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Time of India
4 days ago
- Health
- Time of India
Hypertension: Making THESE changes in the diet can lower blood pressure, according to experts
A recent study highlights the significant benefits of a diet rich in fruits and vegetables for individuals with hypertension. The research demonstrates that incorporating more fruits and vegetables into one's diet can effectively lower blood pressure, improve kidney health, and reduce cardiovascular disease risk. Unlike sodium bicarbonate, fruits and vegetables achieve these benefits while potentially reducing the need for medication. High blood pressure, aka hypertension, affects about 1.28 billion adults (aged 30–79) globally. Among these, about 46% are unaware that this condition exists, according to the WHO . High blood pressure is a silent killer and could lead to chronic illnesses, such as heart disease, stroke, and kidney failure. Certain factors increase the risk of hypertension; however, some of them are in our control, and one is diet. A 2024 study found that making certain dietary changes can lower blood pressure and improve kidney and heart health. The findings of the five-year interventional randomized control trial are published in The American Journal of Medicine . Watch what you eat Focusing on a diet that is rich in fruits and vegetables is crucial in the treatment of hypertension patients, according to doctors. Despite efforts, hypertension-related chronic kidney disease and its cardiovascular mortality are increasing. Heart disease is the number one reason that patients with chronic kidney disease die. So what should you eat to lower blood pressure? DASH. Yes, the Dietary Approaches to Stop Hypertension (DASH) diet, is proven to lower blood pressure. This is a flexible and balanced eating plan, that is rich in fruits and vegetables. It is the recommended first-line treatment for primary hypertension. Despite scientific evidence, the DASH diet is under-prescribed and under-implemented. 'As a nephrologist (kidney doctor), my acid-base laboratory studies ways by which the kidney removes acid from the blood and puts it into the urine. Our animal studies showed years ago that mechanisms used by the kidneys to remove acid from the blood can cause kidney injury if the animals were chronically (long-term) exposed to an acid-producing diet. Our patient studies showed similar findings: that is, an acid-producing diet (one high in animal products) was kidney-harmful, and one that is base-producing (one high in fruits and vegetables) is kidney-healthy. Other investigators showed that a diet high in fruits and vegetables is heart-healthy. We hypothesized that one way that fruits and vegetables are both kidney- and heart-healthy is that they reduce the amount of acid in the diet and therefore the amount of acid that kidneys have to remove from the body,' Donald E. Wesson, MD, MBA, lead investigator Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, said, in a statement. The study To test the hypothesis, they conducted a study with participants who had hypertension, but not diabetes, and very high levels of urine albumin excretion (macroalbuminuria). Those with macroalbuminuria have chronic kidney disease, a high risk for the worsening of their kidney disease with time, and a high risk to subsequently developing cardiovascular diseases. The trial took over a five-year period, where the 153 participants with hypertension were divided into three groups: Study participants added 2-4 cups of base-producing fruits and vegetables in addition to their usual daily food intake Study participants were prescribed NaHCO3 (acid-reducing sodium bicarbonate, which is common baking soda) tablets in two daily doses of 4-5 650 mg tablets Study participants receiving standard medical care from primary care clinicians How diet plays a crucial role The findings of the study confirmed that consumption of fruits and vegetables and NaHCO3 improved kidney health, but only fruits and vegetables, and not NaHCO3, reduced blood pressure and improved indices of cardiovascular disease risk. 'Importantly, fruits and vegetables achieved the latter two benefits with lower doses of medication used to lower blood pressure and reduce cardiovascular disease risk. This means that one can get the kidney health benefits with either fruits and vegetables or NaHCO3, but we get the blood pressure reduction and reduced cardiovascular disease risk with fruits and vegetables, but not with NaHCO3. This supports our recommendation that fruits and vegetables should be 'foundational' treatment for patients with hypertension, because we accomplish all three goals (kidney health, lower blood pressure, and reduced cardiovascular disease risk) with fruits and vegetables, and we can do so with lower medication doses,' co-investigator Maninder Kahlon, PhD, Department of Population Health, Dell Medical School, The University of Texas at Austin, explains. Low blood pressure got you down? Try these 4 home fixes! "Dietary interventions for chronic disease management are often not recommended and even less often executed because of the many challenges to get patients to implement them. Nevertheless, they are effective, and in this instance, kidney and cardiovascular protective. We must increase our efforts to incorporate them into patient management and more broadly, make healthy diets more accessible to populations at increased risk for kidney and cardiovascular disease,' Dr. Wesson adds. Get the latest lifestyle updates on Times of India, along with Happy Independence Day wishes, messages , and quotes !
Medscape
30-06-2025
- Health
- Medscape
Patient Progress Notes Often ‘Fail.' They Can Be Fixed
Crafting the ideal patient progress note, at least judging from the literature, seems more easily achieved in theory than in execution. Since the late 2000s, when the electronic health record replaced pen and paper in chronicling a hospital patient's story, from entry to exit, senior physicians have struggled with house staff to make entries into the patient's record that actually mirror the patient's progress. Various articles over the past 15 years have decried the condition of these notes, finding they contained unnecessary information and many inaccuracies — primarily because the note authors had copied and pasted prior input; this keyboard capability has been dubbed an 'egregious danger.' 'These notes not only fail to reflect the orderly progression of thought and action…but also rarely provide clear documentation of the day's events,' authors of one study in The American Journal of Medicine wrote in 2009. About 5 years ago, the American College of Physicians chimed in: 'At present, it is far too easy to open a patient chart, read volumes of data, and find that no single person has stated what they believe is happening.' Other articles have attempted to create audit tools or best practice recommendations. ('Pulling in a full list of current medications is unlikely to improve the value of the note and may become outdated quickly depending on the timing of when a note is written.') In 2019, JAMA Network Open published a California hospitals-based study that showed the significant disconnect between the number and type of exams that a group of nine emergency department trainees recorded as having completed and the actual number and type of exams that 12 observers witnessed either via direct audiovisual observation or by a review of the recorded observation. The agreement between what was actually recorded and observed was barely 50%. The observers, however, jibed with each other 90% of the time. Contributing to the progress notes' bloat factor is how the hospitals use them, namely for coding, billing, and quality reporting. These entries make them legal documents and therefore the justified recipient of all non-care patient information. This extra information often obfuscates the point of the note's existence. And it most likely negatively affects the person in the bed. 'Poor notes negatively impact patient care,' wrote the authors of a new study conducted at Johns Hopkins, Baltimore, and published in the Journal of General Internal Medicine . Bottom line: It is finding the right balance — combining seasoned staff's clinical experience with the nearly innate tech know-how of incoming juniors — that has continued to elude all. Creating Readable, Usable Progress Notes Refusing to accept that, Johns Hopkins' Samuel Durso, MD, MBA, executive vice chair, Department of Medicine, Johns Hopkins University, and director, Department of Medicine, Johns Hopkins Bayview Medical Center, decided on a new tack for his study. He said in a recent interview that he had had enough of seeing poorly devised notes. Samuel Durso, MD, MBA 'Most of the time, you can't tell what is going on,' said Durso. The Durso team took a different path for getting seasoned hospitalists to create readable, usable patient progress notes. They created a rubric with 15 gradable items, devised an educational intervention that was used when necessary, and included a control group. The total number of hospitalist participants was 26. The participants were all about 40 years old and had worked in hospital medicine for an average of about 9 years. The study team rated 156 of the study participants' notes, taken 6 months prior to the educational instruction and after. The creation of the rubric was based on a literature review, 100 progress notes, the team's assessment of existing admissions notes, and peer feedback. The study results showed that progress-note quality improved if hospital physicians were guided via the rubric. P -value scores were significant in 8 of the 15 graded items. Hospital physicians do not deliberately create poor progress notes, Durso said. 'It's not because people are stupid or lazy; it's because hospital systems are set up a certain way,' he said. As for what happens next, Durso said he is thinking about ways to maintain gains from the study results by 'baking' them into the actual workday. 'We don't have that answer yet,' he said. 'It takes people to do this and train them.' One option could be to use Johns Hopkins' existing artificial intelligence software to incorporate note quality. He addressed the size of his study. 'We didn't need this study to tell us we have a problem,' he said. His team wanted to see if it could design a plan that was workable in the Johns Hopkins environment 'to give us an indication of whether the teaching method is effective.' The study also provided the methodology some credibility. 'At least what we have shown is we can train people to improve their notes, with adjudication between observers.'
Miami Herald
11-05-2025
- Health
- Miami Herald
Managing PoTS: Tips for Living with the Chronic Illness Affecting Millions
Imagine standing up and your heart suddenly races as if you've sprinted a mile-except you haven't budged. For millions of Americans with Postural Orthostatic Tachycardia Syndrome (PoTS), this dizzying, exhausting reality is their daily norm. Though not fatal, PoTS profoundly disrupts everyday life, causing a spectrum of symptoms-dizziness, near‑fainting, brain fog, palpitations, fatigue, tremors, chest discomfort, headaches, nausea and gastrointestinal distress. Recent data suggest PoTS is on the rise. "PoTS can be triggered by SARS‑CoV‑2 infection as part of long COVID," said Dr. Svetlana Blitshteyn, professor of neurology at the University at Buffalo. A 2025 study in The American Journal of Medicine found that nearly 80 percent of long‑COVID patients met the diagnostic criteria for PoTS. "Prior to the pandemic, at least 3 to 5 million people had PoTS, which has likely doubled after the pandemic," Blitshteyn told Newsweek. "We still don't know exactly how many Americans currently have PoTS, but it is estimated that millions more Americans are now suffering from this disease," added Dr. Brit Adler, a professor of medicine in the division of rheumatology at Johns Hopkins University. PoTS is described as an abnormality in the functioning of the autonomic nervous system, the system controlling breathing, gut function, heart rate, blood pressure and many other bodily functions. It can also be linked to problems like "low blood volume, vascular dysfunction, or other mechanisms," Adler said, adding that those with hypermobility syndromes like Ehlers-Danlos Syndrome often had the condition as well. PoTS comes as a result of the autonomic nervous system's "adjustment to being upright not functioning properly," Professor Lesley Kavi, the chairperson of the U.K.-based charity organization PoTS UK, told Newsweek. As many basic tasks in the day require postural changes and standing, a person with PoTS is constantly being put under strain as they navigate simple tasks. Symptoms tend to lessen when a patient is horizontal, but it can sometimes take a long time for symptoms to ease off once flared. Things like heat, prolonged standing, dehydration, stress, intensive exercise, viruses, infections, and menstruation can all worsen PoTS symptoms. Kavi said that major surgery, injuries such as concussion, and exposure to a traumatic event can trigger an onset of PoTS, but she added that there isn't enough data and research yet to be able to determine precisely what mechanisms are going wrong within the body. Dr. Zachary Spiritos, a specialist in gastroenterology and hepatology at North Carolina's UNC Health, told Newsweek: "Many people may be born with a vulnerability, and then something in the environment - often an infection or injury - triggers the onset of symptoms. It's multifactorial, and the exact blend is different for everyone." Prevalence estimates range widely: the Cleveland Clinic cites 1–3 million U.S. cases, while Dysautonomia International reports 3–6 million. This variability stems largely from under-recognition-most clinicians seldom consider PoTS during evaluation, according to Spiritos. Women account for approximately 80 percent of cases in the U.S., according to Dysautonomia International, likely due to hormonal influences and autoimmune predisposition. "This is partly because the X chromosome carries many immune-related genes, and women have two copies, which can lead to more robust, but also more error-prone, immune responses," Spiritos said, "[And] we see anecdotal patterns where estrogen can worsen PoTS symptoms, while testosterone may be protective." Lesley Kavi from PoTS UK said that avoiding symptom triggers can be a good place to start for managing the condition, although this is very individual. For some, this could include avoiding prolonged standing, dehydrating things like the heat, alcohol, and caffeine, she added. Increasing fluid intake is essential, Kavi said, adding an adult with PoTS should aim to drink between two to three liters of water a day, or more if they exercise or are in a hot environment. In order to ensure the water stays in your system, increasing sodium intake is also important, Kavi said. Patients are advised to increase their sodium intake to as much as 10,000-12,000 mg per day, but each patient will respond best to a different amount. Compression clothing, particularly tights or leggings that cover the abdomen, are helpful in boosting blood circulation too, Kavi said. Typically medical grade compression is required of between 20 to 30 mmHg. "Exercise can be something that helps the most for some people, but the problem with exercise is that it can make others feel really terrible afterwards, even for a day or two," Kavi added. Starting "low and slow" is always the way to go, Kavi said, adding that it was important to get expert input. The best forms of exercise to start with are horizontal, she added, pointing to exercise bikes, Pilates, rowing machines, and swimming. Although, it is always best to get professional support, Blitshteyn said. "While there are no cures, there is treatment to help you improve and function better in your life." It is also important to remember "you're not alone and PoTS is a real, physiologic disorder," Adler said. "Many people go years without a diagnosis and are often told that their symptoms are from anxiety and it is in their head." Spiritos said it's a good idea to educate yourself, as "understanding the condition is empowering," and recommended listening to the POTScast and Bendy Bodies podcasts. "Ultimately, community and knowledge are power, and with the right tools, you can get better," he added. 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