Wood Street Clinic Blog

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What role does the immune system play in hypertension?

Millions of people in the United States and across the world have hypertension, a condition that, without proper management, can contribute to the risk of heart disease and stroke.
woman getting her blood pressure checked
Specialist white blood cells play an important role in the regulation of blood pressure, a new study finds.

Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 75 million adults in the U.S. live with hypertension.

American Heart Association (AHA) guidelines from 2017 define "hypertension" as systolic blood pressure (during a heartbeat) of 130 millimeters of mercury (mm Hg) or higher and diastolic blood pressure (when the heart is resting) of 80 mm Hg or higher.

The AHA also name lack of physical activity, an unhealthful diet, high cholesterol, and stress as some of the primary modifiable factors that increase the risk of hypertension.

New research by scientists at the University of Edinburgh in the United Kingdom has now uncovered another factor that seems to play a role in the development of this condition.

The study, which the British Heart Foundation funded, found that a type of specialized immune cell could make a real difference to the risk of hypertension.

"Hypertension affects millions of people across the globe, including 70 percent of people over 70," says lead researcher Prof. Matthew Bailey.

"Our discovery sheds light on risk factors and, crucially, opens routes to investigate new drugs that could help patients," he adds.

Prof. Bailey and team's findings appear in the European Heart Journal, and they are available online.

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Cellular debris-eaters and blood pressure

In the new study, the researchers worked with mouse models and zeroed in on macrophages, a type of white blood cell that forms part of the immune system.

The role of macrophages is to identify and "eat up" foreign bodies that are present due to injury and infection. The immune cells also "eat" cellular debris, which consists of the remains of cells that are no longer functional.

The current research has now uncovered a new role that macrophages play. It seems that they also consume molecules of endothelin, which is a hormone that acts as a vasoconstrictor, meaning that it can stimulate blood vessels to narrow.

Prof. Bailey and colleagues explain that, by controlling blood levels of endothelin, macrophages can ensure that blood vessels properly relax, which helps lower blood pressure.

The researchers verified this mechanism by feeding mice with lowered blood macrophage levels a high-salt diet (which increases the risk of high blood pressure) and monitoring their physiological reactions.

These rodents, the researchers soon found, experienced high blood pressure. However, when the team allowed macrophage levels to return to normal, the mice's blood pressure became healthy again, which suggests that the specialist white blood cells had an important role to play.

When they repeated the experiment in mice that they had genetically modified to have poor endothelin system functioning, the findings remained consistent.

The researchers further verified the link between macrophages and blood pressure in rodents with drug-induced hypertension.

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A potential therapeutical target

To see whether these findings were also valid in humans, the research team analyzed macrophage activity in individuals who took drugs for the management of antineutrophil cytoplasmic antibody vasculitis, a condition that affects the immune system and damages blood vessels.

The scientists found that the drugs that lowered macrophage levels, such as cyclophosphamide, led to higher blood pressure readings in the people who took them.

These findings, note Prof. Bailey and team, could help doctors better identify people who are most at risk of hypertension, and they could also lead to new and improved therapies for high blood pressure.

Still, the researchers caution that further studies are necessary before the interaction between macrophages and endothelin can get the go-ahead as a therapeutic target.

"Our next steps will be to investigate the role of macrophages in people living with hypertension," says Prof. Bailey.

"[Undiagnosed high blood pressure] causes damage to the heart and blood vessels, putting you at risk of a potentially fatal heart attack or stroke. But, we still don't fully understand all the mechanisms that lead to high blood pressure," adds Jeremy Pearson, the associate medical director of the British Heart Foundation, who was not involved in the study.

"This study shows for the first time that macrophages — a type of cell that helps regulate our immune responses — can be involved in the control of blood pressure. More research is needed but these cells could be a new target for drugs to treat the condition."

Jeremy Pearson

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What is a stent? Everything you need to know

A stent is a tiny tube that a doctor places in an artery or duct to help keep it open and restore the flow of bodily fluids in the area.

Stents help relieve blockages and treat narrow or weakened arteries. Doctors may also insert stents in other areas of the body to support blood vessels in the brain or ducts that carry urine and bile.

A stent is usually a mesh-like metal tube, although fabric stents are also available. Sometimes, doctors will use dissolvable stents coated in medication as a temporary solution.

In this article, learn about why doctors use stents, as well as the benefits and possible risks.

Uses Doctor holding up heart stent
A stent can open up blood vessels with plaque blockages.

One of the most common uses for a stent is to open up a blood vessel that has a plaque blockage.

Plaque is a buildup of cholesterol, fat, and other substances found in the blood. When this plaque collects in the bloodstream, it sticks to the walls of the arteries.

Over time, this buildup narrows the arteries, limiting the amount of fresh blood that can reach the body.

A buildup of plaque in the arteries is a cause of coronary heart disease. Over time, people with narrowed arteries may begin to notice warning symptoms, such as chest pain. If people with the condition do not receive treatment, they may be at a higher risk of complications, such as a heart attack or stroke.

If the artery is at risk of collapsing or becoming blocked again, doctors may recommend inserting a stent to keep it open.

Doctors put a stent into an artery in a procedure known as a percutaneous coronary intervention (PCI), or angioplasty with stent.

During PCI, doctors will insert a catheter into the artery. The catheter has a small balloon with a stent around it on one end.

When the catheter reaches the point of the blockage, the doctor will inflate the balloon. When the balloon inflates, the stent expands and locks into place. The doctor will then remove the catheter, leaving the stent in place to hold the artery open.

A doctor will decide whether or not to insert a stent based on a few factors, such as the size of the artery and where the blockage occurs.

Doctors may also use stents for:

blood vessels in the brain or aorta that are at risk of an aneurysm bronchi in the lungs that are at risk of collapse ureters, which carry urine from the kidneys into the bladder bile ducts, which carry bile between the organs and small intestine Thank you for supporting Medical News Today Risks Surgeon looking at screen in operating theatre
A surgeon can explain the risks and benefits of PCI. PCI carries a small risk of complications, which include: bleeding from the catheter insertion site an infection an allergic reaction damage to the artery from inserting the catheter damage to the kidneys irregular heartbeat In some cases, restenosis may occur. Restenosis is when too much tissue grows around the stent. This could narrow or block the artery again. Doctors may recommend forms of radiation therapy or opt to insert a medication-coated stent to slow the growth of the tissue. People at risk of complications include: A stent can cause blood clotting, which may increase the risk of heart attack or stroke. The National Heart, Lung, and Blood Institute state that about 1 to 2 percent of people who have stented arteries develop a blood clot at the site of the stent. Doctors will usually prescribe one or more drugs to prevent clotting. Anti-clotting medications may carry their own risks and can cause irritating side effects, such as rashes. In rare cases, a person's body may reject the stent, or they may have an allergic reaction to the material in the stent. Anyone who has a known reaction to metals should talk to their doctor about alternatives. What to expect The surgeon will discuss the procedure with a person in advance, but it can help to know what to expect. Before the surgery A doctor will advise individuals on how they should prepare for a stent procedure. They will give them information on when to stop eating and drinking, as well as when to start or stop taking medications before the procedure. Anyone who has any other health conditions, such as diabetes or kidney disease, must tell their doctor. The doctor may then have to consider some additional steps. Doctors may also give the person prescriptions to fill before having the stent inserted, as they will need to start taking the medications as soon as the procedure is complete. During the surgery According to the National Heart, Lung, and Blood Institute, a stent procedure only takes about an hour and does not require general anesthesia. The person remains awake during the entire process so can hear any instructions the doctors may have. Doctors will administer medication to help the person relax. They will also numb the area where they insert the catheter. Most people do not feel the catheter threading through the artery. They may, however, feel a bit of pain as the balloon expands and pushes the stent into place. After placing the stent, doctors deflate the balloon and remove the catheter. They bandage the area where the catheter entered the skin and put pressure on the bandage to help prevent bleeding. After the surgery Most people will need to stay in the hospital for at least one night after having the procedure. This allows hospital staff to monitor the person. During the hospital stay, a nurse will regularly check the person's heart rate and blood pressure. They may also change the dressings or clean the wound. The person may leave the hospital the following day if there are no complications. As the insertion site heals, it will bruise and may develop into a small knot of tissue, which is normal. The area may remain tender for at least a week. Thank you for supporting Medical News Today Recovery Patient in hospital bed.
A person may have to rest for about a week after surgery. A successful stent surgery should reduce symptoms, such as chest pain and shortness of breath. Many people may be able to return to work and most normal activities within a week of a successful stent surgery. During recovery, doctors will prescribe antiplatelet drugs to help prevent blood clots from forming near the stent. Aspirin is an antiplatelet drug that a person will need to take daily for an indefinite period after having a stent inserted. Doctors may also recommend a drug called a P2Y inhibitor. P2Y inhibitors include clopidogrel, ticagrelor, and prasugrel. They will also provide the person with special recovery instructions, such as avoiding strenuous work or exercise while the body heals. Long-term use Most stents remain in the artery permanently to keep it open and prevent collapse and potentially life-threatening complications. Some stents are temporary. Doctors may use stents coated in particular medications that help break down plaque or prevent it from building up in the area. These stents will dissolve over time. While a stent may relieve symptoms, such as chest pain, it is not a cure for other underlying issues, such as atherosclerosis and coronary heart disease. Even with a stent, a person with these conditions may need to take steps to prevent further complications. Doctors will recommend healthy lifestyle changes after inserting a stent to help prevent plaque building up in the body. These recommendations often include: eating a healthful diet exercising regularly maintaining a healthy weight quitting smoking and tobacco use reducing stress Stents are often just one part of treatment. Doctors may also prescribe medications for any underlying conditions. If anyone experiences any bothersome side effects, it is best to talk to a doctor. They may recommend alternative medications or change the dose to help relieve side effects. Do not stop taking any medications without consulting a doctor first, however. Thank you for supporting Medical News Today Outlook Doctors commonly insert stents to widen arteries and prevent complications from coronary heart disease and other conditions. While a stent may provide relief, it is only one part of a treatment program. Even with a stent, it is possible for severe complications to occur. Always follow a doctor's advice about medications and recovery.
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Our guide to the Mediterranean diet

Many doctors and dietitians recommend a Mediterranean diet to prevent disease and keep people healthy for longer.

The Mediterranean diet emphasizes fruits, vegetables, and whole grains, and it includes less dairy and meat than a typical Western diet.

In this article, we explain what the Mediterranean diet is and provide a 7-day meal plan for people to follow.

What is a Mediterranean diet? Foods from a Mediterranean diet
A Mediterranean diet includes fresh produce and some healthful fats and oils.

Essentially, following a Mediterranean diet means eating in the way that the people in the Mediterranean region traditionally ate.

A traditional diet from the Mediterranean region includes a generous portion of fresh produce, whole grains, and legumes, as well as some healthful fats and fish.

The general guidelines of the diet recommend that people eat:

a wide variety of vegetables, fruits, and whole grains healthful fats, such as nuts, seeds, and olive oil moderate amounts of dairy and fish very little white meat and red meat few eggs red wine in moderation

The American Heart Association note that the average Mediterranean diet contains a high percentage of calories from fat.

Although more than half of the calories from fat come from monounsaturated fats, such as olive oil, the diet may not be right for people who need to limit their fat intake.

Thank you for supporting Medical News Today Building a meal plan The Mediterranean diet puts a higher focus on plant foods than many other diets. It is not uncommon for vegetables, whole grains, and legumes to make up all or most of a meal. People following the diet typically cook these foods using healthful fats, such as olive oil, and add plenty of flavorful spices. Meals may include small portions of fish, meat, or eggs. Water and sparkling water are common drink choices, as well as moderate amounts of red wine. People on a Mediterranean diet avoid the following foods: refined grains, such as white bread, white pasta, and pizza dough containing white flour refined oils, which include canola oil and soybean oil foods with added sugars, such as pastries, sodas, and candies deli meats, hot dogs, and other processed meats processed or packaged foods 7-day meal plan Here is an example of a 7-day Mediterranean diet meal plan: Day 1 Greek yoghurt with blueberries and walnuts
One breakfast option is greek yogurt with blueberries and walnuts. Breakfast one pan-fried egg whole-wheat toast grilled tomatoes For additional calories, add another egg or some sliced avocado to the toast. Lunch 2 cups of mixed salad greens with cherry tomatoes and olives on top and a dressing of olive oil and vinegar whole-grain pita bread 2 ounces (oz) of hummus Dinner whole-grain pizza with tomato sauce, grilled vegetables, and low-fat cheese as toppings For added calories, add some shredded chicken, ham, tuna, or pine nuts to the pizza. Day 2 Breakfast 1 cup of Greek yogurt One-half of a cup of fruits, such as blueberries, raspberries, or chopped nectarines For additional calories, add 1–2 oz of almonds or walnuts. Lunch Whole-grain sandwich with grilled vegetables, such as eggplant, zucchini, bell pepper, and onion To increase the calorie content, spread hummus or avocado on the bread before adding the fillings. Dinner one portion of baked cod or salmon with garlic and black pepper to add flavor one roasted potato with olive oil and chives Day 3 Breakfast 1 cup of whole-grain oats with cinnamon, dates, and honey top with low-sugar fruits, such as raspberries 1 oz of shredded almonds (optional) Lunch boiled white beans with spices, such as laurel, garlic, and cumin 1 cup of arugula with an olive oil dressing and toppings of tomato, cucumber, and feta cheese Dinner one-half of a cup of whole-grain pasta with tomato sauce, olive oil, and grilled vegetables 1 tablespoon of Parmesan cheese Day 4 Breakfast two-egg scramble with bell peppers, onions, and tomatoes top with 1 oz of queso fresco or one-quarter of an avocado Lunch roasted anchovies in olive oil on whole-grain toast with a sprinkling of lemon juice a warm salad comprising 2 cups of steamed kale and tomatoes Dinner 2 cups of steamed spinach with a sprinkling of lemon juice and herbs one boiled artichoke with olive oil, garlic powder, and salt Add another artichoke for a hearty, filling meal. Day 5 Breakfast 1 cup of Greek yogurt with cinnamon and honey on top mix in a chopped apple and shredded almonds Lunch 1 cup of quinoa with bell peppers, sun-dried tomatoes, and olives roasted garbanzo beans with oregano and thyme top with feta cheese crumbles or avocado (optional) Dinner 2 cups of steamed kale with tomato, cucumber, olives, lemon juice, and Parmesan cheese a portion of grilled sardines with a slice of lemon Day 6 Breakfast two slices of whole-grain toast with soft cheese, such as ricotta, queso fresco, or goat cheese add chopped blueberries or figs for sweetness Lunch 2 cups of mixed greens with tomato and cucumber a small portion of roasted chicken with a sprinkling of olive oil and lemon juice Dinner oven-roasted vegetables, such as: artichoke carrot zucchini eggplant sweet potato tomato toss in olive oil and heavy herbs before roasting 1 cup of whole-grain couscous Day 7 Breakfast whole-grain oats with cinnamon, dates, and maple syrup top with low-sugar fruits, such as raspberries or blackberries Lunch stewed zucchini, yellow squash, onion, and potato in a tomato and herb sauce Dinner 2 cups of greens, such as arugula or spinach, with tomato, olives, and olive oil a small portion of white fish leftover vegetable stew from lunch Thank you for supporting Medical News Today Snacks Avocado on toast
Avocado on toast is a healthful snack for people on a Mediterranean diet. There are many snack options available as part of the Mediterranean diet. Suitable snacks include: a small serving of nuts whole fruits, such as oranges, plums, and grapes dried fruits, including apricots and figs a small serving of yogurt hummus with celery, carrots, or other vegetables avocado on whole-grain toast Health benefits The Mediterranean diet receives a lot of attention from the medical community because many studies verify its benefits. The benefits of a Mediterranean diet include: Lowering the risk of cardiovascular disease Evidence suggests that a Mediterranean diet may reduce the risk of cardiovascular disease. A study that featured in The New England Journal of Medicine compared two Mediterranean diets with a control diet for almost 5 years. The research suggested that the diet reduced the risk of cardiovascular issues, including stroke, heart attack, and death, by about 30 percent compared with the control group. More studies are necessary to determine whether lifestyle factors, such as more physical activity and extended social support systems, are partly responsible for the lower incidence of heart disease in Mediterranean countries than in the United States. Improving sleep quality In a 2018 study, researchers explored how the Mediterranean diet affects sleep. Their research suggested that adhering to a Mediterranean diet may improve sleep quality in older adults. The diet did not seem to affect sleep quality in younger people. Weight loss The Mediterranean diet may also be helpful for people who are trying to lose weight. The authors of a 2016 review noted that people who were overweight or had obesity lost more weight on the Mediterranean diet than on a low-fat diet. The Mediterranean diet group achieved results that were similar to those of the participants on other standard weight loss diets. Thank you for supporting Medical News Today Summary Following a Mediterranean diet involves making long-term, sustainable dietary changes. Generally speaking, a person should aim for a diet that is rich in natural foods, including plenty of vegetables, whole grains, and healthful fats. Anyone who finds that the diet does not feel satisfying should talk to a dietitian. They can recommend additional or alternative foods to help increase satiety.
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Could bone broth boost heart health?

Recently, bone broth has enjoyed a boost in popularity. To add to its new-found fame, a recent study concludes that it could have benefits for heart health, too.
Woman eating bone broth
Bone broth may be fashionable, but is it good for your heart?

Bone broth is a soup containing brewed bones and connective tissue.

Slowly cooking the bones in vinegar releases some of the nutrients that a person might otherwise discard with the rest of the carcass.

According to some quarters, drinking bone broth carries a multitude of benefits.

From reducing inflammation to improving sleep, bone broth can seemingly do no wrong.

Although some are hailing bone broths as "the new coffee," there is little evidence to support its benefits.

It is true that bone broth delivers nutrients, including amino acids and minerals, but not in any higher quantities than might be found in many other foods.

Bone broth contains collagen, leading some supporters to claim that bone broth improves skin health and joint function. However, collagen that we consume never reaches the skin or joints because it is broken down into amino acids by the digestive system.

The authors of the most recent study into bone broth published their findings in the Journal of Agricultural and Food Chemistry. They focused on the amino acids and peptides that the bone and connective tissue produce as they break down.

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Bone broth and cardiovascular health

In particular, the researchers were interested in how cooked bones might release proteins which, during digestion, are broken down further into smaller chains of amino acids, referred to as peptides.

Once broken down in this way, peptides can have very different properties from the original proteins.

The scientists, led by Leticia Mora, wanted to understand whether Spanish dry-cured ham bones could be a source of heart-beneficial peptides. To investigate, they simulated both cooking and human digestion.

Once they had the final product, they tested the resulting peptides to see if they might block particular enzymes known to be involved in heart disease.

The enzymes of interest included angiotensin 1-converting enzyme (ACE-1), endothelin-converting enzyme, dipeptidyl peptidase-4, and platelet-activating factor acetylhydrolase.

All of the enzymes above regulate aspects of the cardiovascular system. ACE-1 inhibitors, for instance, are used to treat high blood pressure and inflammation-based heart disease. If scientists could source these peptides from foods, this might be beneficial for people who have an elevated risk of developing these conditions.

According to the authors, "their inhibition can result in the reduction of high blood pressure and alleviation of disorders, including type 2 diabetes, obesity, atherosclerosis, and inflammatory diseases."

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Potential heart benefits

The scientists found that peptides — predominantly derived from hemoglobin and collagen — could block the enzymes related to heart disease, even after cooking and digestion.

Additionally, they measured the presence of other peptides; many of these were chains of just two or three amino acids, making them more likely to be able to travel through the intestinal wall and be active in the body. The authors conclude:

"These results suggest that dry-cured ham bones [used in] stews and broths could have a positive impact on cardiovascular health and a possible reduction of high blood pressure for consumers."

However, as the authors note, measuring these peptides under artificial conditions is not the same as assessing their impact on living organisms. Scientists will need to do much more work before they can confirm the heart benefits of bone broth.

Understanding the chemistry of foods is only one small step toward realizing their impact on health. These findings might further boost bone broth's popularity, but the trend will probably be over before conclusive evidence rolls in.

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7 simple steps for heart health also prevent diabetes

New research suggests that following the American Heart Association's guidelines for maintaining heart health can also drastically reduce the risk of developing type 2 diabetes.
woman drinking smoothie after exercising
Exercising and healthful eating are among the "simple 7" guidelines that the AHA recommend.

According to the American Heart Association (AHA), there are seven cardiovascular risk factors that people can change to improve their heart health.

Dubbed "Life's Simple 7," these risk factors are: "smoking status, physical activity, weight, diet, blood glucose, cholesterol, and blood pressure."

The AHA note that research has shown that maintaining a minimum of five of the seven factors at an ideal level can lower the risk of cardiovascular death by almost 80 percent.

New research, which features in Diabetologia, the journal of the European Association for the Study of Diabetes, finds that these seven modifiable risk factors can also stave off diabetes.

Coming up with new strategies for preventing diabetes is crucial as over 100 million people in the United States are currently living with the condition or with prediabetes.

According to the Centers for Disease Control and Prevention (CDC), untreated prediabetes can progress into full-blown type 2 diabetes within 5 years.

Dr. Joshua J. Joseph, an endocrinologist and assistant professor at The Ohio State University Wexner Medical Center in Columbus, led the new research.

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In the new study, Dr. Joseph and colleagues evaluated diabetes status in 7,758 individuals who participated in the REasons for Geographic and Racial Differences in Stroke Study.

The team used the AHA's seven factors to assess the cardiovascular health of the participants.

The analysis revealed that participants who had at least four out of the seven factors within the ideal range were 70 percent less likely to develop diabetes over the next 10 years.

"What's interesting," reports the study's lead researcher, "is [that] when we compared people who had normal blood glucose and those who already had impaired blood glucose, [...] [t]hose in normal levels who attained four or more guideline factors had an 80 percent lower risk of developing diabetes."

However, he notes that those who already had prediabetes and met four of the seven factors did not seem to benefit from the lifestyle changes. Instead, their risk of diabetes remained the same.

This is further proof, continues the researcher, that people should use the "simple 7" to prevent the onset of diabetes.

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"Healthy people need to work to stay healthy," says Dr. Joseph. "Follow the guidelines," he advises.

"Don't proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes."

Dr. Joshua J. Joseph

The physician also stresses the importance of educating the public about preventing diabetes. He and his team are actively engaged in community outreach programs that inform people about healthful practices.

"We don't wait for people to come to us as patients," Dr. Joseph says. "We're very engaged in taking our work from the lab and applying it to our populations so we can help keep our communities healthy."

The video below further details the findings and zooms in on the case of Tim Anderson, a man who has recently received a diabetes diagnosis:

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