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New 'triple pill' could eliminate high blood pressure

A new combination drug may have the potential to revolutionize hypertension treatment worldwide, after a clinical trial has declared it safe to use and very effective.
concept photo of heart pills and pulse
A recent clinical trial has confirmed that a new pill can treat hypertension more effectively than traditional therapy.

In a recent clinical trial led by researchers from the George Institute for Global Health — with branches in the United Kingdom, Australia, and India — they tested the effectiveness and safety of using an innovative drug for the treatment of high blood pressure, or hypertension.

This drug, nicknamed the "triple pill" by the investigators, combines low doses of three existing drugs for blood pressure.

Namely, these are: telmisartan (20 milligrams), amlodipine (2.5 milligrams), and chlorthalidone (12.5 milligrams).

According to World Health Organization (WHO) data from 2008, about 40 perecent of adults aged over 25 had raised blood pressure worldwide. The WHO also estimate that hypertension is responsible for 7.5 million of all deaths across the globe.

That is because this condition is a major risk factor for both heart disease and stroke, making it a priority to have effective treatments in place for the regulation of blood pressure.

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Normally, people with hypertension start taking one blood pressure drug at low doses, only to have to return to their doctors time and again. They then get prescriptions for increasingly higher doses and more hypertension drugs.

According to study co-author Dr. Ruth Webster, "Patients are brought back [to the doctor's office] at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage."

"The problem with this approach," she adds, is that it "is not only time inefficient, it's costly. We also know that many doctors and patients find it too complicated and often don't stick to the process."

So, Dr. Webster and colleagues tested a method that, they hoped, would be more efficient, would not have additional side effects, and would remove some of the inconveniences related to a traditional treatment.

This is how they came up with the "triple pill," which combines fixed low doses of three already existent drugs commonly used to treat hypertension.

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'Triple pill' vs. traditional therapy

The clinical trial testing the efficacy and safety of the new combination pill took place in Sri Lanka. It involved 700 participants — aged 56, on average — whose average blood pressure amounted to 154/90 millimeters of mercury (mm Hg), which is a typical sign of hypertension.

Of all the participants, some took the combination pill, while others continued to follow their usual blood pressure-lowering therapy, as per their doctors' advice.

In contrast to those following traditional therapy for hypertension, a larger number of those taking the combination pill were able to lower their blood pressure effectively, reaching their target pressure of 140/90 mm Hg or under.

The target for individuals with diabetes or kidney disease was 130/80 mm Hg, which many people taking the "triple pill" were able to reach.

More specifically, 70 percent of the people taking the "triple pill" achieved their target blood pressure, compared with a little over 50 percent of the participants who continued on traditional hypertension therapy.

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In the study paper they published in JAMA, the authors explain that after 6 months from the start of the trial, 83 percent of the people who had started on the "triple pill" were still following this same treatment.

To the contrary, most of the participants following a traditional treatment had added medication or increased drug quantities by the 6-month mark.

"The World Heart Federation [have] set an ambitious goal that by 2025 there will be a 25 percent reduction in blood pressure levels globally," says study co-author Prof. Anushka Patel.

"The triple pill," she continues, "could be a low-cost way of helping countries around the world to meet this target."

'This study has global relevance'

Researchers at the George Institute believe that their "triple pill" could really make a difference to current therapy for hypertension.

Right now, the team is looking into the combination drug's cost effectiveness for various countries and putting into place strategies to make the drug accessible across the world. "This study has global relevance," says Prof. Patel.

"While the most pressing need, from the perspective of the global burden of disease, is low- and middle-income countries, it's equally relevant in a country like Australia where we're still achieving only [40–50 percent] control rates for high blood pressure."

Prof. Anushka Patel

In the video below, you can listen to Prof. Patel as she explains exactly how the "triple pill" works.

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Foods to eat for better sex

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Barassi, A., Corsi Romanelli, M. M., Pezzilli, R., Damele, C. A. L., Vaccalluzzo, L., Goi, G., . . . Melzi d'Eril, G. V. (2017, February 8). Levels of L-arginine and L-citrulline in patients with erectile dysfunction of different etiology. Andrology, 5(2), 256–261. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/andr.12293/full

Cassidy, A., Franz, M., & Rimm, E. B. (2016, February 1). Dietary flavonoid intake and incidence of erectile dysfunction. The American Journal of Clinical Nutrition, 103(2), 534–541. Retrieved from https://academic.oup.com/ajcn/article/103/2/534/4564750

Davis, S. R., Worsley, R., Miller, K. K., Parish, S. J., & Santoro, N. (2016, February). Androgens and female sexual function and dysfunction – Findings from the Fourth International Consultation of Sexual Medicine [Abstract]. Journal of Sexual Medicine, 13(2), 168–178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26953831

English, J. (2013, April 19). A natural approach to enhancing sexual libido and performance. Retrieved from https://nutritionreview.org/2013/04/arginine-select-phytonutrients-enhance-libido/

Fallah, A., Mohammad-Hasani, A., & Colagar, A. H. (2018, April–June). Zinc is an essential element for male fertility: A review of Zn roles in men's health, germination, sperm quality, and fertilization. Journal of Reproduction & Infertility, 19(2), 69–81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/

Fulgoni III, V. L., Dreher, M., & Davenport, A. J. (2013, January 2). Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: Results from the National Health and Nutrition Examination Survey (NHANES) 2001–2008. Nutrition Journal, 12(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545982/

Higdon, J. (2016, February). Flavonoids. Retrieved from https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/flavonoids

Kaya, E., Sikka, S. C., & Gur, S. (2015, April). A comprehensive review of metabolic syndrome affecting erectile dysfunction [Abstract]. Journal of Sexual Medicine, 12(4), 856–875. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsm.12828

Kotta, S., Ansari, S. H., & Ali, J. (2013, January–June). Exploring scientifically proven herbal aphrodisiacs. Pharmacognosy Review, 7(13), 1–10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731873/

Leung, K. W., & Wong, A. S. T. (2013, September 13). Ginseng and male reproductive function. Spermatogenesis, 3(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

Maca. (2016, March 14). Retrieved from https://medlineplus.gov/druginfo/natural/555.html

Munglue, P., Kupittayanant, S., & Kupittayanant, P. (2014, January). Effects of watermelon (Citrullus lanatus) flesh extract on sexual behavior in male rats. Chiang Mai University Journal of Natural Sciences, 13(1), 12982. Retrieved from https://www.researchgate.net/publication/271073831_Effect_of_Watermelon_Citrullus_lanatus_Flesh_Extract_on_Sexual_Behavior_of_Male_Rats?enrichId=rgreq-984b664ec0ffa10d07f2aae94217a475-XXX&enrichSource=Y292ZXJQYWdlOzI3MTA3MzgzMTtBUzoxODczMjA2NjU5MTEyOThAMTQyMTY3MjEzNTcxMA%3D%3D&el=1_x_2&_esc=publicationCoverPdf

Steels, E., Rao, A., & Vitetta, L. (2011, September). Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation [Abstract]. Phytotherapy Research, 25(9), 1294–1300. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21312304

The American Heart Association's diet and lifestyle recommendations. (2018, April 17). Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.W1Y5Aa3Mwkg

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Zinc [Fact sheet]. (2018, March 2). Retrieved from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

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How much salt does it really take to harm your heart?

Too much salt is bad for you, particulary because it is associated with an increased risk of heart problems — but how much is too much? A new study suggests that we may not have to worry so much about how salty we like our food to be.
salt shaker
A new international study suggests that we may want to rethink how much salt is actually harmful.

Table salt, which we commonly use to season our food, contains sodium.

Sodium, if often ingested in large quantities, can lead to a range of cardiovascular problems, including hypertension.

The World Health Organization (WHO) say that a person should not consume more than 2 grams of sodium per day, which is about 5 grams of salt per day.

The American Heart Association (AHA) recommend no more than 2.5 grams of sodium per day, though they state that the ideal intake is of no more than 1.5 grams per day for an adult.

However, researchers from a range of international institutions — including McMaster University and Hamilton Health Sciences, both in Hamilton, Canada, as well institutions from 21 other countries — suggest that these limits are unnecessarily low.

Researcher Andrew Mente and colleagues conducted a study of 94,000 people aged 35–70, aiming to establish how much sodium really is too much for heart health.

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Current guidelines, the team notes, push for standards that are unrealistic for many, seeing as salt is often an almost invisible ingredient contained by numerous packaged foods.

"The [WHO recommend] consumption of less than 2 grams of sodium — that's one teaspoon of salt — a day as a preventative measure against cardiovascular disease," says Mente.

He also adds, however, that "there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level."

The new study, whose results are now featured in The Lancet, now suggests that we can be more lenient about our salt consumption without fearing that it will harm our cardiovascular health.

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Slightly higher sodium intake is safe

The study followed the participants — who were based in communities across 18 different countries — for an average period of 8 years.

Mente and his colleagues revealed that a high intake of sodium did lead to an increased risk of cardiovascular disease and stroke — but only in communities where the average intake for an adult was greater than 5 grams per day.

This amounts to about 2.5 teaspoons of table salt, the researchers explain.

Encouragingly, the researchers also noticed that under 5 percent of the participants coming from developed countries exceeded the 5-gram cutoff point for sodium intake.

In most of the countries, the majority of the communities that the researchers observed had an average sodium intake of 3–5 grams of sodium — or 1.5 to 2.5 teaspoons of salt — per day.

In fact, of all the populations in the study, only those from China showed a consistently high intake of sodium. Specifically, 80 percent of the communities from China had a sodium intake that was higher than 5 grams per day.

"Only in the communities with the most sodium intake — those over 5 grams [per] day of sodium — which is mainly in China, did we find a direct link between sodium intake and major cardiovascular events like heart attack and stroke," Mente explains.

On the other hand, he adds, "In communities that consumed less than 5 grams of sodium a day, the opposite was the case. Sodium consumption was inversely associated with myocardial infarction or heart attacks and total mortality, and [there was] no increase in stroke."

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Community interventions can help

Even in the case of individuals who do consume too much table salt, however, the situation is not unsalvageable, the researchers say.

Mente notes that people can easily redress the balance and protect their heart health by making a few simple adjustments to their diets, such as adding more fruits, vegetables, and foods naturally rich in potassium.

"We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes, and nuts and beans," says the study author.

Another one of the researches involved with the current study, Martin O'Donnell, notes that most of the studies looking at the relationship between sodium intake and cardiovascular risk so far have focused on individual data, rather than information collected from larger cohorts.

This, he suggests, may have skewed the best practice guidelines into a direction that is both unrealistic and perhaps too cautious.

"Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality."

Martin O'Donnell

"There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke," O'Donnell adds.

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'Monster' radish might help fight heart disease

Discovering ways of reducing cardiovascular risk is an ongoing challenge for medical science. A recent study asks whether "monster" radishes might provide some assistance.
Radish heart shape
The Sakurajima radish dwarfs the regular radishes pictured here.

The official name for the so-called monster radish is the Sakurajima daikon.

Originally cultivated on the island of Sakurajima, Japan, centuries ago, it is an impressive beast.

The largest Sakurajima on record weighed almost 69 pounds, measuring well over 1 meter in circumference.

Radishes in general are known to contain high levels of antioxidants. Also, according to earlier studies, they may influence factors associated with heart attack and stroke — namely, increased blood pressure and the risk of blood clots.

Roughly 1 in 4 deaths are due to cardiovascular diseases, such as heart attack and stroke, so discovering a natural chemical that can reduce the risks would be a big win.

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Dissecting the monster radish

To date, no studies have investigated the potential cardiovascular benefits of the monster radish. So, recently, researchers from Kagoshima University in Japan set up a trial to see whether the radishes' health benefits are as sizable as its girth. The results were published recently in the Journal of Agricultural and Food Chemistry.

The team of scientists, led by Katsuko Kajiya, was particularly interested in the Sakurajima's influence over nitric oxide production, an important regulator of blood vessel function.

The cells that line blood vessels — vascular endothelial cells — produce nitric oxide; when this gas is released into the bloodstream, it causes blood vessels to relax, which reduces blood pressure.

Nitric oxide helps reduce cardiovascular risk in more than one way: white and red blood cells sometimes attach to blood vessel walls, which increases the risk of clots forming. Nitric oxide release prevents this from happening so freely.

Antioxidants are thought to damage endothelial cells, which reduces their ability to produce nitric oxide and therefore increases the risk of cardiovascular disease.

Uncovering interventions that can induce nitric oxide release from these cells would, therefore, have a protective effect on vascular health.

The team used vascular endothelial cells from both humans and pigs to pit Sakurajima daikon against other, less impressive types of radish. Using a range of tests, including fluorescence microscopy, the scientists demonstrated that the monster radish "induced more nitric oxide production" than its diminutive cousins.

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Radish compound identified

Kajiya also wanted to understand exactly how the Sakurajima daikon influences nitric oxide. After ruling out other potential compounds, including the neurotransmitter GABA, the team concluded that a plant hormone called trigonelline could be the main player.

Trigonelline seems to trigger a molecular cascade that boosts nitric oxide production. Interestingly, trigonelline is not a stranger to medical research, as the authors explain:

"The compound is found in coffee and some agricultural and marine products. [...] Trigonelline has been reported to reduce brain aging and Alzheimer-type dementias, and it has inhibitory effects on the invasion of cancer cells."

The compound may also be useful in the prevention of diabetes. It is present in a number of plants, including garden peas, hemp seed, oats, and potatoes. It might be that, over the coming years, we hear more about the potential uses of this chemical.

The authors of the new study hope that their results will be useful to scientists looking for active components in other vegetables.

Once the mechanism is understood in more detail, it could lead to much improved pharmaceutical interventions that slow the progression of cardiovascular disease or prevent it from developing in the first place.

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Can you have hypoglycemia without diabetes?

Hypoglycemia occurs when blood sugar levels fall dangerously low. It is more common in people with diabetes, but it can affect others.

In this article, we explore the health conditions beyond diabetes that can cause hypoglycemia. We also look at treatment options and the dietary changes that can help prevent low blood sugar.

What is hypoglycemia? Blood sugar
Hypoglycemia is when blood sugar levels are very low.

Hypoglycemia occurs when blood sugar levels drop below 70 milligrams per deciliter (mg/dl). Severe hypoglycemia can be life-threatening if a person does not receive treatment. Treatments focus on returning blood sugar to safe levels.

Blood sugar, or glucose, is the body's primary source of energy. When levels fall too low, the body does not have enough energy to function fully. This is called hypoglycemia.

Insulin helps the body's cells to absorb sugar from the bloodstream. A person with diabetes may take insulin shots because their body is resistant to insulin or because it does not produce enough.

In people with diabetes, taking too much insulin can cause blood sugar levels to drop too low. Not eating enough or exercising too much after taking insulin can have the same effect.

However, people who do not have diabetes can also experience hypoglycemia.

Thank you for supporting Medical News Today Causes of hypoglycemia without diabetes In people without diabetes, hypoglycemia can result from the body producing too much insulin after a meal, causing blood sugar levels to drop. This is called reactive hypoglycemia. Reactive hypoglycemia can be an early sign of diabetes. Other health issues can also cause hypoglycemia, including: Drinking too much alcohol When a person's blood sugar levels are low, the pancreas releases a hormone called glucagon. Glucagon tells the liver to break down stored energy. The liver then releases glucose back into the bloodstream to normalize blood sugar levels. Drinking too much alcohol can make it difficult for the liver to function. It may no longer be able to release glucose back into the bloodstream, which can cause temporary hypoglycemia. Medication Taking another person's diabetes medication can cause hypoglycemia. Hypoglycemia can also be a side effect of: Some groups have an increased risk of medication-induced hypoglycemia, including children and people with kidney failure. Anorexia A person with the eating disorder anorexia may not be consuming enough food for their body to produce sufficient glucose. Hepatitis Hepatitis is an inflammatory condition that affects the liver. Having hepatitis can prevent the liver from working properly. If the liver cannot produce or release enough glucose, this can cause problems with blood sugar levels and lead to hypoglycemia. Adrenal or pituitary gland disorders Problems with the pituitary gland or adrenal glands can cause hypoglycemia because these parts of the body affect the hormones that control glucose production. Kidney problems The kidneys help the body process medication and excrete waste. If a person has a problem with their kidneys, medication can build up in their bloodstream. This type of buildup can change blood sugar levels and lead to hypoglycemia. Pancreatic tumor Pancreatic tumors are rare, but having one can lead to hypoglycemia. Tumors in the pancreas can cause the organ to produce too much insulin. If insulin levels are too high, blood sugar levels will drop. Symptoms Dizzy and confused senior woman outdoors.
Dizziness and confusion can be symptoms of hypoglycemia. When a person has hypoglycemia, they may feel: shaky dizzy unable to concentrate unable to focus their eyes confused moody hungry A person with hypoglycemia may develop a headache or pass out (lose consciousness). If a person has hypoglycemia often, they may stop experiencing symptoms. This is called hypoglycemia unawareness. Thank you for supporting Medical News Today Diagnosis To diagnose hypoglycemia, a doctor first asks a person about their symptoms. If the doctor suspects hypoglycemia, they may perform a blood test. Blood sugar levels below 70 mg/dl can indicate hypoglycemia. However, everyone has a different base blood sugar level, and the measurement that determines hypoglycemia can vary. The doctor may use other tests to determine the underlying cause of low blood sugar. Treatment Pink round tablet supplements
Glucose tablets can help to raise blood sugar levels. Treating the underlying cause is the best way to prevent hypoglycemia in the long term. In the short term, receiving glucose helps blood sugar levels return to normal. According to research from 2014, the best way to treat mild hypoglycemia is to: take 15 grams of glucose wait for 15 minutes measure blood glucose levels again repeat this treatment if hypoglycemia persists There are many ways to receive glucose, including: taking a glucose tablet injecting glucose drinking fruit juice eating carbohydrates Eating slow-release carbohydrates may help sustain blood sugar levels. Thank you for supporting Medical News Today Non-diabetic hypoglycemia diet A non-diabetic hypoglycemia diet can help keep blood sugar levels balanced. The following tips can help to prevent hypoglycemia: eating small meals regularly, rather than three large meals eating every 3 hours eating a variety of foods, including protein, healthful fats, and fiber avoiding sugary foods Carrying a snack to eat at the first sign of hypoglycemia can prevent blood sugar levels from dipping too low. Ultimately, the best way to prevent hypoglycemia is to identify and treat the underlying cause.
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