Sensitivity to salt emerging as cardiovascular risk factor

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A different brilliant observation in connection with heart health.

By AMERICAN HEART ASSOCIATION NEWS An exaggerated response to too much sodium in the diet may be as dangerous as high blood pressure when it comes to cardiovascular diseases. But researchers are still years away from being able to detect and treat so-called salt sensitivity in everyday practice, according to […]

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Types of Blood Pressure Medications

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Additional superior editorial about heart health.

PillsAndTabletsMany high blood pressure medications are available. Most options fall within these eight categories.


You may also hear diuretics called “water pills”. They increase the elimination of sodium and water by the kidneys. This decreases blood vessel fluid volume, which reduces pressure against artery walls, thereby lowering blood pressure.

The three classes of diuretic drugs include thiazide, loop, and potassium-sparing.

Examples of diuretics include:

  • Chlorothiazide (Diuril)
  • Hydrochlorothiazide (Microzide)
  • Furosemide (Lasix)
  • Bumetanide
  • Amiloride
  • Eplerenone (Inspra)


This drug category may also be called beta-adrenergic blocking agents. Beta-blockers inhibit the effects of the hormone epinephrine (aka adrenaline), resulting in a slower, less forceful heartbeat. Beta-blockers can also promote vasodilation (i.e. widening of the blood vessels). These two actions results in reduced blood pressure.

Examples of beta-blockers include:

  • Acebutol (Sectral)
  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)

ACE inhibitors

ACE stands for Angiotensiin-converting enzyme. Angiotensin II is a substance that promotes blood vessel narrowing and increased blood pressure. ACE inhibitors reduce enzyme production of angiotensin II; therefore, resulting in lower blood pressure.

Examples of ACE inhibitors include:

  • Quinapril (Accupril)
  • Benazepril (Lotensin)
  • Fosinopril
  • Ramipril (Altace)

Angiotensin II receptor blockers

As well as narrowing blood vessels and increasing blood pressure, angiotensin II also releases a hormone to increase sodium and water in your body. More fluid/blood volume leads to higher blood pressure. Angiotensin II also promotes arteriosclerosis, which is the thickening and stiffening of blood vessels.

Angiotensin II receptor blockers inhibit the actions of angiotensin II to promote vasodilation and lower blood pressure.

Examples of angiotensin II receptor blockers include:

  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Valsartan (Diovan)

Please note, both ACE inhibitors and angiotensin II receptor blockers promote lower blood pressure by impacting angiotensin II, but they do so in slightly different ways. Therefore, one type of medication may provide different results than the other.

Calcium channel blockers

This drug category may also be called calcium antagonists. Calcium channel blockers lower blood pressure by decreasing the excitability of muscle cells in arterial walls. This is done by preventing calcium from entering muscle cells of the arterial walls. This allows blood vessels to widen and blood pressure to decrease.

There are short-acting and long-acting forms of calcium channel blockers. Short-acting, which take quick effect, only have impact for a few hours. While long-acting are released slowly for longer impact.

Examples of calcium channel blockers include:

  • Amlodipine (Norvasc)
  • Felodipine
  • Nifedipine (Procardia)

Alpha blockers

This drug category may also be called alpha-adrenergic antagonists. Alpha blockers inhibit the actions of norepinephrine. The hormone norepinephrine causes blood vessel muscles to tighten. Alpha blockers relax muscles to allow for wider blood vessels and lower blood pressure.

Like calcium channel blockers, there are short-acting and long-acting forms of alpha blockers.

Examples of alpha blockers include:

  • Doxazosin (Cardura)
  • Prazosin (Minipress)

Central agonists

This drug category may also be called central-acting agents, central alpha agonists, or central adrenergic inhibitors. alpha-adrenergic antagonists. Central agonists prevent increased heart rate and the narrowing of blood vessels by reducing signals to the nervous system, resulting in lower blood pressure.

Examples of central agonists include:

  • Clonidine (Catapres)
  • Guanfacine (Tenex)

Renin inhibitors

Renin is an enzyme that promotes the production of angiotensin II. As we’ve discussed, angiontensin II leads to vasoconstriction and increased blood pressure. Renin inhibitors prevent renin actions, promoting vasodilation and lower blood pressure.

Examples of renin inhibitors include:

  • Aliskiren (Tekturna)

Depending on the severity of your high blood pressure, your doctor may prescribe more than one blood pressure medication. All medications come with side effects, such as headaches, dizziness, fatigue, nausea, and constipation.

Reduce your dependence on medication by making dietary and lifestyle changes to lower blood pressure levels.

Sigmaceutical is passionate about spreading health and strongly advocates the idea of strengthening the body’s defenses against sickness and disease through world class nutritional supplement formulations.

Try Sigmaceutical Blood Pressure Support today!

Where should heart rate after exercise fall?

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An unusual first-rate report on the topic of heart health.

Woman stretching with raised leg over railing

Heart rate after exercise may be used as an indicator of your heart fitness.

Normal resting heart rate

According to the National Institute of Health, normal average resting heart rate should be:

  • 60 – 100 beats per minutes for children 10 years and older, as well as adults/seniors
  • 40-60 beats per minute for well-trained athletes

Target heart rate during exercise

For moderate intensity activities your target heart rate is 50 – 69% maximum heart rate. For vigorous activity levels your target heart rate is 70-85% maximum heart rate.

To calculate your target heart rate subtract your age from 220. This gives you your maximum heart rate. Now, multiple your maximum heart rate by 0.5 and 0.69 to obtain your target heart rate range for moderate intensity activities. Multiply your maximum heart rate by 0.7 and 0.85 to obtain your target heart rate range for vigorous activities.

Depending on your goal intensity – moderate vs. vigorous – your heart rate should fall within your target heart rate range during activities.

If you are typically inactive, set your goal for the lower end (50-60% maximum heart rate) and work your way up over time.

There are blood pressure medications that lower maximum heart rates. Discuss with your doctor if you currently take blood pressure medications. Your target heart rate zone may need to be adjusted.

How to measure heart rate

The easiest and most accessible location for measuring heart rate during exercise is your wrist. Please your index and middle fingers over the underside of your opposite wrist and press until your feel your pulse.

Once you locate your pulse, count the beats for 30 seconds and multiply by 2 to obtain beats per minute. Alternate time lengths for measuring:

  • Count the beats for 15 seconds and multiply by 4
  • Count the beats for 10 seconds and multiply by 6

If you want to check your resting heart rate, rest for at least 10 minutes period to measuring.

When exercise, if your heart rate is too high you working too hard and need to slow down. The opposite is also true, if your heart rate is too slow, you need to increase your intensity.

Once you have a feel for where your heart rate falls when working out, you can also estimate your heart rate by using the talk test.

  • If you can talk with no trouble, pick up the pace.
  • If you can talk, but need to take a breath every 4-5 words, you’re right on track.
  • If you’re gasping for breath after every word, slow down!

Post exercise heart rate

The better your heart fitness, the quicker heart rate after exercise returns to normal.

Typically, heart rate drops quickly within the first minute after exercise. After this initial drop, it should then continue to return to normal at a rate of ~20 beats per minute.

Heart rate benefits of exercising

Aerobic exercise, such as jogging, enlarges and strengths the heart muscle allowing the heart to circulate more blood with each beat. This means as the heart is strengthened it can beat slower during activity (and at rest).

A high resting heart rate has been associated with increased risk of heart disease independent of other cardiovascular risk factors, such as high blood pressure and high cholesterol.

A low resting heart rate is generally an indicator better heart health.

If you are working to increase your activity level but struggle sticking with it week after week access How to Make Heart Healthy Changes into Lifelong Habits here.


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Sigmaceutical is passionate about spreading health and strongly advocates the idea of strengthening the body’s defenses against sickness and disease through world class nutritional supplement formulations.

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Will the Real Pulmonary Hypertension Specialists Please Stand Up?

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An original brilliant observation with reference to heart health.

Feldman SymposiumI was recently cruising the Internet looking to see what type of search results I would obtain when I put in the term “pulmonary hypertension specialist in Phoenix”.  I was somewhat mortified.  Every healthcare system in town had a webpage purporting to have a specialized program replete with a range of experts well versed in all aspects of pulmonary hypertension care.  I thought to myself how blessed are the patients in Arizona to have a pulmonary hypertension specialist on every corner in every hospital.  So I searched in different cities across the country and to my great surprise I found the same.  It would seem that there are pulmonary hypertension specialists sprouting up all around the country.

After collecting myself from the disbelief that so many PAH experts are now scattered across the country I came back to reality.  What does it mean when a hospital or a doctor’s practice advertises themselves as having a pulmonary hypertension program or being expert in the care of PAH patients?  First, it reinforced my sense that most of what you read on the Internet is not to be trusted (this site notwithstanding of course).  Second it reminded me that regardless of how much we would like to think otherwise, medicine is big business.  Health care systems, hospitals and doctors’ practices are vying for your business, much like a restaurant is vying for your patronage.  However, the downside of pseudo-expert care is much greater than a bad Italian meal or a taco that just was not up to par.

This made me reflect on how we measure quality and honesty in healthcare.  How do we deliver the best care to our patients?  Medicine in general is struggling with this question.  We have board certifications that attempt to establish some minimal standard of knowledge.  We have requirements to have completed the requisite lengthy training.  But at the end of the day, some diseases really require true expertise to deliver the best outcomes for our patients.  If you went to a surgeon with a life-threatening problem and the surgeon had seen 5 other patients with a similar problem in their career would you really want to be that surgeon’s sixth case?  What is the magic number of patients?  What type of infrastructure helps ensure that the best care will be delivered?

Perhaps what we really have is a crisis of honesty in America.  Advertisers can claim almost anything they want about their products.  Doctors can claim to have expertise that they most certainly don’t possess. Hospitals can claim to have programs that don’t exist simply to pull patients into their businesses.

Comprehensive Care Centers for Pulmonary Hypertension

The Pulmonary Hypertension Association has responded to this crisis by recognizing about 35 PH centers around the country as meeting a rigorous set of requirements to be called Comprehensive Care Centers (the highest designation).   This designation requires an impressive commitment to pulmonary hypertension care.

Let me tell you about how my center earned this designation.  First, the two physicians that care for PAH patients both have super-specialized training in pulmonary hypertension at nationally recognized powerhouse institutions.  This was not a weekend course but a year of focused training.  Second, we have developed an infrastructure that includes 2 dedicated nurse-coordinators, an administrative assistant, and a medical assistant.  Next we have a research operation that includes five research coordinators.  We have been amongst the busiest pulmonary hypertension research operations in the country for more than a decade.

The hospital where we practice has worked with us to develop a dedicated pulmonary hypertension ICU and a step-down floor.  We have procedures and protocols for the care of our patients.  The hospital carries all PAH medications and their use are restricted to PAH specialists.  I have done well over 3,000 heart catheterizations to diagnose and monitor pulmonary hypertension patients.  We have done more than 500 general anesthesia surgeries without a single perioperative death from pulmonary hypertension.

The PHA did not simply take my word for it either.  They came and inspected the hospital and my practice.  They audited my charts to make sure that I was actually delivering the care that I said I delivered.  They inspected all of my procedures and protocols for the care of PAH patients.  Then they went away and discussed my program.  A few weeks later we received a letter indicating that we had met the rigorous criteria to be a nationally recognized center of excellence (Comprehensive Care Center).

Our commitment to PAH includes a deep commitment to education and advancing the science of caring for PAH patients.  My partner and I speak across the country on pulmonary hypertension.  We publish in high quality peer-reviewed journals and present at national meetings on pulmonary hypertension. We run an annual educational symposium at our hospital for nurses and physicians.  Lastly, I maintain a website that reaches thousands of viewers each month.

A word of caution–I would be skeptical of doctors that advertise that they give talks about PAH.  The bar is not high to do this.  Many doctors that are on the “speakers bureau” for drug companies fall far short of being real experts on PAH.

So when you see a physician or hospital that is a self-described “expert” in PAH, it would be very reasonable to inquire what that means.  Here are some useful questions to ask.

  1. What type of formal training do they have?
  2. Any specialized training beyond fellowship?
  3. How long have they been treating PAH?
  4. How many patients with PAH do they care for?
  5. Do they have experience in all medications including intravenous and subcutaneous infused therapies?
  6. Do they participate in PAH research studies?
  7. How many research coordinators do they have?
  8. Have they published any peer-reviewed articles on PAH in the past 2 years?
  9. Is their program recognized by the PHA as a center of excellence?
  10. What infrastructure exists to help deliver the care for PAH patients?

Sigmaceutical is passionate about spreading health and strongly advocates the idea of strengthening the body’s defenses against sickness and disease through world class nutritional supplement formulations.

Try Sigmaceutical Blood Pressure Support today!

Is it now considered okay to eat saturated fat from butter and tropical oils?

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An innovative first-class composition regarding heart health.

saturated-fat[1]It’s no wonder so many of us are confused about healthy eating. Even the nation’s dietary experts keep changing their mind about what we should eat and what we should avoid. We asked USC School of Pharmacy Research Professor Roger Clemens to help remove some of the confusion surrounding healthy fats.

Q: What are the latest dietary guidelines regarding fat and cholesterol?

Dr. Clemens: The 2015 Dietary Guidelines Advisory Committee Scientific Report states that cholesterol is no longer a nutrient of concern. The available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol. This is consistent with the conclusion of the American Heart Association and American College of Cardiology report.

Q: Can you explain this change in thinking over the past several decades?

Dr. Clemens: Nutritional science is dynamic. In the 1980s, the Dietary Guidelines suggested consumers avoid too much total fat and saturated fat. Over time, total fat guidelines have been upwardly adjusted with the 2010 Guidelines suggesting diets with up 35 percent of daily calories from fat. The 2015 executive summary suggests no upper limit for total fat consumption. Saturated fat guidelines have similarly evolved and now suggest including up to 10 percent in a healthy diet, and replacing saturated fat with polyunsaturated and mono-unsaturated fat. This thinking may still be changing, however. Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

Q: What does the science say regarding low-fat diets?

There’s now strong evidence that replacing saturated fat with carbohydrates, a hallmark of low-fat diets, does not necessarily lower the risk of cardiovascular disease. Replacing saturated fats with carbohydrates reduces total and LDL-C cholesterol, but they may significantly increase triglycerides and reduce the good cholesterol, HDL-C.

Further, a meta-analysis published last year in the Annals of Internal Medicine concluded that current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.

Studies show low-fat diets don’t result in weight loss. The Women’s Health Initiative followed more than 20,000 women on low-fat diet for an average of 7.5 years. Participants were randomly assigned to a control group and low-fat diet group. Those in the low-fat diet group had a goal to reduce dietary fat intake from ~38% of calories from fat to 20%. After 7.5 years, the weight of the women in the low-fat group was not significantly lower with a weight loss of ~1 pound versus those in the control group following their usual diet.

Q: Is this new report encouraging people to eat butter and tropical oils again?

Dr. Clemens: It’s not that simple. The guidelines state that a diet lower in calories and animal-based foods is more health-promoting and associated with less environmental impact that the current U.S. diet. Although dietary cholesterol is clearly not an issue, this report isn’t a free license to eat as much butter as we want. We need to consume foods in moderation if we’re going to make a real difference in our health.

Q: So we should be eating a variety of foods, including a variety of healthy fats?  

Dr. Clemens: Even single foods often contain a complex nutrient mix. Judging a food or an individual’s diet as harmful because it contains more saturated fatty acids, or beneficial because it contains less, is intrinsically flawed. The emphasis should be on optimizing the types of dietary fat we’re eating, not on reducing total fat. As we look forward to food and health, the real emphasis should be on the dietary patterns that are culturally appropriate.”

As recently as 2010, it has been acknowledged that the stearic acid found in Malaysian certified sustainable palm fruit oil is not known to raise LDL cholesterol. In fact, evidence suggests stearic acid should not even be categorized with known cholesterol-raising fats.

Variations in your genetics, lifestyle and life stage can all influence how your body responds to your diet. Concentrate on eating a variety of foods, instead of getting your nutrients from a minimal number of sources. And weigh news about diet and health carefully, understanding that it can take years for the strongest evidence to emerge.

For more guidance to lower cholesterol levels, access the free ecourse “How to Lower Cholesterol in 8 Simple Steps” at

Lisa Nelson RD
Health Pro for HealthCentral

About Dr. Roger Clemens

Dr. Clemens is adjunct Professor of Pharmacology and Pharmaceutical Sciences within the USC School of Pharmacy, International Center for Regulatory Science. He served on the USDA 2010 Dietary Guidelines Advisory Committee with primary responsibilities in food safety, and dietary lipids and health. He has been cited and interviewed by more than 500 domestic and international health journalists’ discussions on contemporary health, nutrition and food safety issues.

He is a professional member of and a Fellow in the Institute of Food Technologists (IFT). He has served on several IFT expert panels, including Functional Foods, and Making Decisions about the Risks of Chemicals in Foods with Limited Scientific Information. He established and contributes to a Food, Medicine and Health column published monthly in Food Technology. He completed a 3-year term on the IFT Board of Directors. He is a fellow in the American College of Nutrition, a fellow in the Marilyn Magaram Center for Food Science, Nutrition and Dietetics, and an active member in the American Society for Nutrition (ASN). He serves as a spokesperson for the ASN, and chairs the ASN Public Information Committee. Currently he is an appointed member of the U.S. Pharmacopeia expert committees on Food Ingredients. He served as the Scientific Advisor for Nestlé USA for more than 21 years. He received a BA in Bacteriology, an MPH in Nutrition, and a DrPH in Public Health Nutrition and Biological Chemistry from the University of California, Los Angeles.

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Sigmaceutical is passionate about spreading health and strongly advocates the idea of strengthening the body’s defenses against sickness and disease through world class nutritional supplement formulations.

Try Sigmaceutical Blood Pressure Support today!