GENIUS: Managing Blood Pressure in Barbershops to Decrease Stroke and Heart Attack

  African American men are more likely than other groups to have high blood pressure that is not adequately controlled and tend to have less contact with the health care system.
  In a stroke of true genius that if scaled up could save millions of lives and prevent many strokes and heart attacks.
  African American men who received medical intervention aimed at controlling their blood pressure at their monthly barbershop visits showed a marked reduction in their systolic blood pressure by 21 mm Hg or more. Amazing.
NEJM 2018;378:1291-1301

High Blood Pressure ? Blame it on Your Childhood

  Children with a history of  childhood mistreatment, poverty or family dysfunction may have poor blood pressure regulation. Blood pressure variability has been linked to numerous problems in adults including increased risk of stroke, poor post-stroke recovery and decreased brain function in the elderly.
AHA Meeting Report  Presentation: 307 Session : EP.AOS.760
  Previous research has found an association between adverse childhood experiences and a more rapid increase of blood pressure in adulthood. Further, early-onset hypertension and prehypertension have been linked to preclinical heart disease such as increased arterial stiffness and left ventricular hypertrophy.

Treat Hypertension Mid-life to Preserve Late-life Brain Function

  According to a review of the literature by a panel of experts, treatment of hypertension in mid-life preserves late-life cognitive function.
  Hypertension disrupts the function and structure of cerebral blood vessels which leads to ischemic damage (as a result of decreased blood flow to brain cell's) of white matter regions critical for cognitive function and may promote Alzheimer pathology.
Hypertension Oct 10 2016
  As previously reported, treatment of elevated blood pressure in the oldest of the old should be more conservative than treatment of younger patients.

Uncontrolled Hypertension Treated with Renal Denervation

   Renal denervation, an intravascular procedure that employs radiofrequency pulses induces denervation of the sympathetic innervation of a patient's renal arteries. Approximately 10,000 patients have been treated worldwide resulting in a drop in blood pressure of 28/10 mm Hg in patients that began their treatment with pressures of approximately 180/100 mm Hg, with a response rate of over 90% and a duration of over 36 months of follow-up.
   Additionally, RD was applied to normotensive patients with heart failure resulting in a 25% improvement in left ventricular ejection fraction 12 months after RD.
   RD is investigational in the US.
Annual Congress of the European Society of Cardiology (Munich)