April 2022
Why Postmenopausal Women Have Higher Exercise BP
The sympathetic nervous system is responsible for the “fight or flight” response that leads to elevated heart rates (HR) and blood pressures (BP.) Interestingly, postmenopausal women tend toward a higher BP response to exercise than younger women. This “exaggerated exercise-induced BP response” is thought to increase cardiovascular risk in postmenopausal women. But no one has yet elucidated why this happens despite the many times we’ve discussed it, such as here and here.
Using a hand-grip, isometric exercise, known to cause BP to rise, a group of researchers used a method – microneurography – that assesses how frequently the nervous system fires at rest and during this exertion. They compared beat-to-beat BP responses in pre- and post-menopausal women; they also tested a small group of the latter after a month of transdermal estradiol (hormone) therapy, which has benefits in other areas, too.
As they’d hypothesized, the sympathetic nervous system is “overactive and increases to a greater extend in the postmenopausal women” leading to larger BP responses. Interestingly, those on hormone therapy had reduced BP responses compared to their unmedicated colleagues.
The obvious conclusion was that postmenopausal women do, indeed, experience higher BP responses to particular types of exercises – isometrics, in this case – and that estradiol therapy might prevent them from developing BP-related cardiovascular disease.
Since exercise is known to reduce one’s risk of heart disease, even though hormone therapy is not considered a primary prevention against it, it might be worthwhile for clinicians to monitor BP in postmenopausal women during exercise to determine if it might help them.
MSSE Mar. 2022
The Vitamin D Non-Issue
Vitamin D has seen a major resurgence of interest in the face of data that has suggested that D-deficiency is highly correlated to adverse covid outcomes. Long held as a crucial component of bone-density therapy, D is held in high regard by many clinicians, especially given the fact that so many older people are deficient, even if they spend a lot of time outdoors. For those who are deficient, the mortality risk from heart disease is elevated but a study out of Australia showed that “older adults without deficiency [get] no significant benefit in terms of survival outcomes…”
In a placebo-controlled trial, 20,000+ adults (average age – 69) were given a D supplement of 60,000 IU once a month or a placebo. Even the placebo group was allowed to continue taking 2000 IU. Over a follow-up period of 5.7 years or so, they found no differences between the groups for heart disease or cancer mortality.
Two factors are at play here. First, does boosting those who are not deficient improve their risk of dying from heart disease? The answer is, probably not. Second, was the study done over a long enough period of time to declare with certainty in either direction? Probably not.
One other factor to consider: as one Nashville endocrinologist said, in a personal note, since most Americans are going, at some point, to become deficient in D, why not start taking supplements before you become so. “You don’t wait to run out of gas to stop at the gas station to fill up.”
Medscape Jan. 2022
Tid Bits
Chronic low back pain (CLBP) has many potential causes and few sure-fire solutions. A small cohort of 113 people with CLBP was divided into 2 groups: 2 x 60-minutes of physical therapy or 2 x 60 minutes of pool therapy for 12 weeks. At the end of the study, half of the pool patients reported significant improvements in pain compared to 21% of the PT patients. Even a year later, this difference held. Swimsuits, anybody? Harvard Health Letter Apr. 2022
Exercise is medicine, it’s said. But how does it help the brain, other than by maintaining healthy blood flow? A post-mortem analysis of more than 400 people’s brains – with their permission, and after they’d died, obviously – showed that those who’d been active late in life had “higher amounts of synaptic proteins,” those that provide “connections between the brain’s nerve cells.” Many of these were found in the hippocampus, the memory center, but also in areas associated with cognition. Those who’d been the most active and had remained so longer had the most synaptic proteins. Harvard Men’s Health Letter Apr. 2022
In a report from Medscape (Mar. 2022), we learn that blood pressure (BP) measurements taken with the wrong size cuff can lead to some very disconcerting results. For example, if the cuff is too large, you might get a systolic BP reading on average 3.6 mm Hg lower. And if the cuff was too small, as in using a regular cuff vs a large adult cuff, you might get an average 4.8 mm Hg higher than what you’d get if you used the right sized cuff. And if you should be using an extra large adult cuff, a large adult cuff might overstate your BP by 19.5 mm Hg. Diastolic readings, the lower number, are also susceptible to misstating your true BP. This information means that using too small a cuff could characterize ~39% of patients as hypertensive, while using too large a cuff might miss 22% of those who should be deemed hypertensive.
