Using Lifestyle Modification to Promote Health.)
For the four-month trial, 140 participants with resistant hypertension received either an intensive lifestyle intervention or standardized education and physician advice.
Those in the lifestyle intervention group were instructed how to follow the DASH diet with a calorie and sodium restriction. (DASH stands for Dietary Approaches to Stop Hypertension.) These participants also received feedback on their adherence to the diet during weekly 45-minute group sessions led by a dietitian and psychologist.
The lifestyle intervention also included 30 to 45 minutes of biking and/or walking (and eventually jogging) three times a week under the supervision of an exercise physiologist.
Participants in the comparison group attended a one-hour educational session and received DASH diet materials. They were also given weight-loss targets and exercise goals which they were to achieve on their own.
All participants adhered to their blood pressure medication regimens during the study.
After 16 weeks, both groups experienced a significant reduction in blood pressure, comparable to that seen with blood-pressure-lowering medications.
Participants in the intensive lifestyle intervention group, however, achieved the greatest reduction in blood pressure. They also lost significantly more weight over the study period, 15 pounds versus 8.5 for those in the comparison group.
Diet and exercise modifications are often recommended before starting a medication to lower blood pressure. These new findings demonstrate that they are also an effective strategy when medications alone are not doing enough to manage blood pressure.
What’s in the DASH diet?
The DASH diet, first proven to lower blood pressure in people with mild hypertension in 1997, focuses on fruits and vegetables, low-fat dairy products, and beans, lentils, nuts and seeds. These foods supply plenty of calcium, magnesium and potassium, minerals that help regulate blood pressure.
The diet plan also emphasizes whole grains and limits red meat and sweets. It also limits foods high in saturated fat such as fatty meats, high-fat dairy products, butter and coconut oil. Sodium intake is restricted to 1,500 to 2,300 milligrams per day. (One teaspoon of table salt contains 2,300 milligrams of sodium.)
The DASH diet advises specific daily or weekly servings of food groups depending on your calorie needs.
A 1,600-calorie DASH diet recommends, for example, eating three to four vegetable servings, four fruit servings, six whole grain servings, two to three low-fat dairy servings, three to six lean protein servings and two unsaturated oil servings daily. A serving of beans, lentils, nuts or seeds is recommended three times per week.
One serving is equivalent to one half-cup cooked vegetables or one cup salad greens, one medium-sized fruit or one half-cup fresh fruit, one slice whole grain bread or one half-cup cooked grains, one cup milk or yogurt, one ounce cooked fish or meat, one teaspoon vegetable oil or two tablespoons salad dressing and one-third-cup nuts or one half-cup cooked beans or lentils.
Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD
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Parents more hesitant to vaccinate kids than themselves, researcher says – Clearwater Times
Jennifer Hubert jumped at the opportunity to get her COVID-19 vaccine, but she’s not looking forward to having to make the decision about whether to vaccinate her three-year-old son Jackson.
She recognizes the safety and effectiveness of vaccines, but said she also understands her son is at a much lower risk for serious illness than older adults.
“To me it’s not a clear benefit,” she said.
While many parents were overjoyed at the news that Health Canada is considering approval of the first COVID-19 vaccine for kids age five to 11 in Canada, parents like Hubert are feeling more trepidatious, and public health officials said they are going to have a much more nuanced conversation with parents about vaccination than they did with adults.
While 82 per cent of eligible Canadians aged 12 and up are already fully vaccinated, a recent survey by Angus Reid shows only 51 per cent of parents plan to immediately vaccinate their kids when a pediatric dose becomes available.
Of parents with children in the five to 11 year age range, 23 per cent said they would never give their kids a COVID-19 vaccine, 18 per cent said they would wait, and nine per cent said they weren’t sure, according to the survey of 5,011 Canadians between Sept. 29 and Oct. 3, which cannot be assigned a margin of error because online surveys are not considered random samples.
“Most of the research that I’ve seen sort of indicates that parents are more hesitant to vaccinate their kids against COVID than themselves,” said Kate Allan, a post-doctoral fellow at the Centre for Vaccine-Preventable Diseases at the University of Toronto.
There are several reasons parents might pause, she said.
It’s true that children are at a much lower risk of serious outcomes associated with COVID-19, and there have been very rare incidents of mRNA vaccines like Pfizer or Moderna linked to cases of myocarditis, a swelling of the heart muscle.
As of Oct. 1, Health Canada has documented 859 cases associated with the vaccines, which mainly seem to affect people under 40 years old, and people who’ve developed the complication have typically been fine.
“I know it’s rare, I know it’s not deadly, but I also see the risk of severe symptoms from COVID as being rare and not deadly for Jackson,” Hubert said when asked about weighing up the risks and benefits of the vaccine.
But public health experts stress that some children do suffer from rare but serious impacts from COVID-19, which can also cause myocarditis as well as the little-understood impacts of the condition known as long COVID.
They say parents should consider the less tangible benefits of vaccination as well.
“It’s less of a conversation about a direct benefit to them, and more of a community benefit,” Allan said.
The pandemic has taken a heavy toll on children, depriving them of school, time with their peers, extracurriculars — and their mental health has suffered as a result, said Dr. Vinita Dubey, associate medical officer of health with Toronto Public Health.
“Not one child has been spared from this pandemic. I mean every single child has had to bear a sacrifice because of the pandemic in one way or the other,” Dubey said.
So far Pfizer-BioNtech is the only manufacturer to request approval for its pediatric COVID-19 vaccine and Health Canada is still reviewing the data.
The regulator has promised the review will be thorough, and the vaccine will only be approved for children if the benefits outweigh the potential risks.
Policy-makers know they’re going to have to take parents’ concerns seriously as well.
On a recent tour of the Children’s Hospital of Eastern Ontario in Ottawa, Prime Minister Justin Trudeau spoke with Dr. Anne Pham-Huy, a pediatric infectious diseases physician.
“Vaccine confidence is going to be the most important part of it this time around,” Pham-Huy said, to which Trudeau agreed.
Dubey has published research on improving parents’ vaccine confidence when it comes to long-established inoculations like mumps and rubella.
While she offered several tips, they mainly come down to building trust. Her research focused on the role of family doctors, but she said during the pandemic anyone can be that trusted sounding board.
“It could be a faith leader, it could be an important family member or friend, someone who you trust, to help guide you to the right sources to make that decision,” she said.
With that in mind, several students from across North America launched a peer-to-peer education program called Students for Herd Immunity to allow kids to have those conversations among themselves.
The public health experts agree, the debate around vaccines has become polarized and open conversations will be the key to addressing parents’ concerns.
“I think one thing to say to parents is you don’t have to make your decision right away,” Dubey said. “I mean for those who are ready to make their decision, but it’s fine but if you have questions, seek the answers.”
Her only advice is to get those answers from a trusted source, and not social media.
Laura Osman, The Canadian Press
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EOHU recommending flu shots for area residents, as winter approaches – The Review Newspaper
As the fall and cooler weather arrive, they bring with them the start of flu season. According to the Eastern Ontario Health Unit, the flu shot is the best protection against the flu, and with the presence of COVID-19 in the community, getting your flu shot is more important now than ever. The flu shot has been approved for use alongside COVID-19 vaccines and is a key step in keeping healthy this season.
“It’s especially important that people get their flu shot this year,” says Dr. Paul Roumeliotis, Medical Officer of Health at the Eastern Ontario Health Unit (EOHU). “Both COVID and the flu share symptoms and, despite their similarities, being fully vaccinated for COVID won’t protect you from the flu.”
“Getting the flu shot can help you stay healthy and reduce the pressure on health care centres.”
Getting the flu shot could also help reduce the demand on COVID-19 assessment centres. The fewer number of people who develop flu symptoms, the fewer who will need to get tested for COVID-19.
The flu shot is available at various locations throughout the five Eastern Counties and Cornwall, including through some healthcare providers, community health centres, participating pharmacies and by appointment at the EOHU for children ages 6 months to under 5 years, and their immediate family.
Appointments for children at the EOHU will be available as of November 1. Call to book your child’s appointment starting on October 25. Residents must bring a piece of identification to their appointment. To find out more about where you can get the flu shot, visit EOHU.ca.
Certain groups of people are at higher risk of complications from the flu and are strongly encouraged to get immunized. These include:
- children 6 months to less than 5 years of age
- people aged 65 and older
- people with chronic medical conditions
If you live with or provide care to someone who falls under one of the groups listed above, or care for newborn infants and children under 6 months of age, it is also highly recommended that you get immunized. This simple step will help protect you and those around you.
For more information about the flu shot, visit EOHU.ca or call 613-933-1375 or 800-267-7120.
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