Tag: high blood pressure

Bioethics Blogs

Creative Minds: Exploring the Role of Immunity in Hypertension

Meena Madhur / Credit: John Russell

If Meena Madhur is correct, people with hypertension will one day pay as much attention to their immune cell profiles as their blood pressure readings. A physician-researcher at Vanderbilt University School of Medicine, Nashville, Madhur is one of a growing number of scientists who thinks the immune system contributes to—or perhaps even triggers—hypertension, which increases the risk of stroke, heart disease, kidney disease, and other serious health problems.

About one of every three adult Americans currently have hypertension, yet a surprising number don’t know they have it and less than half have their high blood pressure under control—leading many health experts to refer to the condition as a “silent killer”[1,2]. For many folks, blood pressure control can be achieved through lifestyle changes, such as losing weight, exercising, limiting salt intake, and taking blood pressure medicines prescribed by their health-care provider. Unfortunately, such measures don’t work for everyone, and some people continue to suffer damage to their kidneys and blood vessels from poorly controlled hypertension.

Madhur wants to know whether the immune system might be playing a role, and whether this might hold some clues for developing new, more targeted ways of treating high blood pressure. To get such answers, this practicing cardiologist will use her 2016 NIH Director’s New Innovator Award to conduct sophisticated, single-cell analyses of the immune systems of people with and without hypertension. Her goal is to produce the most comprehensive catalog to date of which human immune cells might be involved in hypertension.

Back in the 1960s, animal studies provided the first indication that the immune system might play a role in hypertension.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Preeclampsia: Study Highlights Need for More Effective Treatment, Prevention

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It’s well known that preeclampsia, a condition characterized by a progressive rise in a pregnant woman’s blood pressure and appearance of protein in the urine, can have negative, even life-threatening impacts on the health of both mother and baby. Now, NIH-funded researchers have documented that preeclampsia is also taking a very high toll on our nation’s economic well-being. In fact, their calculations show that, in 2012 alone, preeclampsia-related care cost the U.S. health care system more than $2 billion.

These findings are especially noteworthy because preeclampsia rates in the United States have been steadily rising over the past 30 years, fueled in part by increases in average maternal age and weight. This highlights the urgent need for more research to develop new and more effective strategies to protect the health of all mothers and their babies.

The causes of preeclampsia remain somewhat mysterious, though recent data suggest a role for proteins produced by the placenta. Because preeclampsia affects a pregnant woman’s vascular system, her unborn child can be deprived of needed oxygen and nutrients. In mild cases, the condition can often be managed with careful monitoring and blood pressure medications. But if the symptoms become severe and potentially life-threatening to either mother or child, the only answer is to induce early delivery, which carries its own health risks and high health care costs.

In the study reported in the American Journal of Obstetrics & Gynecology, a team led by Anupam Jena at Harvard Medical School, Boston, set out for the first time to quantify those costs up to a year after delivery.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Bariatric surgery for teenagers?

American doctors are debating whether to offer bariatric surgery for severely obese young people. The market is huge: about 3 to 4 million teenagers are eligible, but only about 1000 a year have the operation. The proportion of adolescents who are severely obese has doubled nearly doubled between 1999 and 2014 – from  5.2% to 10.2 % of all people  aged 12 to 19.  But most doctors are deeply sceptical of the health benefits of the operation.

On the other hand, it is sometime the only thing that seems to work. “We’re at a point in this field where surgery is the only thing that works for these kids but we don’t know the long term outcomes,” Aaron Kelly, an expert in pediatric obesity at the University of Minnesota told the New York Times.

For many teens severe obesity is medically, socially and psychologically challenging. It is associated with type 2 diabetes, high blood pressure, sleep apnea, acid reflux, fatty liver and high cholesterol levels and depression. “I’ve had many patients tell me they’d rather be dead,” than remain fat, one doctor told the Times. .

On the other hand, it is not spectacularly successful. According to the most recent studies, most participants shed about one-third of their weight and kept it off for at least five years. But two-thirds remained severely obese and some developed vitamin deficiencies.

So doctors are thinking of offering the operation at an even younger age, since diets, exercise and behavioural therapy just do not work. The longer doctors wait, the more likely it is that the obese teenager will become an obese adult.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Four myths about IVF in older women

Dominic Wilkinson, @Neonatalethics

Reports that a 62-year-old Spanish woman has given birth after IVF treatment have led many to question whether there should be age limits with such treatment. Lina Alvarez, a doctor in north-west Spain, isn’t the oldest person to have had success with IVF. Earlier this year, in India, Daljinder Kaur is said to have given birth at the age of 72, prompting calls from the Indian Medical Council for a ban on fertility treatment in women over the age of 50.

In many countries where there is funding assistance for IVF there is a limit to obtaining treatment over a certain age. In Britain, for example, the bar is set at age 42. But Alvarez received private treatment. So why care about her age? And what business is it of the rest of us whether she has access to IVF?

There are several arguments that typically surface in debates about age and fertility treatment – and they are all deeply flawed.

1. Having an older mother is harmful

It is sometimes claimed that children will be harmed if older mothers are allowed access to IVF. This might be because older mothers will not be able to meet the physical demands of lifting, playing with and caring for a small child. It might be because it would be a bad thing for a child if their mother were to die while they are still young.

However, in some countries women of Alvarez’s age on average can expect to live to the age of 85.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Slouching Towards Gattaca

Genetics is the determinism of our age (“Your destiny is determined by your genes”). It appears more scientific than the determinisms of previous ages such as astrology (“Your destiny is in the stars”) or Marxism (“Your destiny is in economics”), and thus has much greater appeal to the people who look to science for The Answers. News headlines breathlessly report the discovery of the “gene for” this behavior or that behavior: the gene for losing your virginity early, the gene for adultery, the gene for lying. What the headlines leave out are the subtleties: yes, our genetics have an influence our behaviors and decisions, but they are not “determinative” in any sense that that word is commonly understood. The same holds true for the genetics of many diseases: genes for things like diabetes and heart disease and high blood pressure and even breast cancer can increase or decrease the likelihood that someone will develop that disease, but are not “determinative.” Many, many factors other than genetics also play a role in developing these diseases.

However, there are some diseases for which the genes do seem to be determinative; that is, if you have certain genes for a condition, you will inevitably develop that condition. Such genetic disorders are called “fully penetrant.” In these cases, destiny does seem to be in the genes . . .

Or maybe not? In a study published earlier this month in Nature Biotechnology, researchers combed through 589,306 genomes obtained from genomic databases such as 23andMe. In so doing, they found thirteen people who have the genes for eight fully-penetrant, usually lethal, childhood-onset disorders; but the adults with those genomes are healthy adults, without the disorders their genes code for.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Weight of the World April 21, 2016 According to a new study published in the medical jou…

April 21, 2016

When I was a young child, I was a very picky eater. I would often refuse to eat the meals my parents put before me, even if it was something that I’d eaten and enjoyed before. Some kids are so-called “selective” eaters because of a medical problem like gastroesophageal reflux disease, gluten intolerance, or some other nutritional or sensory disorder, but my picky eating was a result of sheer stubbornness. 

Like most mothers, mine resorted to all sorts of inducements, incentives and threats to get me to eat, including using the age-old remonstration about starving children in India or Ethiopia. My usual retort was to offer to pay the postage out of my allowance so that she could send the food there.

What a change 40 years can make. The rebellious five-year-old boy who would go a whole month eating nothing but buttered noodles is now a very adventurous eater. I have even sampled such exotic foods as snake, spiders, jellyfish and grasshoppers while traveling overseas. Even more surprising, although there is still a massive problem of hunger and malnutrition in India, Ethiopia and even in the United States – as many as 1 in 7 Americans go to bed hungry – there are now more people who are obese than who are malnourished globally.

According to a new study published in the medical journal The Lancet last week, the number of people in the world who are clinically obese has increased six-fold over the last four decades. Using a measure of body fat composition known as the body mass index (or BMI, which is calculated as an individual’s weight in kilograms divided by their height in meters squared), researchers compared historical rates of obesity among 20 million people from 186 different countries. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Common Medicines Tied to Changes in the Brain

April 20, 2016

(Reuters) – Commonly used drugs for problems like colds, allergies, depression, high blood pressure and heart disease have long been linked to cognitive impairment and dementia. Now researchers have some fresh evidence that may help explain the connection. The drugs, known as anticholinergics, stop a chemical called acetylcholine from working properly in the nervous system. By doing so, they can relieve unpleasant gastrointestinal, respiratory or urinary symptoms, for example.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

On Living to 100 or More

Sometime around my mid-50’s I began to ask myself a question: how long should I want to live? My father had died at 64, my mother at 85, my various uncles and aunts in their 60s and 70s. Occasional news stories, always with a picture, reported on those few people who made it to 100. I am now 85 and still turning that question over in my mind.

I could serve as a geriatric poster-child for my age: some Parkinson’s disease, fairly advanced emphysema, arthritis, moderately severe asthma, and elevated but controlled high blood pressure—a typical potpourri of those chronic diseases that now mark the elderly. I call this the great trade-off. Earlier generations lived shorter lives and had faster deaths. We now live longer but medical advances typically give us a slower death from those diseases.

I did over time answer the question of how long I should want to live. First, to live long enough to do most of those things that life makes possible: to become educated, have a satisfying career, see a bit of the world, develop a circle of friends, and to marry and raise a family. I have now done all those things, well and fully (if not always perfectly).  Second, I want to die at a stage in life when those in my family and community see no significant social loss to society in my death even though (I hope) they will personally miss me.

 It was once acceptable to say, with few tears, that “he died a natural death.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

National Kidney Month

The California Legislature passed a resolution proclaiming March as National Kidney Month.  

WHEREAS, The Month of March is National Kidney Month, and March 10, 2016, is World Kidney Day; and

WHEREAS, Approximately 50 years ago, kidney failure was a death sentence; and

WHEREAS, In 1972, the United States Congress developed the Medicare End-Stage Renal Disease (ESRD) program. In doing so, Congress ensured that regardless of age or income, any American would have access to life-saving dialysis care; and

WHEREAS, One in 10 adults in the United States are living with kidney disease; the leading causes are diabetes, high blood pressure, and a family history of chronic kidney disease (CKD); and

WHEREAS, Kidney disease is the ninth leading cause of death in the United States. Once diagnosed, an individual with kidney failure must either get a kidney transplant or receive dialysis treatment at least three times per week, for three to four hours per treatment, to live; and
   
WHEREAS, CKD is a progressive disease that may lead to premature death or kidney failure; and
   
WHEREAS, More than 26 million Americans have CKD, but most are unaware that they have it, and another 73 million are at risk. Many of them only discover that they have kidney failure, also known as end-stage renal disease (ESRD), when they “crash” in a hospital emergency room after fainting or suffering from extreme dizziness; and

WHEREAS, Nearly 616,000 Americans have ESRD, and more than 430,000 rely on life-sustaining dialysis; and

WHEREAS, The only treatment options for kidney failure are a kidney transplant or dialysis; and
   
WHEREAS, More than 95,000 individuals are waiting for kidney transplants; and 

WHEREAS, Since 2000, the number of patients who have been diagnosed with kidney failure has increased by 57 percent; and
   
WHEREAS, According to statistics from the federal Centers for Disease Control and Prevention, one in three people with diabetes has kidney disease; one in five adults with high blood pressure has chronic kidney disease; African Americans are about three and a half times more likely to develop kidney failure than Caucasians; Latinos are one and a half times more likely to develop kidney failure than non-Latinos; and Asian and Pacific Islander Americans are twice as likely to develop kidney failure as Caucasians; now, therefore, be it

Resolved by the Assembly of the State of California, the Senate thereof concurring, That the Legislature proclaims the month of March 2016, and each year thereafter, as National Kidney Month in California; and be it further
   
Resolved, That the Legislature supports programs to increase awareness of kidney disease, work to educate Californians about healthy eating and drinking habits, and encourage individuals to seek early screening and treatment of diabetes and high blood pressure; and be it further

Resolved, That the Legislature encourages health care providers, as they detect and treat diabetes and high blood pressure, to engage in an aggressive program with their patients that includes a treatment regimen that meets and exceeds minimum treatment guidelines; and be it further
  
Resolved, That the Chief Clerk of the Assembly transmit copies of the resolution to the author for appropriate distribution.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

IVF an “evolutionary experiment” – genetics expert

A leading evolutionary biologist has labelled IVF an “evolutionary experiment” that may have serious effects on children in later life. 

Speaking at the American Association for the Advancement of Science annual meeting in Washington DC, Dr Pascal Gagneux of University of California, San Diego said that the long-term effects of IVF are still unclear.

“…We’re engaging in an evolutionary experiment … I would compare it to high fructose corn syrup and fast food in the US. It took 50 years; it was fantastic, you got bigger and healthier, and now the US are the first generation that are shorter and heavier and die younger. But it took 50 years…”

He noted that the oldest IVF child in the world is only 39.

According to Dr Gagneux some possible long-term side-effects are diabetes, high blood pressure and even premature death. He cited a study in which a large group of IVF and naturally conceived children were taken to a high altitude, low oxygen environment that mimicked the effects of ageing. 

Heart and artery malfunction was reported “very convincingly” in the assisted reproduction children, including those with brothers and sisters who were conceived naturally, Dr Gagneux said.

A number of IVF specialists have responded to Dr. Gagneux’s remarks, saying he lacked evidence for his bold claims.  Allan Pacey, Professor of Andrology at the University of Sheffield, said: “There is a wealth of epidemiological evidence to suggest that the babies born through IVF technologies are on the whole as healthy as their naturally conceived counterparts.

“Where some differences have been observed, these are largely explained by genetic defects in the sperm of the father rather than the fact that fertilisation and embryo development occurred outside of the body.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.