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Study deepens understanding of treatment-resistant hypertension

A new study conducted in the United States has identified a medication that could bring treatment-resistant hypertension under control.
Elevated blood pressure affects more than one billion adults worldwide. Its prevalence increases with age with more than 60% of adults over the age of 65 diagnosed with the condition, which can lead to stroke or heart attack. A person’s lifetime risk of developing the serious medical complaint is 90%.
The condition needs medication to keep it at bay. But in some cases, the prescribed treatment doesn’t work.
Known as apparent resistant hypertension (aRH), this form of high blood pressure needs more medication and medical management.
New research from investigators in the Smidt Heart Institute at Cedars-Sinai in Los Angeles, California, published in the peer-reviewed journal Hypertension, has found that aRH prevalence was lower in a real-world sample than previously reported, but still relatively frequent, affecting nearly one in 10 hypertensive patients.
Through their analysis, investigators also learned that patients with well-managed aRH were more likely to be treated with a commonplace medication called mineralocorticoid receptor antagonists, or MRA, such as spironolactone and eplerenone.
These MRA treatments were used in 34% of patients with controlled aRH, but only 11% of patients with the uncontrolled condition.

Dr Joseph Ebinger. Image: Cedars-Sinai
Joseph Ebinger, assistant professor of cardiology in the Smidt Heart Institute and corresponding author of the study, said: “Apparent resistant hypertension is more common than many would anticipate. We also learned that within this high-risk population, there are large differences in how providers treat high blood pressure, exemplifying a need to standardise care.”
The study findings were based on a unique design, which used clinically generated data from the electronic health records of three large, geographically diverse healthcare organisations.
Of the 2,420,468 patients analysed in the study, 55% were hypertensive. Of these hypertension patients, 8.5%, or 113,992 individuals, met the criteria for aRH.
According to Dr Ebinger, treating aRH can be just as tricky as diagnosing it.
The term “apparent” in apparent resistant hypertension stems from the fact that before diagnosis, medical professionals must first rule out other potential reasons for a patient’s blood pressure being high.
These reasons might include medication non-adherence, inappropriate medication selection, or artificially elevated blood pressure in the doctor’s surgery or other clinical environment, commonly known as ‘white coat hypertension’ or ‘white coat syndrome’ when you get a normal reading at home.
Dr Ebinger said: “Large amounts of data tell us that patients with aRH, compared to those with non-resistant forms of hypertension, are at greatest risk for adverse cardiovascular events. Identifying these patients and possible causes for their elevated blood pressure is increasingly important.”
The stand out lesson, Dr Ebinger said, is awareness – for both medical professionals and patients.
Providers should be mindful that if it’s taking four or more antihypertensive medications to control a patient’s blood pressure, they should consider evaluation for alternative causes of hypertension, or refer patients to a specialist, he emphasised.
Similarly, patients should lean on their medical providers to help them navigate the complex disease, including having a conversation around strategies for remembering to take their medication and addressing possible treatment side effects.
Treating patients with complex cardiac issues like aRH is at the heart of Cedars-Sinai’s expertise.
The Smidt Heart Institute was recently awarded the American Heart Association’s Comprehensive Hypertension Centre Certification, recognising the establishment’s commitment to following proven, research-based treatment guidelines to care for people with complex or difficult-to-treat hypertension.
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Study reveals link between cheese and dementia

A 25-year Swedish study links higher cheese intake to lower Alzheimer’s risk in people without known genetic risk, with cream also tied to lower dementia risk.
However, researchers emphasise that the results should be interpreted with caution.
The study tracked 27,670 people over 25 years.
During that time, 3,208 participants were diagnosed with dementia.
Among individuals without a known genetic risk for Alzheimer’s disease, those who consumed more than 50 grams of full-fat cheese per day showed a 13 to 17 per cent lower risk of developing Alzheimer’s.
This association did not appear in participants who carried genetic risk factors for the disease.
People who consumed more than 20 grams of full-fat cream per day also showed a lower risk of dementia overall, ranging from 16 to 24 per cent.
No meaningful links were found for low-fat or high-fat milk, fermented or non-fermented milk, or low-fat cream.
The results stand out because public health guidance has long encouraged people to choose low-fat dairy to protect heart health.
This connection matters because cardiovascular disease (conditions affecting the heart and blood vessels) and dementia share many underlying risk factors, including high blood pressure, diabetes and obesity.
When evidence from previous studies is combined, analyses suggest that cheese consumption may also be linked to a lower risk of heart disease, and that full-fat dairy does not necessarily increase cardiovascular risk.
Several other studies have explored whether similar patterns apply to brain health, but the results are mixed.
Evidence overall suggests that studies conducted in Asian populations are more likely to report benefits of dairy consumption for cognitive health (the ability to think, remember and reason), while many European studies do not.
One possible explanation is that average dairy intake tends to be much lower in Asian countries, meaning modest consumption may have different effects than higher intakes.
For example, one Japanese study reported a reduced dementia risk among people who ate cheese, but overall consumption levels were very low and the research was sponsored by a cheese producer.
In contrast, another Japanese study funded by government grants found no protective effect of cheese.
Some long-term European studies have also reported benefits.
In a Finnish study of 2,497 middle-aged men followed for 22 years, cheese was the only food associated with a lower dementia risk, reduced by 28 per cent.
Other dietary factors also appear to matter.
Higher consumption of milk and processed red meat was associated with worse performance on cognitive tests, while fish intake was linked to better results.
A large study in the UK that followed nearly 250,000 people found lower dementia risk among those who ate fish two to four times a week, fruit daily and cheese once a week.
However, these studies have important limitations.
What people eat is usually self-reported, and changes in memory can affect both eating habits and how accurately people remember what they have eaten. To deal with this, the Swedish researchers took two extra steps.
First, they excluded anyone who already had dementia when the study began.
Then they repeated the same calculations after removing people who went on to develop dementia within the first ten years of the study.
This did not mean starting the study again or recruiting new participants. It simply meant re-checking the results using a smaller group of people who remained dementia-free for longer.
The reason for doing this is that the early stages of dementia can subtly change behaviour long before diagnosis.
People may eat differently, lose appetite or struggle to recall their usual diet. By focusing on participants who stayed cognitively healthy for many years, the researchers reduced the chance that these early changes were influencing the results.
Another important question is whether substitution played a role.
Some of the apparent benefits may reflect replacing red or processed meat with cheese or cream, rather than an effect of dairy itself.
Supporting this idea, the Swedish study found no association between full-fat dairy and dementia risk among participants whose diets remained stable over five years.
Most importantly, foods should not be considered in isolation.
Dietary patterns matter more than individual ingredients. Diets such as the Mediterranean diet, which is consistently associated with lower risks of both dementia and heart disease, include cheese alongside vegetables, fish, whole grains and fruit.
In the Swedish study, people who consumed more full-fat cheese and cream were also more educated, less likely to be overweight and had lower rates of conditions linked to dementia, including heart disease, stroke, high blood pressure and diabetes.
All of these factors independently reduce dementia risk.
This suggests that higher cheese intake tended to occur within healthier overall lifestyles, rather than alongside excess calorie consumption or poor metabolic health.
Overall, the evidence does not support the idea that full-fat dairy causes dementia, nor that fermented milk products reliably protect against it.
Full-fat cheese contains several nutrients relevant to brain health, including fat-soluble vitamins A, D and K2, as well as vitamin B12, folate, iodine, zinc and selenium.
These nutrients play roles in neurological function and may help support cognitive health.
That said, the data do not justify eating large amounts of cheese or cream as protective foods against dementia or heart disease.
The most consistent message remains that balanced diets, moderation and overall lifestyle matter far more than any single item on the cheese board.
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