Sleep deprivation and SLEEP APNEA both bad for the heart

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Both sleep deprivation andSLEEP APNEA have been linked to a higher risk of heart disease.

Over time, inadequate or poor quality sleep can increase the risk of heart disease. Short–term sleep deprivation is linked with high cholesterol, high triglycerides and high blood pressure.

SLEEP APNEA makes people temporarily stop breathing many times during the night. Up to 83% of people with heart disease also haveSLEEP APNEA.

In sleep apnea, oxygen levels dip and the brain sends an urgent “Breathe now!” signal. That signal briefly wakes the sleeper and makes him or her gasp for air. That signal also jolts the same stress hormone and nerve pathways that are stimulated when you are angry or frightened. As a result, the heart beats faster and blood pressure rises — along with other things that can threaten heart health such as inflammation and an increase in blood clotting ability. (Source Harvard)

Treatment of mild hypertension in low-risk patients

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There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease.

A meta-analysis combined four placebo-controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow-up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk six meters in less than eight seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

References

  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.

Relaxation Therapy

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  • Relaxation techniques share two components: the repetitive focus (on a word, sound, prayer, phrase, body sensation, or muscular activity) and adoption of a passive attitude (towards intrusive thoughts.)
  • They induce relaxation response characterized by decreased arousal and diminished sympathetic activity (decreased heart rate and lower blood pressure) and increased EEG slow wave activity.
  • Relaxation techniques may be subdivided into two methods, deep and brief, or by the specific strategy used to induce the relaxed state, including progressive muscle relaxation, autogenic training and breath training.
  • Adverse reactions are intrusive thoughts, fear of losing control, upsetting sensory experiences, muscle cramps, sexual arousal and psychotic symptoms
  • Adverse reactions are relaxation–induced anxiety or relaxation-induced panic.
  • Relaxation–induced anxiety is a gradual increase in behavioral, physiologic, and psychological anxiety, whereas relaxation–induced panic is severe anxiety of rapid onset.
  • Patients with a history of generalized anxiety disorder or panic disorder and those with a history of hyperventilation are more likely to experience these adverse effects.
  • Patients should also be introduced to deep breathing techniques that often accompany relaxation in a gradual manner and not more than couple of minutes at a time.
  • Relaxation techniques can relieve pain in cancer.

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