4 times better than beets for increasing nitric oxide and lowering blood pressure

4 times better than beets for increasing nitric oxide and lowering blood pressure

By Dr. Mercola

While known as a salad green with a tangy, slightly peppery kick, arugula is actually a relative of the cruciferous family, which includes radishes, Brussels sprouts, kale, cauliflower, and broccoli. Like other members of this family, arugula contains a number of medicinal nutrients, including cancer-fighting compounds and carotenoids known for their importance for good eyesight.

It’s an excellent source of fiber, vitamins A, C and K, folate, calcium, iron, magnesium, phosphorus, potassium, and manganese. Arugula also provides high levels of protein, thiamin, riboflavin, vitamin B6, zinc, copper and pantothenic acid (vitamin B5).

Its flavonoid content helps improve blood vessel function, increase blood flow, lower blood pressure and lower inflammation. Arugula even has cleansing properties to counteract the poisoning effects of heavy metals in the system, particularly in the liver, and helps eliminate pesticides and herbicides from your body.

Arugula has long been considered an aphrodisiac, and modern science supports this notion, showing trace minerals and antioxidants help block absorption of environmental contaminants suspected of impacting your libido.

Arugula Is a Heart-Healthy Food

Arugula also contains about 480 milligrams (mg) of nitrates per 100-gram serving, which your body uses as raw material to make nitric oxide (NO), an important biological signaling molecule that supports normal endothelial function and protects your mitochondria.


Acting as a potent vasodilator, NO helps relax and widen the diameter of your blood vessels, supporting healthy blood flow and oxygenation of your tissues. It also carries away waste material and carbon dioxide. A diet high in nitrate is a natural strategy recommended for the treatment of prehypertension and hypertension (high blood pressure), and helps protect against heart attacks.

Raw beets are perhaps the most well-known for their ability to lower blood pressure (thanks to their nitrate content), but arugula actually contains the highest levels of nitrates of any vegetable. For comparison, 100 grams of whole red beets provide a mere 110 mg of nitrates to arugula’s 480 mg.

How to Grow Arugula

Arugula is a cool season crop, and can be added to your fall garden plantings. It’s forgiving in that it can tolerate low-fertility soils and frost, and is really easy to care for, although it does best in humus-rich soils with a pH between 6 and 6.8. Seeds germinate best at temperatures between 40 and 55 degrees F. Plant your seeds directly into your garden bed, but avoid planting them in a spot where you just harvested another cabbage family crop.

As noted in the video above, there are two main types of arugula. Common arugula (Eruca sativa) is best for eating and cooking, as it produces large, lush growth, while the wild Italian arugula (Eruca selvatica) — which does have a bolder flavor — tends to be more stemmy. The Italian variety will also bolt faster.

Plant your seeds about one-fourth inch deep, 1 inch apart. Rows should be about 3 inches apart. Seedlings will sprout in about 10 to 14 days. Arugula will do well planted next to lettuce and peas. For a continuous harvest through the fall, plant new seeds every two weeks up until about four weeks before your first frost date. Dry, hot weather will speed bolting. If temperatures are still on the high side, you can slow bolting by providing shade and making sure the soil doesn’t dry out.

Addressing Pests

A common cabbage family pest is the flea beetle. Row covers can be used to protect tender seedlings. Another protective measure is to sprinkle food grade diatomaceous earth around the seedlings. Diatomaceous earth is available at most garden centers. One drawback is that it will kill any soft-body insect, so in addition to fleas, it could also have a detrimental effect on worms and even bees. For this reason, it’s best to use it only when absolutely necessary.

Another alternative suggested in the video above is Reemay fabric. Used as a row cover, it allows about 75 percent of sunlight through, and is permeable enough to allow water through — but not the pests. Simply pin the fabric down so that it’s loosely covering the plants, allowing for growth.

Harvest — and Eat

Mature arugula is ready to harvest in about 40 days. “Graze” harvesting means selectively picking just a few leaves here and there to add to your cooking. The smaller the leaf, the milder its flavor will be. Alternatively, use a pair of garden shears to cut back about one-third of each plant, selecting the largest leaves in each bunch. The remainder will continue to regenerate and grow back.

Once the arugula starts to flower, it’ll start turning bitter. At this point, your best option is to pull the whole plant out by its roots. Salvage whatever leaves you still find edible and compost the rest. The arugula tends to bolt quickly, so keep an eye out for the telltale signs of flowers (shown in the video above), and harvest right away. Ideally, harvest at a time when it’s cooler and shadier, as the leaves will wilt quickly when cut in full sun.

Arugula is a popular salad green, but can be added to any number of dishes, such as sandwiches and hot or cold pesto, although it will lose some of its peppery punch when cooked. For a delicious side salad, try my grapefruit and arugula salad with avocado recipe.

How to Save the Seeds

Arugula seeds are easy to collect and save, and can be stored for up to five years. The plant will produce small, white flowers. Once flowers emerge, small seed pods will start to form along the stem. If you like, you can actually eat the seeds. They have a strong spicy kick, similar to a radish. Once the plant bolts, the leaves will turn bitter and begin to brown.

There are a number of ways to collect the seeds. Some will cover the stem with a nylon stocking to catch the seeds as the pods break open. Alternatively, clip the stem, tie a paper bag around it and hang upside down to dry.

To check if the seeds are ready to be collected, gently shake the seed pod. The seeds are ready when you hear them rattling around inside the pod. Eventually, the pods will break, releasing the seeds, or you can crush the pod if you like. To separate the seed from the chaff, Heirloom Organics suggests the following method:

“If your seeds are in a bag already, you can shake the bag or stick your hand in the bag and crumble the dried seed pods. You’ll end up with a pile of tiny dark seeds mixed in with papery seed pod chaff.

To separate this out, you can do it the old-fashioned way, which is to put everything in a shallow pan and blow the chaff off the top of the pile. The seeds weigh more than the chaff, so they will stay put. Another way is to put them in a sieve that has holes bigger than the seeds, but smaller than the chaff and shake.”

Store your seeds in a paper envelope or jar in a cool, dark, dry place. Alternatively, store them in a zipper bag in your refrigerator.

Try Arugula Microgreens

A simple and inexpensive way to boost your nutrition is to grow microgreens. Any regular herb or vegetable, including arugula, can be turned into a microgreen simply by harvesting it while the plant is still young. It’s simply a matter of not waiting until it’s fully mature. A microgreen or “baby” green is harvested when just a week or two old, when it’s reached a height of about 2 to 4 inches.

Many of the benefits of sprouts and microgreens relate to the fact that, in their initial and early phase of growth, the plants contain more concentrated amounts of nutrients. Vitamins like A, B-complex, C and E also increase in sprouted foods, sometimes by 20 percent within just a few days of germination. As a result, you need to eat far less, in terms of amount, compared to a mature plant. As noted in the book, “Microgreens: Novel, Fresh and Functional Food to Explore All the Value of Biodiversity:”

“Microgreens are … increasingly used by haute cuisine chefs to prepare gourmet dishes intended to satisfy the needs of modern consumers, more and more health conscious and particularly attentive to their health, diet and food quality.

Although [they] are often used with the main aesthetic purpose of garnishing dishes, microgreens also have a very good nutritional profile and … are considered ‘functional foods’ or ‘super foods’ as … they can also provide bioactive compounds able to improve some functions of the organism and/or reduce the risk of diseases.”

Do You Have a Victory Garden?

The idea of planting Victory Gardens goes back to World War I and II, and was advertised as a way for patriots to make a difference on the home front. Planting these gardens helped the citizens combat food shortages by supplying themselves and their neighbors with fresh produce.

Planting your own Victory Garden can go a long way toward healthier eating, and in the long run, it can provide incentive for industry-wide change, and a return to a diet of real food, for everyone, everywhere. A great way to get started on your own is by sprouting. They may be small, but sprouts are packed with nutrition and best of all, they’re easy and inexpensive to grow.

Study Finds Pomegranate Juice Lowers Blood Pressure

Last year, the study Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials was published in the journal Pharmacological Research. Eight different randomized placebo-controlled trials (RCTs) were analyzed to determine the efficacy of pomegranate juice for lowering high blood pressure, also known as hypertension.

Many past studies have suggested antiatherogenic, antioxidant, antihypertensive, and anti-inflammatory effects of pomegranate juice. Potential cardioprotective properties of pomegranate juice warrant further investigation and discussion.

In the aforementioned study a meta-analysis of eight previous RCTs was conducted using a random-effects model. Publication bias, quality assessment, and sensitivity analysis were implemented to gain an objective overview of pomegranate juice’s potential efficacy for lowering high blood pressure.

In layman’s terms, roughly 8 fl oz (~240 ml) of pomegranate juice consumed on a daily basis lowered both systolic blood pressure (the first number) and diastolic blood pressure (the second number) across the board.

From the abstract’s conclusion,

The present meta-analysis suggests consistent benefits of pomegranate juice consumption on blood pressure. This evidence suggests it may be prudent to include this fruit juice in a heart-healthy diet.

Positive results were observed from patients that consumed pomegranate juice for less than the 12 week period as well as those that consumed pomegranate for an excess of 12 weeks. Results suggest that pomegranate juice is effective at lowering both systolic and diastolic blood pressure when consumed regularly.

The efficacy and effectiveness appear to be extremely favorable for long term use of pomegranate juice; however, the results of this study suggest that working pomegranate into your diet can have relativity quick, short-term cardiovascular benefits as well.

[Related: Study Finds Pomegranate Outperforms Drugs For Managing Cholesterol Level]

To reap the full benefits discussed in the study we recommend choosing 100% juice, not-from-concentrate, and organic options when possible (find here). At the moment, there is plenty of organic pomegranate juice sold in glass bottles available here. If you or someone you know pays for medication to reduce high blood pressure, this may be a more affordable solution!

As always, it is wise to discuss any changes you may want to make to your current prescription regimen with a qualified practitioner. Unfortunately finding an allopathic doctor that will consider a healthy alternative to expensive prescription pills is rare.

The good news is that trained naturopathic physicians can be found in most areas in this day and age. These are doctors that believe in healing the body holistically instead of simply prescribing pills to mask symptoms. They take the time to read studies such as this and will work with you to achieve the diet and health goals that you desire.

The appeal of naturopathic medicine to many people is that conventional medicine may be implemented in emergency situations, rather than a complete dependence on it. If you’re unsure of whether or not there is a practicing naturopath near you, a search feature is available here.

You can find organic pomegranate juice, not-from-concentrate, in glass bottles by following this link. You can find a cheaper-per-ounce alternative here that is not certified organic such as the first link provided. Regardless, both options taste great making the 8oz daily intake quite achievable.

Sources and References:
Ella Olsson/flickrCC 2.0

Seven herbs that lower blood pressure


Reducing blood pressure helps ensure that people do not suffer any of the devastating side effects that can occur when it gets too high. Hypertension, as high blood pressure is often called, is responsible for an increased risk of kidney disease, heart attack, vision problems, heart failure, stroke and many other life threatening health conditions. Unfortunately, many people either do not take these threats seriously or they have found that the medications their doctor prescribed came with side effects that make them feel worse.

Medication is not the only solution

As part of a treatment plan for high blood pressure, the physician often emphasizes to the patient how important their lifestyle choices are to their health. Things such as exercising and eating a diet that focuses on eating more fruits and vegetables and less meats and dairy products can go a long way toward reducing high blood pressure. In addition to the DASH (Dietary Approaches to Stop Hypertension) diet, formulated at the National Heart, Lung and Blood Institute (NHLB), a part of the National Institutes of Health (NIH), people who suffer from high blood pressure can add other measures at home that are designed to help lower their blood pressure.

7 Herbs that can help

The following seven herbs, many of them popular and already in use in kitchens around the world, can help reduce blood pressure and the need for medications.

  • Garlic: A study at the Clinical Research Center of New Orleans found that allicin, a substance in garlic, helped nine research subjects with severe incidences of hypertension experience its reduction.
  • Onions: A Journal of Nutrition study found that the antioxidant flavonol, quercetin, caused subjects to experience a reduction of both their diastolic and systolic pressures compared with subjects who only took a placebo.
  • Cinnamon: This herb has many health properties, including lowering blood pressure and fighting diabetes. Research subjects who ingested a water soluble form of cinnamon had an increase in the antioxidants that lower blood sugar levels.
  • Oregano: An animal subject study found that a compound found in oregano, carvacrol, reduced arterial pressure, diastolic and systolic pressures and the heart rate.
  • Cardamom: After taking this herb for only three months, 20 people who were recently diagnosed with severe hypertension saw their blood pressure levels significantly reduced.
  • Olives: Olive oil, a staple in the Mediterranean diet, has been shown to reduce blood pressure, making people who live in that area some of the world’s healthiest.
  • Hawthorn: When 79 people with Type 2 diabetes took 1200mg of hawthorn extract for sixteen weeks, their mean diastolic pressure was reduced.

The above herbs are proof that just because a diet change is necessary for good health, it does not mean that the diet must be bland. Generous use of some of the most popular herbs can lead to better health.

Are You Low in This Powerful Nutrient?

Potassium, a mineral and electrolyte, is essential for your cells, tissues, and organs to function properly. It plays a vital role in heart health, digestive, and muscular function, bone health, and more.

While potassium is found in many foods commonly consumed in the US – including fruits, vegetables, dairy products, salmon, sardines, and nuts – only 2 percent of US adults get the recommended daily amount of 4,700 milligrams (mg).1

This is especially problematic because potassium is a nutrient that needs to be kept in proper balance with sodium in your blood. If you consume too much sodium, which is common if you eat a lot of processed foods, you’ll have an increased need for potassium.

Others who are at particular risk of low potassium, or hypokalemia, are those with chronic malabsorption syndromes, such as Crohn’s disease, or those taking heart medicine (particularly loop diuretics).2

However, anyone who eats a poor diet – an excess of processed foods and not enough fresh, whole foods – is potentially at risk of inadequate potassium levels.

Optimizing Your Potassium Level Helps Lower Your Blood Pressure

The number of deaths due to hypertension, or high blood pressure, increased nearly 62 percent from 2000 to 2013, according to a new report from the US Centers for Disease Control and Prevention (CDC).3 Currently, about 70 million US adults struggle with the condition, which amounts to one in every three adults.

Only 52 percent of those who have been diagnosed have their blood pressure levels under control, and another one in three US adults has pre-hypertension, which means blood pressure is elevated and at risk of progressing to full-blown hypertension.4

Yet, many are not aware that an imbalanced sodium-potassium ratio may lead to hypertension, as a higher level of potassium may blunt the effect of excess salt on blood pressure.5

A recent meta-analysis revealed that daily potassium supplementation is associated with a reduction of blood pressure in patients with high blood pressure. The researchers noted:6

“The reduction in blood pressure significantly correlates with decreased daily urinary sodium-to-potassium ratio and increased urinary potassium. Patients with elevated blood pressure may benefit from increased potassium intake along with controlled or decreased sodium intake.”

Similarly, one four-year observational study (the Prospective Urban Rural Epidemiology [PURE] study), which included more than 100,000 people in 17 countries, found that while higher sodium levels correlate with an increased risk for high blood pressure, potassium helps offset sodium’s adverse effects.7

In the study, those with the lowest risk for heart problems or death from any cause were consuming three to six grams of sodium a day — far more than US daily recommended limits. So while there is a relationship between sodium and blood pressure, it’s not a linear relationship, and potassium plays a role.

Increasing Potassium May Be More Important Than Decreasing Salt for High Blood Pressure

The authors proposed that instead of recommending aggressive sodium reduction across the board, it might be wiser to recommend high-quality diets rich in potassium instead.

This, they surmised, might achieve greater public health benefits, including blood-pressure reduction. As noted by one of the researchers, Dr. Martin O’Donnell of McMaster University:8

“Potatoes, bananas, avocados, leafy greens, nuts, apricots, salmon, and mushrooms are high in potassium, and it’s easier for people to add things to their diet than to take away something like salt.”

For comparison, according to a 1985 article in The New England Journal of Medicine, titled “Paleolithic Nutrition,” our ancient ancestors got about 11,000 mg of potassium a day and about 700 mg of sodium.9 This equates to nearly 16 times more potassium than sodium.

In contrast, daily potassium consumption with the Standard American Diet averages about 2,500 mg, along with 3,600 mg of sodium.

Researchers have also determined that increasing average potassium intake to the recommended 4,700 mg a day would reduce systolic blood pressure by between 1.7 and 3.2 mm Hg on a population-wide scale.

This decrease, they suggest, is similar to the reduction that would occur if Americans lowered their salt intake by 4 grams a day.10 This isn’t to say that I advise consuming all the salt you want, of course, particularly if it’s processed salt.

The easiest way to achieve an imbalance in your sodium-to-potassium ratio is by consuming a diet of processed foods, which are notoriously low in potassium while high in processed salt.

Potassium May Lower Your Risk of Stroke

Consuming enough potassium isn’t only a matter of maintaining a healthy blood pressure; it also helps to lower your risk of stroke (which makes sense, since elevated blood pressure is a major risk factor for stroke).

Research found that women without hypertension who consumed the most potassium (nearly 3,200 mg/day) had a 21 percent reduced risk of stroke.

Further, women who consumed the most potassium were 12 percent less likely to suffer from a stroke, and 12 percent less likely to die during the study period, than those who consumed the least.11 According to the study’s lead researcher:12

Potassium may play a role in improving blood vessel function in our brains. This could allow better oxygenation of our brain tissue, and prevent tissue death that occurs from lack of oxygen to the brain… The effect of potassium consumption on reduced stroke risk could also be due to a better diet overall, though we did not investigate this in our study.”

Separate research also revealed that for every 1000-mg/day increase in potassium intake, the risk of stroke decreased by 11 percent. “Dietary potassium intake is inversely associated with risk of strok.,”

The researchers wrote, “in particular ischemic stroke.”13 (Ischemic stroke, the most common type, results from an obstruction in a blood vessel supplying blood to your brain.)

Why You Should Strive to Get Your Potassium from Your Diet

It’s typically preferable to get your nutrients from foods instead of supplements, and this is certainly the case with potassium. Potassium in fruits and vegetablesis potassium citrate or potassium malate, while that found in supplements is typically potassium chloride.

The citrate, malate, and other compounds in dietary potassium, particularly that in produce, helps your body produce alkali, which may promote bone health14and even help preserve lean muscle mass as you get older.15 As researcher Dr. Bess DawsonHughes, of Tufts University, explained to Nutrition Action:16

If you don’t have adequate alkali to balance the acid load from the grains and protein in a typical American diet, you lose calcium in the urine and you have bone loss…

When the body has more acid than it is easily able to excrete, bone cells get a signal that the body needs to neutralize the acid with alkali… And bone is a big alkali reservoir, so the body breaks down some bone to add alkali to the system.”

That bone loss could lead to brittle bones or even osteoporosis over time. But while potassium in fruits and vegetables may help build bone health, the potassium chloride in supplements may not.

Research by Dawson-Hughes found that people who were in the neutral range for net acid excretion, meaning they had a fairly healthy balance for bone and muscle health, were eating just over eight servings of fruits and vegetables a day along with 5.5 servings of grains.

When they rounded this out, it came to about half as many grains as fruits and vegetables. For many Americans a simple recommendation to increase your alkali (and potassium) while reducing acid is to eat more vegetables and fewer grains.17

What Else Is Potassium Good For?

There’s no doubt that potassium is a superstar for heart health, lowering both your risk of high blood pressure and stroke. It’s also beneficial for lowering your risk of heart disease. According to the University of Maryland Medical Center:18

“Studies show that [people with] a higher sodium-potassium ratio have a higher risk of heart disease and all-cause mortality. Other studies show that heart attack patients who have moderate potassium levels… have a lower risk of death.”

As mentioned, eating a diet rich in potassium is also associated with bone health, particularly in elderly women, and, possibly, reducing the risk of osteoporosis. Symptoms of low potassium include weakness, lack of energy, muscle cramps, stomach disturbances, an irregular heartbeat, and an abnormal EKG (electrocardiogram, a test that measures heart function).19 If you’re wondering what your potassium levels are, ask your physician for a blood test.

Is Your Sodium-to-Potassium Ratio Out of Balance?

If you eat a lot of processed foods and not many vegetables, there’s a good chance your sodium-to-potassium ratio is unbalanced. If you’re not sure, try a free app like My Fitness Pal, which allows you to enter the foods you eat and then calculates the ratio automatically. It’s generally recommended that you consume five times more potassium than sodium, but most Americans get two times more sodium than potassium. If your ratio is out of balance…

  • First, ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients
  • Eat a diet of whole, unprocessed foods, ideally organically and locally grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium
  • When using added salt, use a natural salt. I believe Himalayan salt may be the most ideal, as it contains lower sodium and higher potassium levels compared to other salts

I do not recommend taking potassium supplements to correct a sodium-potassium imbalance. Instead, it is best to simply alter your diet and incorporate more potassium-rich whole foods. Green vegetable juicing is an excellent way to ensure you’re getting enough nutrients for optimal health, including about 300 to 400 mg of potassium per cup. Some additional rich sources of potassium are:

  • Lima beans (955 mg/cup)
  • Winter squash (896 mg/cup)
  • Cooked spinach (839 mg/cup)
  • Avocado (500 mg per medium)

Other potassium-rich fruits and vegetables include:

  • Fruits: papayas, prunes, cantaloupe, and bananas. (But be careful of bananas as they are high in sugar and have half the potassium of an equivalent amount of green vegetables. It is a myth that you are getting loads of potassium from bananas; the potassium is twice as high in green vegetables)
  • Vegetables: broccoli, Brussels sprouts, avocados, asparagus, pumpkin, Swiss chard, and beet greens

‘Lifesaving’ Study Urges New Goals on Blood Pressure .

Jackson T. Wright Jr., a blood pressure expert at Case Western Reserve University and University Hospitals Case Medical Center as well as a Sprint study investigator, said changing blood pressure guidelines could cause the falling death rate from heart attacks and stroke to drop even more.
 Declaring they had “potentially lifesaving information,” federal health officials said on Friday that they were ending a major study more than a year early because it has already conclusively answered a question cardiologists have puzzled over for decades: How low should blood pressure go?

The answer: way lower than the current guidelines.

For years doctors have been uncertain what the optimal goal should be for patients with high blood pressure. The aim of course is to bring it down, but how far and how aggressively remained a mystery. There are trade-offs — risks and side effects from drugs — and there were lingering questions about whether older patients needed somewhat higher blood pressure to push blood to the brain.

The study found that patients who were assigned to reach a systolic blood pressure goal below 120 — far lower than current guidelines of 140, or 150 for people over 60 — had their risk of heart attacks, heart failure and strokes reduced by a third and their risk of death reduced by nearly a quarter.

Lack of sleep could increase common cold risk

A new study published in Sleep has reinforced the importance of getting a good night’s sleep. Researchers have demonstrated that not getting enough sleep could increase the risk of catching a cold.
The team reports that people who only get 6 hours sleep a night or less are four times more likely to catch a cold after exposure to the virus than people that get 7 or more hours sleep a night.
“Short sleep was more important than any other factor in predicting subjects’ likelihood of catching cold,” says lead author Aric Prather, assistant professor of Psychiatry at the University of California-San Francisco (UCSF).
“It didn’t matter how old people were, their stress levels, their race, education or income. It didn’t matter if they were a smoker. With all those things taken into account, statistically sleep still carried the day.”
The Centers for Disease Control and Prevention (CDC) have previously referred to insufficient sleep as a “public health epidemic,” linking it with motor vehicle crashes, industrial disasters and occupational errors.
Poor sleep may be linked to poor metabolic health and could raise the risk of heart attack and stroke.
Less than 5 hours sleep, 4.5 times the risk of catching a cold

2)Naps May Do a Heart Good
Study found they lowered blood pressure in patients, were
linked to better heart and vessel health
Taking a midday nap might
be beneficial for your heart, new
research suggests.
The investigators looked at how an hour-long siesta at noon
affected blood pressure among nearly 400 middle-aged
people with high blood pressure.
The result: those who napped saw their systolic blood
pressure reading (the number on top of the standard blood
pressure ratio) drop an average of 5 percent over the course
of the day, compared with patients who didn’t rest.
More specifically, the team found that nappers saw their
blood pressure readings fall by 4 percent during the day and
by 6 percent while sleeping at night.
“Although the mean BP [blood pressure] decrease seems low,
it has to be mentioned that reductions as small as 2 mmHg
in systolic blood pressure can reduce the risk of
cardiovascular events by up to 10 percent,” study author Dr.
Manolis Kallistrato, a cardiologist at Asklepielon Voula
General Hospital in Athens, said in a European Society of
Cardiology news release.
Kallistrato and his colleagues presented their findings
Saturday at a meeting of the European Society of Cardiology
in London. Research presented at medical meetings is
considered preliminary until published in a peer-reviewed
In all, the study involved about 200 men and 186 women,
with an average age of just over 61.
The finding appeared to hold up even after accounting for a
variety of factors that can affect blood pressure, including
smoking history, salt, alcohol and coffee intake, and activity
routines, the researchers said.
Napping was also linked to a reduction in the size of the left
atrium section of the heart, as well as a more than 10
percent drop in so-called “pulse wave velocity” levels. Pulse
wave velocity measures the stiffness of arteries.
“These findings suggest that midday sleepers have less
damage from high blood pressure in their arteries and heart,”
Kallistrato said.
The research can only point to an association, however, and
it does not prove that naps will curb heart disease.
According to Kallistrato, “our study shows that not only is
midday sleep associated with lower blood pressure, but
longer sleeps are even more beneficial… We also found that
hypertensive patients who slept at noon were under fewer
antihypertensive medications compared to those who didn’t
sleep midday.”

Preoperative Hypotension Linked to Mortality Risk

Researchers analyzed data from a quarter-million surgery patients

In the unadjusted analysis, both preoperative hypertension and hypotension were associated with mortality risk. However, after adjusting for risk factors and confounders, the risk associated with hypertension disappeared, reported lead investigator Robert Sanders, MBBS, PhD, FRCA, of the University of Wisconsin, and colleagues.

Sanders and colleagues analyzed data from more than 250,000 patients from the United Kingdom Clinical Practice Research Datalink who underwent noncardiac surgery. They looked for a link between preoperative blood pressure and 30-day perioperative mortality, adjusting for 29 risk factors including age, gender, race, comorbidities, surgical risk score, and end-organ vascular damage.

For patients with a preoperative systolic blood pressure less than 100 mmHg, mortality risk increased by 40% (OR 1.40; 95% CI 1.05-1.86) in the adjusted analysis. For those with a preoperative diastolic BP less than 40 mmHg, mortality risk increased by approximately 250% (OR 2.49; 95% CI 1.43-4.33).

As preoperative blood pressure decreased below the threshold of 100/40 mmHg, the odds of mortality increased.

“While high blood pressure control is important for long-term health, high blood pressure itself does not impose a significant risk of postoperative death,” the study authors said in a press release. “Rather the health consequences of uncontrolled high blood pressure convey other health risks — therefore we still recommend that patients’ blood pressure should be as well controlled as possible prior to surgery.”

“What these data tell us is that patients with low blood pressure before surgery are at higher risk. What we don’t have is causality. There could be some other factor we haven’t measured which is driving this risk. That will be the next step in our research,” Sanders said in an interview with MedPage Today.

“But we still think this is significant new information,” Sanders said. “It will be important to understand how we can mitigate this risk to make sure these patients are less vulnerable.”

“This study is important because it makes us step back and recognize that hypotension, rather than hypertension, is the dominant problem,” P.J. Devereaux, MD, PhD, of McMaster University in Hamilton, Ontario, toldMedPage Today. Devereaux was not involved in the study.

Physicians should be more aware of hypotension as a potential complication for surgical patients and have good procedures in place for measuring and monitoring it, Devereaux said.

Advising patients to take all of their high blood pressure medicine the morning before surgery might need to be reconsidered in some cases, Devereaux said. “If you have an elderly patient who has fasted overnight and then takes three or four hypertension medications that morning, this might lead to a hypotensive episode that gets them into trouble.”

Richard Dutton, MD, an anesthesiologist at the University of Chicago and Chief Quality Officer for the American Society of Anesthesiologists, was more cautious in interpreting the study results.

“This is a retrospective study, so it can show an association but it can’t prove cause and effect,” Dutton said in an interview with MedPage Today. “And you can’t account for all the variables and potential confounders.” Dutton was not involved in the study.

Hypotensive patients may have fared worse in this study because they were sicker to begin with, Dutton said. A patient going into surgery with low blood pressure may be suffering from internal bleeding, dehydration, uncontrolled diabetes, malnourishment, or any number of maladies.

“Still, this study increases my awareness of low blood pressure as a risk factor, and it raises the possibility that correcting low blood pressure might improve surgical outcomes,” Dutton said.

Too Much Salt: How A Diet Too High In Sodium Can Affect Your Heart, Brain, And Even Bone Health

Sodium, the main component in table salt, can be detrimental to the body in high quantities. 

Salt has always been of high importance to humanity. In ancient Egypt, salt was an integral part of religious ceremonies, and the Moors in Africa would trade salt pound for pound with gold. Part of our adoration for salt, however, lies in its main ingredient, sodium. (It’s also composed of chloride and iodine sources.) According to the American Heart Association, about 75 percent of the sodium we consume comes not from the salt shaker, but rather in processed and restaurant food.

Our Love Affair With Salt

Sodium is essential to human health. The mineral helps to regulate fluids by letting the body know when it’s time to replenish or dispose of water. Along with that, sodium also maintains nerve transmissions and muscle contractions — functions vital to our survival. As a result, our bodies evolved a desire for sodium akin to addiction to ensure that we never went without enough.

A 2011 Australian study found that the brain responds to sodium similar to how it does for substances such as heroin, cocaine, and nicotine, which may explain why so many of us tend to overindulge in high-sodium foods. Unfortunately, too much of a good thing can actually prove deadly.

Your Brain On Salt

A 2011 Canadian study on 1,200 older sedentary adults with normal brain function found that over the course of three years, high-sodium diets were linked to increased risk of cognitive decline. This result was “independent of hypertension and global diet quality” and “suggests that sodium intake alone may affect cognitive function in sedentary older adults above and beyond the effects of overall diet,” the researchers wrote.

The reason why sodium is detrimental to the brain is not fully understood, but according to Dr. David L. Katz, a researcher involved in the study, physical exercise may be able to protect the brain from the effects of too much salt, Medscape reported.


Sodium plays a key role in balancing the levels of fluid in our bodies by signaling to the kidneys when to retain water and when to get rid of water. A high-sodium diet can interfere with this delicate process and reduce kidney function. The result is less water removed from the body, which may lead to higher blood pressure. As explained by The World Action on Salt and Health, this excess strain on the kidneys can lead to kidney disease or exacerbate kidney problems in those already with the condition.

High-sodium diets may also increase your risk of developing renal stones, also known as kidney stones. The main cause of kidney stones is urinary calcium, a mineral which is noted to increase in those with high-sodium intake.


Excessive calcium excretion in the urine is believed by some experts to increase the risk of bone thinning. According to WASH, over long periods of time, this excessive calcium loss is associated with osteoporosis, especially in postmenopausal women.


Due to salt’s fluid retention effect, in some individuals excessive amounts of salt in their diet can lead to high blood pressure. High blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood, and high blood pressure can lead to many serious conditions, such as stroke and heart failure. Although blood pressure increases naturally with age, according to the American Heart Association, reducing your salt intake can help prevent your blood pressure from increasing too much.


Excessive salt in the diet can cause a symptom known as edema. As reported by Medical News Today, edema is characterized by swelling, particularly in the hands, arms, ankles, legs, andfeet, caused by fluid retention. Excessive salt consumption commonly causes edema; however, the symptom can be caused by a number of other health concerns ranging from menstruation to genetic disposition. Edema is non-life threatening and is a symptom of another underlying health condition, rather than a condition on its own.

While edema may be an extreme symptom of excessive salt consumption, even something as simple as having an extra-large popcorn the night before can leave your skin looking a bit puffier than usual. Dr. Neal B. Schultz, a dermatologist practicing in New York City, told Shapethat susceptibility to swelling due to salt consumption increases with age.


A 1996 study published in the International Journal of Epidemiology found that death from stomach cancer in both men and women was closely linked to salt consumption. High salt intake is also associated with stomach ulcers. The reason for this is not completely understood, but one study theorized that the salt may have an adverse effect on the mucous lining of the stomach and cause the stomach tissue to become abnormal and unhealthy, according to Livestrong.



While the link between salt and hypertension is well known, scientists until now haven’t understood how high salt intake increased blood pressure. By studying the brains of rats, a team led by Prof. Charles Bourque of McGill’s Faculty of Medicine discovered that ingesting large amounts of dietary salt causes changes in key brain circuits.

“We found that a period of high dietary salt intake in rats causes a biochemical change in the neurons that release vasopressin (VP) into the systemic circulation”, says Bourque who is also a researcher at the The Research Institute of the McGill University Health Centre (RI-MUHC). “This change, which involves a neurotrophic molecule called BDNF (brain-derived neurotrophic factor), prevents the inhibition of these particular neurons by other cells”.

The team’s findings, published today in the journal Neuron, found that high salt intake prevents the inhibition of VP neurons by the body’s arterial pressure detection circuit. The disabling of this natural safety mechanism allows blood pressure to rise when a high amount of salt is ingested over a long period of time.

While the team’s discovery advances the understanding of the link between salt intake and blood pressure, more work is needed to define new targets that could potentially be explored for therapeutic intervention. Among the questions for further research: Does the same reprogramming effect hold true for humans? If so, how might it be reversed?

In the meantime, Bourque says, the message remains: limit dietary salt.

Reconsidering Allopurinol for Hypertension

Of late, we are beginning to look at old drugs that might have new uses. This has been the case with spironolactone, for example, a mineralocorticoid antagonist. It has turned out to be good in heart failure and resistant hypertension.

There are also some ideas that this might be the case with allopurinol, a xanthine oxidase inhibitor widely used in the 1960s, 1970s, and 1980s. A couple of small studies in obese adolescents and adolescent patients with hypertension showed reductions in blood pressure.[1,2]

Is allopurinol a good drug for lowering blood pressure? That is the question that has been posed [in this study by Beattie and colleagues].[3]

It is interesting because there is a plausible mechanism to explain why a xanthine oxidase inhibitor might reduce blood pressure and cardiovascular events. This also is seen with uricosuric agents, so is it just lowering of the uric acid level or is there something special about what allopurinol and similar drugs do?

This is an example of “big data.” Investigators looked at the United Kingdom Clinical Practice Research Datalink to see whether they could tease out which individuals had received allopurinol. They looked at people who were older than 65 years of age, because there were no issues about paying for prescription drugs in that group. The sought to determine how many people were in that group and how the drug influenced their pressure.

Only 3% of the people in that very large database who were over the age of 65 had taken allopurinol. The investigators compared [a subsection of] these people [who had blood pressure readings taken before and after being prescribed allopurinol] with people who had not taken allopurinol, using a propensity analysis that matched people as closely as possible.

The findings were interesting: There was a modest reduction of blood pressure that was not related to the primary uric acid level or to other drugs the patients were taking (80% were on a thiazide diuretic, which can raise uric acid levels), and they saw an issue of physician preference for drugs. They also looked at patients who received no treatment or no change in treatment, with the same results. There was a hint, at least, in certain groups that allopurinol lowered blood pressure.
They recommended giving a high dose (≥ 300 mg daily) of allopurinol. No patient received a higher dose than 300 mg daily. Adolescents received 200 mg twice daily. This is a large assumption—that we ought to be giving people large doses of allopurinol, which can cause Stevens-Johnson syndrome and other side effects.

Before we embark on a good clinical trial, we had better decide whether we are willing to take on the risks associated with this agent. It is very good for the prevention of gout, but should we start giving it to people who don’t have gout and to those in whom it is not indicated?

We will see. This may be a look at big data, but it might also be an abuse of big data before we can make recommendations for clinical practice.


  1. Soletsky B, Feig DI. Uric acid reduction rectifies prehypertension in obese adolescents. Hypertension. 2012;60:1148-1156. Abstract
  2. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA. 2008;300:924-930. Abstract
  3. Beattie CJ, Fulton RL, Higgins P, et al. Allopurinol initiation and change in blood pressure in older adults with hypertension. Hypertension. 2014;64:1102-1107. Abstract
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