Greater Reductions in Blood Pressure in Hypertensive Patients Further Reduce Stroke Risk

The data reported in this study can be added to the considerable weight of prior evidence showing that greater sustained reductions of blood pressure in hypertensive patients is better for long term health. Blood pressure should be lowered more aggressively than has been the case in the past, in other words. This is old news in some respects. The medical community has already adjusted its recommendations in recent years, reducing the pressure thresholds at which blood pressure is considered harmful and a risk to future health.

Raised blood pressure, hypertension, is very influential on the trajectory of age-related disease. It speeds up the development of atherosclerosis, and makes stroke and heart attack due to rupture of atherosclerotic plaques more likely. It causes a raised rate of rupture in small blood vessels, producing microbleeds that harm delicate tissues in the brain, kidney, and elsewhere. The size of these effects is large enough that forcing a reduction in blood pressure without addressing any of the underlying dysfunction that causes hypertension can still produce benefits.

The better path forward, however, would be to address the causes. This approach should be easier, in sense of being more efficient, more cost-effective, and also produce more extensive benefits by reducing the impact of all of the other problems that those underlying causes produce. Damage to tissues never has just one consequence. What causes hypertension? To a first approximation, this is a problem of stiffening of blood vessels. As blood vessels fail to contract and relax appropriately, the feedback mechanisms controlling blood pressure become distorted, resulting in hypertension.

Why do blood vessels stiffen? Because of cross-linking in the extracellular matrix of blood vessel walls, changing its structural properties, particularly elasticity, and separately because of loss of elastin in the extracellular matrix. Because senescent cells and other sources of chronic inflammation lead to calcification of blood vessel tissue, as well as dysfunction in the smooth muscle cells responsible for constriction. Those smooth muscle cells are further hampered by mitochondrial dysfunction, as illustrated by the point that ways of boosting mitochondrial activity reduce blood pressure in older individuals. There is never just one cause, but all of these causes can in principle be repaired. We just need to build the rejuvenation biotechnologies to do it.

Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke

In 2010, the absolute number of people with a first stroke in the world was 16.9 million, and the number with stroke-related deaths was 5.9 million. Therefore, prevention of primary and secondary stroke is a priority. Elevated blood pressure (BP) is the most relevant and prevalent risk factor for stroke. Reduction in BP is the most effective intervention to prevent both primary and secondary strokes. In clinical trials for primary prevention of cardiovascular events, including stroke, the lower the better seems acceptable for stroke prevention in hypertensive patients, with less than 115 mm Hg suggested as the optimum target level of systolic BP.

After a stroke, lowering BP in the chronic stage reduced the rates of recurrent stroke among both hypertensive and nonhypertensive patients in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). A post hoc analysis of the PROGRESS suggested that the optimum target level of systolic BP for the prevention of recurrent stroke is less than 120 mm Hg. In the Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trial, the BP target was first evaluated in patients with recent stroke. The trial randomly assigned those with lacunar stroke to a systolic BP target of 130 to 149 mm Hg or less than 130 mm Hg, and the authors showed that the use of a systolic BP target less than 130 mm Hg is likely to be beneficial, especially for the prevention of hemorrhagic stroke.

A recent meta-analysis demonstrated that strict and aggressive control of BP with achieved mean systolic and diastolic BP levels less than 130 mm Hg and less than 85 mm Hg, respectively, seemed to be beneficial for secondary prevention. In primary prevention, the Systolic Blood Pressure Intervention Trial (SPRINT) proved the benefit of aggressive BP control, demonstrating that targeting a systolic BP less than 120 mm Hg resulted in lower rates of major cardiovascular events compared with less than 140 mm Hg. Although a pooled analysis of three studies (3632 participants) comparing different systolic BP targets suggested that intensive BP lowering reduced the rate of recurrent stroke, no clinical trials to date have tested the effect of such aggressive BP lowering for secondary stroke prevention.

In the Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study, we herein tested the hypothesis that targeting intensive BP lowering of systolic and diastolic blood BP less than 120 mm Hg and less than 80 mm Hg, respectively, reduces the rate of stroke recurrence compared with a standard BP-lowering regimen. In this randomized clinical trial that included 1263 patients with a history of stroke, intensive blood pressure control to less than 120/80 mm Hg tended to reduce stroke recurrence compared with standard blood pressure control (less than 140/90 mm Hg). When this finding was pooled with the results of prior trials of intensive blood pressure control for secondary stroke prevention in an updated meta-analysis, intensive blood pressure treatment significantly reduced stroke recurrence by 22%.

Comments

I wonder if plaque formation can be reversed by starvation? Some studies of people during WW2 indicate this is the case.

Let's say you are 70 years and you go on a two year starvation diet. You eliminate plaque so your blood vessels are similar to a 40 year old. Then you eat normally for three years, would your body then be like a 75 year old, or a person in their forties?

It's probably not healthy to starve yourself but I like to understand the mechanism. Is it reversing aging, or is just a temporary fix?

Posted by: Peter Lind at September 4th, 2019 7:20 PM

Hi Peter! Just a 2 cents.

For sure, starvation would have a positive effect because this is a calorie restriction/annulation (in this case, because no calories starvation), you have to be careful with starvation diet; it can cause frailty and even accelerate the disease (I had (still have) plaques in my arteries...), the thing is a starvation diet is a 'calorie crisis' -> high stress on the body. The body will enter into ketosis (ketone bodies in blood, acidic like substances that completely hamper glucose system)), it will try to use 'fat' as fuel, instead of glucose...if you are thin (like I was, always), you can die prematurely from this. Because, you just don't have 'much' left on you to 'burn'....when you have less a few % of body fat on you and your body is most skeleton/muscle...like I was...that is dangerous (i.e. the body has 'nothing' to burn, your brown/white adipose tissue is nill, so is your visceral fat - or rather, I had visceral fat around organs - yet can be thin; visceral fat accumulates in thin or obese people, around their diseased organs). Atherosclerosis made me lose 40 pounds, was 150 lbs..went down to 110...I did Not stop eating at all, I eated same but I cut the crap junk food out. I was still eating 'at my satiety/fullness'...I got my calories fully and Still, lost all this weight. Someone 150 is thin/normal...someone 100lbs is meager/frail border/underweight (if that person measure 5'10' tall), that was me. If you are an obese person, than it's safer, you stand to lose some pounds/would do your health good. Not, if your are thin already - AND - diseased; these people exist.

I would not recommend doing 'starvation diet'...I would recommend you (just a suggestion/a 2 cents), to do a CR diet....mild, only. like say, 20-40% less calories; taht's a good start.

And, no, it's not because you do a 2 years starvation diet that all is solved...I ahd atherosclerosis 4 years ago now (and survived it), I still live of the consequences of it and still ahve plaques of it; though shrinking/stabilized. It's Much longer than '2 years'...it could take up to 10-15 years to 'recoup' to that young of a body; so, no, a 70 year old person does not go back to 40, in 2 years, after they suffered what I suffered. Maybe in 20 years, a big maybe. Now, if you are an healthy 70 year old and want to do a starvation diet, it's a bit different; but, surely, you will gain for sure; Highly Doubt that you will go back to 40; very doubtful of that. What you May gain is 5 years approx...that sounds right, thus, a 70 year old could go back to 65 or, maybe, 60. Centenarians show that they were - 8 years younger epibiologically on methylome, that demonstrates they were not 30 years younger (when 70,,,not 40). And, still outlived everyone, to reach a 100+ years old.
Yes, exactly, starving yourself, is not healthy - because your body needs calories to function. 300-600 minimum a day or it will collapse/ATP loss.

It is a bit of both, reversing aging - and - fixing problems/damages...but it is not as drastic as you said; it's far more 'therapeutical' in effect (to reimprove your health) - than a Big Reversal of your biolgocal age.

Just a 2 cent.

Posted by: CANanonymity at September 4th, 2019 9:20 PM

@Peter Lind, @CANanonymity
Starvation , fasting or CR dinner incorrectly can do harm. There would be basically the same as malnutrition. Fasting and calorie restriction have great potential but first your body sold be able to handle them. If you're bmi is below 18 your approach Shirl
Sold be different they somebody with bmi of 40. Gal bladder stones can form or enlarge with frequent fasting, etc. Some conditions are strictly counter indicating while others have to be taken with caution. People FEEL better water fasting but we don't have conclusive studies wether the atherosclerotic plaque for reduced. The pressure might even have grown. So it is a bit of uncharted territory. For example diabetic type II respond very well to fasting. Type I , On the other hand if insuline d├ępendant will be extremely dangerous to combine insuline intake with fasting.

Posted by: Cuberat at September 5th, 2019 4:13 AM

Peter said:"Let's say you are 70 years and you go on a two year starvation diet. You eliminate plaque so your blood vessels are similar to a 40 year old. Then you eat normally for three years, would your body then be like a 75 year old, or a person in their forties?"
Maybe is not that simple. We should consider not only the plaque, but the age of those veins and arteries. Even without the plaque, arteries of a 70 y/o could be stiffer (and probably thinner and more delicate) than those of a 40 y/o with hypercholesterolemia ( I guess.)

Posted by: Beta at September 5th, 2019 5:20 AM

@ CANanonymity Thanks for your answer. I'm not considering going on a starvation diet.

Interesting to hear that you were able to stabilise your condition. If there is a mechanism in the body that can reduce plaque, maybe there is a way we could trigger it without starvation? There must be an organism in the body that is able to remove plaque.

Posted by: Peter Lind at September 5th, 2019 4:51 PM

@Peter Lind
It seems that nattokinase can disoblige cholesterol plaques. However, it is definitely not proven for humans yet. And even if it can be done you have to be very careful because of the courtroom lasion starts melting it can get detached and leaf to thrombosis, which is basically the cause for heart attacks and stroke.

Posted by: Cuberat at September 5th, 2019 7:00 PM

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