Blood Pressure Levels Appear to Decrease Progressively Before Death

Exeter, UK—It’s not always a good sign when patients have to discontinue antihypertensive medications because of dropping blood pressure. 

That trend could be predicting something else in older patients, suggests a new study published in JAMA Internal Medicine. Researchers from Great Britain and the United States set out to examine the evidence that blood pressure (BP) stabilizes or decreases in later life. 

The study team sought to clarify whether those downward trends were because of advancing age, proximity to end of life, or selective survival of persons free from hypertension. To do that, they created a trial to estimate individual patient BP for each of the 20 years before death, while also teasing out the reasons for the changes.

The population-based Clinical Practice Research Datalink primary care and linked hospitalization electronic medical records from the United Kingdom were analyzed, including BP measures over 20 years. The focus was on 46,634 patients who were at least 60 when they died, from 2010 to 2014. Participants, with slightly more women than men, had a mean age of death of 82.4.

At the same time, the investigators tracked BP trajectories from 10 to 3 years before death for 20,207 participants who died, comparing them to an equal number of birth-year and sex-matched participants who survived longer than 9 years.

Results indicate that systolic blood pressure (SDP) and diastolic blood pressure (DSP) reached high points between 18 and 14 years prior to death before decreasing progressively. Declines in SBP from peak values ranged from a drop of 8.5 mm HG for those dying between ages 60 to 69 years, to a drop of 22.0 mm HG for those dying at age 90 years or older.

“Overall, 64.0% of individuals had SBP changes of greater than ?10 mm Hg,” study authors report.

The study found that decreases in BP appeared linear from 10 to 3 years before death, with steeper declines in the last 2 years of life.  

While decreases in SBP from 10 to 3 years before death were detected in older people not treated with blood pressure medications, the average yearly changes were sharpest in patients with hypertension, with an average decline of 1.58; dementia, with an average decline of 1.81; and heart failure, with an average decline of 1.66, as well as in those with late-life weight loss. 

“Mean SBP and DBP decreased for more than a decade before death in patients dying at 60 years and older,” the researchers write. “These BP decreases are not simply attributable to age, treatment of hypertension, or better survival without hypertension. Late-life BP decreases may have implications for risk estimation, treatment monitoring, and trial design.”

In an accompanying commentary, James S. Goodwin, MD, of the University of Texas Medical Branch in Galveston said the value of this study and others using similar databases is that they “should help us dissect out many different trajectories that end in death, to better inform physicians and their patients about what they might expect. ”

Low blood pressure linked to high mortality in older adults — ScienceDaily

that found a link between low blood pressure and higher mortality rates.

A largescale study led by the University of Exeter, published in Age and Ageing and funded by NIHR, analysed 415,980 electronic medical records of older adults in England.

The research was conducted after some countries have changed blood pressure guidelines to encourage clinicians to take measures to reduce blood pressure in a bid to improve health outcomes. UK blood pressure guidelines are within safe parameters for all. However, previous research has not considered the impact on frail older adults, who are often omitted from trials.

The team found that people aged 75 or over with low blood pressure (below 130 / 80) had increased mortality rates in the follow-up, compared to those with normal blood pressure. This was especially pronounced in ‘frail’ individuals, who had 62 per cent increased risk of death during the ten year follow-up.

Although high blood pressure increased risk of cardiovascular incidents, such as heart attacks, it was not linked to higher mortality in frail adults over 75. Older people aged 85 and over who had raised blood pressure actually had reduced mortality rates, compared to those with lower blood pressure, regardless of whether they were frail or not.

Jane Masoli, a geriatrician and NIHR Doctoral Research Fellow, who led the study as part of her PhD at the University of Exeter, said: “Internationally, guidelines are moving towards tight blood pressure targets, but our findings indicate that this may not be appropriate in frail older adults. We need more research to ascertain whether aggressive blood pressure control is safe in older adults, and then for which patient groups there may be benefit, so we can move towards more personalised blood pressure management in older adults.”

She added: “We know that treating blood pressure helps to prevent strokes and heart attacks and we would not advise anyone to stop taking their medications unless guided by their doctor. “

Story Source:

Materials provided by University of Exeter. Note: Content may be edited for style and length.

Low Blood Pressure Linked to Death Risk, Study Finds

MONDAY August 19, 2013 — Lowering blood pressure to a healthy level is a goal for many people. But for chronic kidney disease patients with the very lowest diastolic blood pressure readings, pressure can go too low and is linked to a higher risk of death. New limits for a safe level of low blood pressure may be in order, say researchers who studied readings in more than 600,000 kidney disease patients.

Researcher Csaba Kovesdy, MD, and others at the Memphis Veterans Affairs Medical Center in Tennessee looked at more than 18 million blood pressure measurements and found that for patients with either very high or very low blood pressure, mortality went up substantially. Relative risk of mortality was significantly increased, by more than five times, according to the study, published today in the Annals of Internal Medicine.

The researchers found that blood pressures in the range of 130 to 159 mm HG systolic over 70 to 89 diastolic were associated with the best health outcomes for the population they studied — men with kidney disease.

Dena Rifkin, MD, suggested that the new study may not yet apply to the general population, but only to this large group of older veterans with chronic kidney disease. Dr. Rifkin is from the Veterans Affairs Healthcare System in San Diego, California.

In the United States, chronic kidney disease affects more than 20 million people and is most common in those 65 years old and up, according to the U.S. Centers for Disease Control, CDC.

Investigator Dr. Kovesdy agreed with Dr. Rifkin. “One of the main messages of our paper is that patients with CKD [chronic kidney disease] have different associations between their blood pressure and mortality than patients in the general population,” the researcher said, adding, “There is no reason to believe that associations in women would be radically different compared to what we saw in men, but this would have to be tested in future studies. “

The Fuzzy Boundaries of Normal Blood Pressure

According to cardiologist and Everyday Health columnist William Abraham, MD, FACP, “For healthy individuals taking no blood pressure lowering medications, there does not appear to be an absolute blood pressure number that is too low. In fact, lower blood pressures are associated with longevity.” Dr. Abraham is Professor of Medicine, Physiology, and Cell Biology, Director, Division of Cardiovascular Medicine at The Ohio State University in Columbus.

But for some people, low blood pressure can be an indicator of an underlying problem. “For normal individuals, a blood pressure under 90/60 should prompt a check-up with a doctor to exclude disorders that may cause low blood pressure,” Dr. Abraham said.

He added that the blood pressure optimum for patients being treated for high blood pressure is now more narrowly defined: “For those on blood pressure medications, there does appear to be a so-called ‘j-shaped curve’ like that described in the present study. Blood pressures that are either too high or too low are associated with worse outcomes. The goal is to find the ‘sweet spot’, ideally around 110-115/70-75.”

Cardiologist and Everyday Health columnist Reena Pande, MD, indicated that what constitutes “normal” blood pressure varies from person to person. “Every patient is different and what would be normal blood pressure for one person might be considered low for another person,” she said. Dr. Pande is an Instructor at Harvard Medical School in Boston, and medical director of the Vascular Diagnostic Laboratory at Brigham and Women’s Hospital in Boston.

What to Do for Symptoms of Too-Low Blood Pressure

“It is a good idea to seek medical attention if low blood pressure is accompanied by any symptoms, such as dizziness or lightheadedness,” advised Pande.

Symptoms of low blood pressure might include the following:

• dizziness or lightheadedness
• fainting spells
• feeling cold and clammy
• blurry vision
• feeling tired

“A sudden change or lowering in one’s blood pressure may be more concerning for an underlying health issue,” she added. “However, in most cases, as long as a patient is not experiencing any symptoms, there is no cause for alarm.”

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Low Blood Pressure | Low Blood Pressure Linked to Risk of Early Death

• According to a new study published in the journal Age and Ageing, there is a link between low blood pressure and early death.
• Low blood pressure isn’t necessarily a cause for concern on its own—but if it’s accompanied by symptoms such as dizziness, lightheadedness, headache, fatigue, and sometimes blurred vision or nausea, that’s when you should see a doctor.

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High blood pressure is a major concern when it comes to your heart health, and it can put you at an increased risk of heart attack and stroke. But contrary to what you may think, “the lower the better” is not necessarily a mantra to follow, according to new research published in the journal Age and Ageing.

In the study, researchers analyzed 415,980 electronic medical records of older adults in England, and they found that people older than 75 years old with low blood pressure—defined here as below 130/80 millimeters of mercury (mmHg), although the Mayo Clinic puts it at 90/60 mmHg—had increased mortality rates compared to those with normal blood pressure. This was especially pronounced in people classified as “frail.”

The researchers concluded that it wasn’t low blood pressure that caused the issue, but rather that it acted as an early warning—those adults who were frail and had low blood pressure likely had underlying and undiagnosed health issues that would make them susceptible to early death.

One caveat to the study is that it was done in less-healthy older people, so for those who are younger and/or fitter, the results might not apply, according to senior author Jane Masoli, Ph.D.(c) a clinical doctoral fellow at the University of Exeter in the U.K.

Masoli also told Runner’s World that this was an observational study, which means the researchers didn’t prove that low blood pressure caused early death, only that there was a link. Even with that said, low blood pressure is a condition to watch—no matter what your age—to make sure it’s not leading to problematic effects.

“If you have low blood pressure, that’s not a cause for concern on its own,” Natasha Trentacosta, M.D., a sports medicine specialist at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, told Runner’s World. “But when that blood pressure is combined with certain symptoms, consider getting checked.”

The most common symptoms are dizziness, lightheadedness, headache, fatigue, and sometimes blurred vision or nausea. There is a condition called “orthostatic hypotension,” she added, which means you get a head rush when you change positions suddenly—especially when you go from sitting to standing.

If you do have low blood pressure, consistent exercise may be able to help in the long-term, but Trentacosta emphasized that you may need to employ different strategies to account for your blood pressure in the short-term. For example, she suggested increasing the intensity level of exercise gradually, and to slow down if symptoms like irregular pulse, dizziness, or unusual weakness occur.

[Blast through a series of HIIT sessions to boost running strength and prevent injury with the IronStrength Workout.]

She also recommends building in more time for stretching before and after exercise to help blood pressure regulate more effectively. But most of all, she emphasizes the importance of staying hydrated.

“Dehydration can affect someone with low blood pressure more,” Trentacosta said. “Definitely drink more water before, during, and after exercise. And if you’re feeling lightheaded, dial down the intensity.”

Elizabeth Millard
Elizabeth Millard is a freelance writer focusing on health, wellness, fitness, and food. 

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Low blood pressure and mortality in the elderly: a 6-year follow-up of 18,022 Norwegian men and women age 65 years and older

Several studies have shown that low blood pressure in individuals age 65 years and older is related to increased overall mortality. We hypothesize that this association is secondary to serious underlying illness, which has caused blood pressure reduction and, subsequently, has increased the risk of dying. Our study population was comprised of individuals age 20 years and older in the county of Nord Trøndelag in Norway, who were studied in a general health survey between 1984 and 1986. We had measurements of blood pressure, blood glucose, weight, height, and other information for 9,732 women and 8,290 men age 65 years or older. During approximately 6 years of follow-up, 2,122 women and 2,578 men died. For both genders, low systolic pressure was not associated with increased mortality, and the mortality curve did not display a J-shaped relation, after adjustment for age, marital status, body mass index, blood glucose, self-assessed health, use of antihypertensive medication, and history of diabetes and cardiovascular diseases. For diastolic pressure, however, women in the lowest category (< 75 mmHg) had an adjusted mortality rate ratio of 1.21 (95% confidence limits = 1.05, 1.39), compared with reference women (80-87 mmHg). Among men, the analogous mortality rate ratio was 1.16 (95% confidence limits = 1.02, 1.31). To reduce further the potential confounding between diastolic pressure and underlying illness, we excluded users of antihypertensive medication as well as the 2 first years of follow-up. After these procedures, the J-shaped mortality curve was not present among women, and it was substantially reduced among men. Thus, the results for both men and women indicated that the age-adjusted J-shaped relation between diastolic blood pressure and mortality was confounded with indicators of ill health, and that the often-found association between low diastolic blood pressure and increased mortality is indirect, possibly caused by serious underlying disease.

High blood pressure causing more deaths despite drop in heart disease, stroke deaths

Fewer Americans are dying from heart disease and stroke, but deaths caused by high blood pressure are on the rise, according to new statistics from the American Heart Association.

Although cardiovascular disease is still the biggest killer in the U.S., deaths fell by nearly a third from 2001 to 2011—a drop scientists say reflects improvements in preventing and treating heart disease and stroke. Doctors are encouraged that the trend will continue as healthcare systems around the country better implement evidence-based prevention and treatment guidelines from the AHA and the American College of Cardiology.

Concerns are growing, however, over a 13 percent uptick in hypertension-related deaths over that same span. The new statistical report(link opens in new window), “Heart Disease and Stroke Statistics — 2015 Update: A Report From the American Heart Association,” was released Wednesday and is the only source for current prevalence data on cardiovascular health.

“Deaths attributable to cardiovascular diseases have been on the decline in recent decades. Yet in the face of this good news, we have several disturbing observations that we need to pay attention to because we’re at risk of eroding the gains we have made,” said AHA President Elliott Antman, M.D., professor of medicine and associate dean at Harvard Medical School and a senior physician in the cardiovascular division of Brigham and Women’s Hospital in Boston.

High blood pressure is a major risk factor for heart disease and stroke. Although the death rate going up for one while the other is going down may seem contradictory, one reason is that hypertension can directly lead to other deadly conditions such as heart failure or kidney failure if it is not controlled.

Beyond the conditions themselves are other possible explanations.

Patients do not always take their blood pressure medications as prescribed, and even if they do, doctor’s orders sometimes are not enough, said Willie E. Lawrence Jr., M.D., chief of cardiology at Research Medical Center in Kansas City, Missouri, and an AHA volunteer.

“I think people with hypertension are often undertreated,” he said. “It usually takes more than one medication to get blood pressure under control.”
Lawrence noted that through awareness campaigns and community-based initiatives like the AHA’s Check. Change. Control program, more people are successfully controlling their blood pressure.

The report found that most cases have been detected—nearly 83 percent. But of the 80 million Americans with high blood pressure, only about half have it under control.
“Awareness is not enough. We have to begin to adequately treat hypertension,” Lawrence said, citing the AHA’s 2020 goal to reduce deaths from cardiovascular diseases and stroke by 20 percent. “We can’t get there by treating coronary artery disease alone.” 

Indeed, a mere 10 percent increase in hypertension treatment would prevent about 14,000 deaths every year, the report noted. For most people, the American Heart Association recommends treatment if blood pressure is 140/90 or higher, and research shows that lowering blood pressure by just 5 points reduces the overall risk of death from any cause by 7 percent.

Antman said the rising hypertension death rate also is probably related to factors plaguing many Americans — lack of physical activity, obesity and too much sodium.

Through programs like Empowered to Serve and the newly launched Heart360 mobile app, the AHA is helping Americans implement an action plan for heart-healthy living, Antman said.
The concerning statistics, however, show there is still more work to be done, he added.

“The sky isn’t falling,” Antman said. “There are clouds in the sky, and there are things the AHA is doing to chase them away.”

Hypertension

What is hypertension?

Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.

Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.

What are the risk factors for hypertension?

Modifiable risk factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.

Non-modifiable risk factors include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease.

What are common symptoms of hypertension?

Hypertension is called a “silent killer”. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured regularly.

When symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions.

What are the complications of uncontrolled hypertension?

Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can cause:

• Chest pain, also called angina.
• Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
• Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
• Irregular heart beat which can lead to a sudden death.

Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke.

In addition, hypertension can cause kidney damage, leading to kidney failure.

Why is hypertension an important issue in low- and middle-income countries?

The prevalence of hypertension varies across regions and country income groups. The WHO African Region has the highest prevalence of hypertension (27%) while the WHO Region of the Americas has the lowest prevalence of hypertension (18%).

The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low- and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations.

How can the burden of hypertension be reduced?

Reducing hypertension prevents heart attack, stroke, and kidney damage, as well as other health problems.

Prevention

• Reducing salt intake (to less than 5g daily).
• Eating more fruit and vegetables.
• Being physically active on a regular basis.
• Avoiding use of tobacco.
• Reducing alcohol consumption.
• Limiting the intake of foods high in saturated fats.
• Eliminating/reducing trans fats in diet.

Management

• Reducing and managing stress.
• Regularly checking blood pressure.
• Treating high blood pressure.
• Managing other medical conditions.

What is the WHO response?

The World Health Organization (WHO) is supporting countries to reduce hypertension as a public health problem.

In 2021, the WHO released a new guideline for on the pharmacological treatment of hypertension in adults. The publication provides evidence-based recommendations for the initiation of treatment of hypertension, and recommended intervals for follow-up. The document also includes target blood pressure to be achieved for control, and information on who, in the health-care system, can initiate treatment.

To support governments in strengthening the prevention and control of cardiovascular disease, WHO and the United States Centers for Disease Control and Prevention (U.S. CDC) launched the Global Hearts Initiative in September 2016, which includes the HEARTS technical package. The six modules of the HEARTS technical package (Healthy-lifestyle counselling, Evidence-based treatment protocols, Access to essential medicines and technology, Risk-based management, Team-based care, and Systems for monitoring) provide a strategic approach to improve cardiovascular health in countries across the world.

In September 2017, WHO began a partnership with Resolve to Save Lives, an initiative of Vital Strategies, to support national governments to implement the Global Hearts Initiative. Other partners contributing to the Global Hearts Initiative are: the CDC Foundation, the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization (PAHO) and the U.S. CDC. Since implementation of the programme in 2017 in 18 low- and middle-income countries, 3 million people have been put on protocol-based hypertension treatment through person-centred models of care. These programmes demonstrate the feasibility and effectiveness of standardized hypertension control programmes.

 

 

90,000 Pressure of a dying person – at what pressure a person dies

Life expectancy depends on the quality of health. Any failure in the work of organs and systems can greatly undermine a person’s immunity. It is especially necessary to monitor the work of the cardiovascular system. To do this, you need to know at what pressure a person’s death occurs and how to avoid a critical condition.

Age norms of blood pressure

The state of the body directly depends on age, physical activity, habits, psycho-emotional stress.Usually, by the age of 50, a person already has a number of chronic diseases. Blood pressure changes as you age.

To determine blood pressure (BP) indicators, a special device is used – a tonometer. They fix the figure of the maximum blood output at the time of contraction of the heart muscle – systolic pressure, and the minimum level – the diastolic indicator.

There are certain age norms of permissible blood pressure indicators:

Age	Systolic (upper) mm Hg.Art.	Diastolic (lower) mmHg
20	110 -120	70-80
30	125-130	70-80
40-50	135-140	80-90
Over 60	150	90

In a healthy person, a pressure of 120/80 mm Hg is considered normal.Art., while the difference between systolic and diastolic indicators should vary within 30-55 mm Hg. Other values ​​indicate disturbances in the functioning of the body. Frequent decrease or increase in values ​​leads to pathological changes in the cardiovascular system and impaired cerebral circulation.

Deaths from a sharp change in blood pressure are also found in healthy people. At what pressure you can die will directly depend on the combination of negative factors, the state of the blood vessels and the heart.

Critical indicators

Abrupt pressure surges up to certain norms can cause serious cerebral and cardiac complications and cause death. In order to prevent the loss of a loved one, it is necessary to remember at what pressure a person dies. Each organism has its own critical indicator. It is believed that raising or lowering blood pressure by 30 points from the usual state is life-threatening.

Experts cannot give an exact figure at what pressure death occurs.It is believed that the maximum body can withstand blood pressure of 260/140 mm Hg. Art., then the person dies. A decrease in diastolic blood pressure leads to a deterioration in blood circulation. The result can be the development of heart failure, hypoxia, loss of consciousness. It is necessary to understand at what pressure a person dies, and when he needs urgent help. A sharp drop in pressure by 30 mm Hg. Art. can cause certain sensations and cardiogenic shock, which is accompanied by cardiac muscle arrest. In most cases, this is fatal.

Terminal state and death

The extinction of the functions of organs and tissues are the harbingers of biological death. General signs of death:

• hypoxia of the brain and tissues;
• circulatory disorder;
• blood acidification;
• Indistinct breathing.

The lowest blood pressure in a person at death occurs in a state of agony. The patient already looks like a corpse, although the duration of the terminal pause can range from a few seconds to 5 minutes.Then comes the agony, expressed in a deep sigh, increased blood pressure and heartbeat.

What is the pressure at the death of a person in agony, only a doctor will say, since it is difficult to catch weak heart murmurs with an ordinary stethoscope. Usually it is not pronounced, but it can rise to 30 mm Hg. Art., while not ensuring the normal activity of the brain.

Next comes the state of clinical death. At this stage, only individual organs are working. Being able to help in the first seconds of cardiac arrest increases the chances of bringing a person back to life.The time of clinical death is 3 – 6 minutes, then the organs are turned off and the person dies.

High and low pressure

In an absolutely healthy person, blood pressure (BP) can change during the day. The indicators are influenced by emotional mood, physical activity, the use of alcohol and certain foods, violation of the mode of work and rest. In a chronic condition of high or low blood pressure, hypertension and hypotension are diagnosed.

Hypertension

Hypertension is one of the most widespread diseases in the world. It takes millions of lives. Pathology is expressed in the persistence of persistently high blood pressure.

Stages of development of the disease:

1. Early stage. It is manifested by temporary jumps in indicators up to 140/90 and an independent decrease. Over time, this leads to further vascular changes.
2. Second stage. It is characterized by an increase in blood pressure up to 180/110, while it can be normalized only with the help of special drugs.
3. Serious condition. Constant blood pressure more than 180 mm Hg. Art. In this case, the heart muscle and blood vessels are badly worn out. Against this background, there are concomitant diseases.

Note. A sharp increase in blood pressure with hypertension causes a crisis, which can lead to the death of a person.

The pressure of a dying person in hypertensive collapse usually exceeds 200 mm Hg. Art. There have been several reported cases of survival with a BP of 300 mm Hg. Art., but this is an exception from the statistics. A person who survived after such cases becomes disabled. Vital organs cease to function normally.

Blood pressure values ​​at which you can die

In order to provide emergency medical care, it is necessary to understand at what pressure people die.A dangerous indicator is a large difference between systolic and diastolic numbers.

Condition in hypertensive crisis:

• 180/140 – moderately severe;
• 240/140 – heavy;
• 200/100 – risks of death;
• 260/100 – especially difficult – a person dies.

Any critical increase in blood pressure can provoke the failure of vital organs, which leads to irreversible consequences or death.

Signs of death from hypertension

High blood pressure of a person at death is characterized by the appearance of the following symptoms:

• severe headache;
• nausea and vomiting, goosebumps;
• a state of fear and panic;
• minor spasm of the body;
• lack of air;
• Increased sweating with cold skin;
• loss of consciousness;
• hemorrhage of the sclera;
• pressure goes off scale by 30-50 points from the usual high values.

All of the above signs indicate an extremely serious condition in which a person can die suddenly. Death occurs due to the failure of the internal organs: heart, brain, rupture of blood vessels. If signs of a hypertensive crisis are detected, first aid should be provided.

Hypotension

This is a pathological decrease in blood pressure. The main causes are chronic diseases of the internal organs. Sufferers of this ailment constantly experience:

• dizziness;
• chronic fatigue;
• syncope;
• irritability;
• swelling;
• muscle pain.

Over time, degenerative changes in the vessels occur. The constant lack of oxygen and nutrients negatively affects the functional ability of the brain. Possible strokes, tachycardia (abnormal heart rhythm), in severe cases – cardiogenic shock.

Symptoms of a dying state at low pressure

The near-death condition with low blood pressure is accompanied by:

• arrhythmia;
• cold sweat;
• severe discomfort, weakness in the legs;
• panic attacks;
• lethargy;
• swelling of the venous arteries;
• marbling of the skin;
• cyanosis (blue lips, mucous membranes).

The patient loses consciousness, lack of blood circulation provokes coma, cardiac muscle arrest. In the absence of adequate care, the patient will die.

The body’s response to critically low indicators

It is possible to determine the severity of the condition by the indicators of blood pressure, the duration of the shock state, the severity of the body’s reactions, oliguria (a sharp decrease in the work of the urinary tract). Below are the numbers at what low pressure a person’s death occurs and is it possible to avoid tragedy.

• HELL within 90/50 mm Hg. Art. quickly stopped by drug therapy.
• 80/50 is accompanied by shock conditions on the part of the cardiovascular system.
• Prolonged decrease in indicators to 60/30, cause pronounced reactions, and may be accompanied by pulmonary edema and cerebral hypoxia.
• With a decrease in blood pressure to 40 mm Hg. signs of a dying state are pronounced.
• Indicators at 20 mm Hg. Art. the usual device is not determined, the person falls into a coma and, in the absence of help, dies.

With readings below 60 mm Hg. the sense of reality is gradually lost, the earth floats underfoot, a shock state of the organism sets in.

Important! At the first symptoms, it is necessary to call an ambulance carriage, especially if there are no people nearby who can provide the necessary assistance.

In order to prevent tragedy, it is necessary to monitor the state of health, periodically measure blood pressure indicators, and lead a healthy lifestyle.At the first sign of a deviation from the norm, consult a specialist. Timely prevention and treatment with medications will allow you to live for many years.

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90,000 Which is more dangerous: low pressure or high? | HEALTH: Medicine | HEALTH

If a person reacts to changes in the weather with pressure surges, this is a reason to consult a doctor.According to cardiologist Tatyana Litvinova , first you need to go to an appointment with a therapist, if necessary, he will refer you to a cardiologist. Especially you need to be more careful if the pressure jumps above 140.

– If there are no other diseases and there are single leaps, then this does not bode well. Perhaps this is a “side effect” of some other diseases. Health problems must be ruled out, ”says Tatiana Litvinova. – But if a person is aged, there are problems with the vessels of the head, plaques, concomitant diseases, you should immediately contact a doctor.In this case, there may be complications in the form of a heart attack, stroke.

By the way, high blood pressure does not always lead to a heart attack. According to the doctor, there are hypertensive patients with blood pressure of 200-300, but they have never had such severe consequences.

– Several factors must combine for a heart attack to occur. It happens at low pressure, and stroke can occur at high and normal.

As for which pressure is more dangerous, then everything is relative. Low is considered to be a variant of the norm.In hypotonic patients, the pressure is lower than generally accepted, but this is not a pathology. In hypertensive patients, high blood pressure may not be felt if at the same time the person feels normal.

For information

The age when heart problems can make themselves felt is 30-35 years. If there is a hereditary predisposition, then, most likely, it is during this period that it will manifest itself.

High pressure symptoms

• Headaches, dizziness – if the head hurts badly, the temples “throb”, it means that the pressure has risen sharply.
• Pain in the region of the heart.
• Deterioration of vision – its acuity is lost, darkens in the eyes.
• Rapid heartbeat.
• Sensation of heat, the face turns red, while the hands and feet become cold.
• Nausea.
• Tinnitus.
• Unreasonable feeling of anxiety.
• Excessive sweating.
• Feeling tired, exhausted.

Low pressure symptoms

• Weakness, malaise, decreased performance and memory.
• Headaches and dizziness, darkening of the eyes.
• Meteosensitivity, sensation of cold.
• Tachycardia, pain in the region of the heart.

In more advanced cases, when the pressure can drop to critical levels (50 mm Hg and below), the following symptoms may join the above symptoms:

• Severe attacks of weakness, fainting.
• Attacks of vomiting.
• Feeling of lack of air.

See also:

90,000 Low blood pressure: 9 main reasons

Many people believe that low blood pressure is good for health and well-being. However, abnormally low rates are a completely different matter, because in this case, a person may face constant dizziness and even fainting. Moreover, in severe cases, hypotension can lead to death. So why does the pressure drop below normal, and what symptoms are worth looking out for? You will learn about this from this material.

Blood pressure is the pressure that blood exerts on the walls of the arteries during the active and passive phases of the heart rhythm.

• Systolic (“high”) pressure is generated during the active phase – when the heart contracts and pushes blood.
• Diastolic (“bottom”) pressure is generated during the passive phase of the heart rhythm – when the heart is relaxed and fills with blood to be pushed out again.

The American Heart Association guidelines state that normal human blood pressure is below 120/80 mm Hg.st ..

During the day, the pressure changes slightly. Its performance is influenced by various factors: body position, breathing rhythm, stress, physical activity, medications taken, food, and even the time of day. The lowest blood pressure is observed at night, and the highest – after waking up.

What is considered reduced pressure for one person is not considered as such for another. Most doctors believe that blood pressure can be called too low only when it falls below the usual values ​​for an individual and causes symptoms.Hypotension is diagnosed only when the systolic pressure drops below 90 mm Hg, and the diastolic pressure falls below 60 mm Hg.

One of the dangerous situations is a sharp drop in pressure. Even a relatively small decrease in indicators – by 20 mm Hg. (drop in systolic pressure from 110 to 90 mmHg) may cause dizziness and fainting. This is due to the fact that the brain does not receive enough blood. A sudden drop in blood pressure can be caused by uncontrolled bleeding, a severe infection, or an allergic reaction, all of which are life-threatening situations.

How to recognize the symptoms of low blood pressure?

If the pressure is 90/60 mm Hg. – this is a common occurrence for you and you feel normal, there is no reason for concern. However, if the brain and other organs receive less blood, and with it oxygen, this is very bad. If this happens, the person develops the following symptoms of low blood pressure:

• Dizziness,
• Fainting,
• Blurred vision,
• Increased heartbeat,
• Nausea,
• General malaise.

Extreme hypotension can lead to shock. If you develop any of the symptoms below, call your doctor urgently:

• Confusion, especially in the elderly,
• Cold, clammy, pale skin,
• Rapid, shallow breathing,
• Weak but fast pulse.

What are the causes of hypotension?

There are several medical reasons that cause a drop in blood pressure, including:

Reason # 1: Pregnancy

As the entire circulatory system expands during pregnancy, many expectant mothers experience a drop in blood pressure.This is normal, and after the birth of the baby, the pressure returns to its usual values.

Reason # 2: heart problems

Certain diseases and disorders that are associated with the heart lead to a decrease in blood pressure. These disorders include bradycardia, valve problems, heart failure, and heart attack.

Reason # 3: endocrine disorders

Pressure may drop with parathyroid disease, adrenal insufficiency, low blood sugar, and in some cases diabetes.

Reason # 4: Dehydration

When our body loses more fluid than it receives, weakness, dizziness and fatigue appear. When dehydrated, the blood volume decreases, which can lead to a significant drop in blood pressure.

Our body intensively loses fluid at elevated temperatures, vomiting, severe diarrhea, the use of diuretics, as well as during physical exertion. If you are wondering why your blood pressure is dropping, it may be because you are not drinking enough fluids.

Reason # 5: Blood loss

Large amounts of blood loss due to serious injury or internal bleeding decreases blood volume. As with dehydration, this leads to a large drop in blood pressure.

Reason # 6: Severe infection (septic shock)

When the bacteria leaves the initially affected area of ​​the body (most often the lungs, abdomen, urinary tract) and enters the bloodstream, septic shock can occur.Once it enters the bloodstream, the bacterium begins to produce toxins that damage the blood vessels. This chain of events leads to life-threatening hypotension.

Reason # 7: Severe allergic reaction (anaphylactic shock)

This is an extremely serious, potentially life-threatening condition. Its triggers can be: separate food, medicines, insect poisons and latex. Anaphylactic shock causes breathing problems, hives, itching, swelling of the throat, and a severe drop in blood pressure.

Reason # 8: Nutrient Deficiency

Deficiency of vitamin B-12 and folate in the diet can lead to insufficient production of red blood cells. Subsequently, the person develops anemia, and with it – hypotension.

Reason # 9: Taking medication

Medicines that lower blood pressure include:

• Diuretics – furosemide and hydrochlorothiazide,
• Alpha blockers such as prazosin,
• atenolol and propranolol,
• Medicines for Parkinson’s disease – pramipexole and those that contain levodopa,
• Certain types of tricyclic antidepressants, including doxepin and imipramine,
• Medicines prescribed for the treatment of erectile dysfunction, or especially if sildenafil take at the same time with nitroglycerin.

Types of hypotension

Depending on the causes and other factors, many doctors distinguish several types of this disorder. We will consider the main ones below:

Orthostatic hypotension (postural)

This type is characterized by a sudden drop in pressure when a person gets up from a sitting or lying position. When we stand, blood collects in our legs due to the force of gravity.To compensate for this, the heart rate increases and the blood vessels constrict. Due to this mechanism, our body provides the brain with a sufficient amount of blood. In people with orthostatic hypotension, this compensatory mechanism is impaired, which leads to a drop in pressure.

This type of hypotension occurs for a variety of reasons, including:

• Dehydration,
• Prolonged bed rest,
• Pregnancy,
• Diabetes mellitus,
• Heart problems,
• Burns, 9010
• Exposure to high temperatures Varicose veins,
• Selected neurological disorders.

P Ostprandial hypotension

In some, blood pressure drops after eating, or in the postprandial period. Most often, this problem affects the elderly. After we have eaten, blood is sent to the digestive tract. Usually, to maintain normal blood pressure, the heartbeat increases and individual vessels narrow. However, for some, this mechanism does not work properly, which leads to dizziness and weakness.

Postprandial hypotension is most common in people with high blood pressure or Parkinson’s disease. To combat this phenomenon, you need to reduce the dosage of drugs for hypertension, as well as eat small portions.

Hypotension neurocardiogenic

In this form of impairment, the communication process between the brain and the heart does not work properly. Children and young people are more likely to suffer from this.In this case, the pressure drops after being on your feet for a long time.

Hypotension due to damage to the nervous system (multisystem atrophy)

This rare disorder is also called Shay-Drager syndrome. It causes progressive damage to the autonomic nervous system, which controls blood pressure, heart rate, respiration, and digestion. This disorder has one feature – when a person lies down, his pressure rises greatly.

What can happen if you ignore the low pressure?

We emphasize once again – if the tonometer numbers do not fall below 90 by 60 mm Hg. and you feel normal, there is nothing to worry about. If the symptoms of low blood pressure listed above appear, do not ignore them. Even a moderate decrease in normal human indicators not only causes dizziness, weakness and fainting. All this can end up in falls and injuries, which very often affect older people.

If a person has very low blood pressure, their organs and tissues may not receive enough oxygen. Ultimately, this leads to dysfunction of the body, as well as damage to the heart and brain. If you periodically experience symptoms of low blood pressure, see your doctor.

Sources:

1. Low blood pressure (hypotension), Mayo Clinic,
2. Low Blood Pressure – When Blood Pressure Is Too Low, American Heart Association,
3. Understanding Blood Pressure Readings, American Heart Association.

pressure must be measured on both hands

Blood pressure should be measured on both the left and right hand. If the “left” pressure differs from the “right” pressure by ten millimeters of mercury or more, this is an alarming sign. It can indicate a risk of heart attack or stroke.

This conclusion was made in a scientific article published in the journal Hypertension by an international group of scientists.

Current guidelines for physicians recommend measuring blood pressure in both arms.However, doctors often ignore this requirement due to lack of time, let alone ordinary users of home blood pressure monitors. Meanwhile, a few minutes spent can save a person’s life, the researchers say.

Scientists have known for a long time that a significant difference between the systolic (“upper”) pressure in the left and right hands is a bad sign. Much research has been done on this topic. Experts from the INTERPRESS-IPD collaboration analyzed almost all available publications on this issue.

A large difference between the pressure on the left and right arm can be a sign of dangerous arterial problems.

By combining data collected in 24 scientific papers, the authors of the meta-analysis obtained a sample of almost 54 thousand people living in Europe, the United States, Africa and Asia. Each of them at one time measured the pressure on the right and left hand. Also, scientists had data on which of the volunteers fell victim to a heart attack, stroke or death from another “cardiovascular” cause within ten years after the survey.

Experts have calculated that every millimeter of mercury difference increases the risk of heart attack, stroke or death by 1%. They call the maximum allowable difference 10 mm Hg. Art. If it is higher, the person is at risk and must carefully monitor their health. Prior to that, the upper limit of the norm was considered a difference of 15 mm Hg. Art.

Researchers note that the difference between the “upper” pressure on the left and right hand is 10 mm Hg. Art. and is more common in 4% of the population.Among patients with hypertension, the proportion of such people is higher: 11%.

Let’s add that earlier Vesti.Ru talked about the new “gold standard” of blood pressure.

90,000 WHO: 1.28 billion people suffer from hypertension, more than half of them are untreated

A joint study by WHO and Imperial College London was published in the medical journal The Lancet. Experts collected and analyzed data on blood pressure in people aged 30 to 79 years from 184 countries of the world from 1990 to 2019.This is the largest study in this area to date.

According to experts, the least number of people suffering from high blood pressure live in rich countries, and most of all – in countries with middle and low income. The lowest rates of hypertension are in Switzerland, Peru and Canada, the highest among women are in the Dominican Republic, Paraguay and Jamaica, and among men in Hungary, Paraguay and Poland.

The top ten countries with the largest proportion of the male population suffering from high blood pressure also include Belarus and Tajikistan.There, hypertension was diagnosed in 52 percent and 51 percent of men, respectively.

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Russia is in the top ten countries in which the incidence of hypertension among women for 30 years has decreased significantly – by 12 percent. Uzbekistan, on the contrary, is among the countries where the corresponding indicators increased significantly for both women and men – by 9% 15%, respectively.

WHO experts emphasize that high blood pressure significantly increases the risk of cardiovascular disease, as well as diseases of the brain and kidneys, and is one of the main causes of death on the planet.

Treatment of hypertension: simple and cheap

At the same time, experts say that hypertension is very easy to diagnose: it is enough just to regularly measure blood pressure, and this can be done even at home. It is also easy to treat, and many high blood pressure medications are inexpensive.

But, as noted in the WHO, only every 4th woman and every 5th man with high blood pressure takes effective medications that allow you to keep the situation under control.

“Even almost half a century after we started treating hypertension, which is easy to diagnose and manage with inexpensive drugs, many people with high blood pressure are still not being treated, and this is a public health failure,” said one study authors, professor at Imperial College London, Majid Ezzati.

One of the world’s highest rates of hypertension treatment is in Kazakhstan. There, 74 percent of women and 66 percent of men suffering from high blood pressure receive the necessary medicines. The top three are Canada, Iceland and South Korea. The worst situation with the treatment of hypertension is in sub-Saharan Africa, in several countries in Southeast Asia and the Pacific island states.

WHO has also provided a number of recommendations to help prevent hypertension. These include reducing salt, alcohol and trans fat intake and quitting smoking.Experts also emphasize the need to lead an active lifestyle.

i have low blood pressure – Translation into Russian – examples English


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I can eat salty because I have low blood pressure .

I have low blood pressure .

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But there is one exception and that is if you have low blood pressure .

How do you have low blood pressure in your skin?

The experimental drug is causing arrhythmia, which causes low blood pressure .

Low blood pressure can cause a syncopal episode.

She suffers from low blood pressure .

Most likely, you’ve got low blood pressure .

Other symptoms reported included coldness in the extremities, decreased heart rate, and low blood pressure .

However, while low blood pressure and anemia are relatively common in the perioperative setting, PION is exceedingly rare.

However, at the same time , low blood pressure and anemia are extremely rare in perioperative PION.

That’s because of a low blood pressure .

Studies have shown that nearly all perioperative PION patients suffered from prolonged periods of low blood pressure during the operation and postoperative anemia.

Studies have shown that almost all postoperative PION patients suffered from prolonged intraoperative hypotension and postoperative anemia.

Severe side effects include low blood pressure .

Magnesium in the laxative caused hypomagnesaemia – respiratory distress, low blood pressure , arrhythmia …

I would think that that’s a low blood pressure event due to dehydration, but I’m a lawyer.

The average surgery duration in PION cases is 7 to 9 hours, which increases the risk of prolonged low blood pressure .

Low blood pressure and anemia are cited as perioperative complications in nearly all reports of PION, which suggests a causal relationship.

Low blood pressure and anemia are cited as postoperative complications in nearly all PION reports that suggest a causal relationship.

This evidence suggests that optic nerve injury in PION patients is caused by more than just anemia and low blood pressure .

This evidence suggests that the optic nerve damage in PION patients is due to something more than anemia and low blood pressure .

Death follows in the form of organ failure from low blood pressure .

Typically, low blood pressure and abdominal pain means an infection.

90,000 Risk factors for sudden death and cancer

Published: Wednesday, 09 August 2019 08:44

Risk factors for sudden death and cancer

According to WHO research, three main factors significantly increase the risk of sudden death: hypertension, hypercholesterolemia and smoking.

The main risk factors for heart disease and stroke (more than 80% of cases) are

unhealthy and unbalanced diet, physical inactivity and tobacco use.Improper nutrition

1.1. Hypercholesterolemia People with a blood cholesterol level of more than 5 mmol / l are diagnosed with varying degrees of severity of cholesterolemia (depending on the value of the recorded indicator). Typically, these people are encouraged to lead a healthy lifestyle and eliminate saturated fats (margarine, animal fats, in particular butter, cheese, gut fat, kidney fat, and white fat on meat, including chicken skins, palm and coconut oils) from their diet.It is recommended to consume at least 500 grams of vegetables and fruits daily.

Smoking – This addiction contributes to the formation of free radicals and a decrease in the supply of vitamin C in the body, which, in the end, significantly increases the likelihood of developing arteriosclerosis. – Heavy smokers have excessively high levels of nicotine and carbon monoxide in the blood. Nicotine has a negative effect on blood vessels, narrowing them, which threatens the development of thrombosis or heart attack.- Carbon monoxide leads to thrombus formation, while reducing the oxygen content in tissues and muscles, in particular in the heart. – Excessive and constant smoking doubles the likelihood of developing CVD.

Alcohol – Alcohol lovers run the risk of not only gaining excess weight, but also high blood pressure – Alcohol increases the stickiness of platelets in the blood, as a result of which it becomes too thick and difficult to pass through the vessels – Alcohol removes magnesium from the body, which also important for the activity of the heart muscle.

High blood pressure The main reason for an increase in blood pressure is the narrowing of the internal lumen of the arteries, against which the blood flow through the vessels is disturbed. Continuous measurement of blood pressure gives an idea of ​​the current state of the inner walls of arteries and veins. If the indicators are high, then this indicates the development of atherosclerosis.

Gender and age Proven fact: myocardial infarction affects men much more often than women. Over the years, the likelihood of developing coronary disease increases significantly, as there is an accumulation of damage in the arteries, moreover, blood pressure increases with age, which also increases the risk.

Physical inactivity People who are physically inactive develop cardiovascular diseases twice as often as those who are active. Therefore, it is recommended to do aerobics, since it puts a load on all muscle groups, in particular on the heart. Swimming, brisk walking, cycling, jogging, skiing, etc. are considered good types of exercise. Such sports increase blood circulation, which improves the delivery of oxygen and nutrients, as well as the process of removing waste products.

Being overweight – Being overweight leads to high blood pressure, and also contributes to an imbalance in the content of good cholesterol levels to bad. – Being overweight restricts people, making them less mobile, which increases the risk of developing CVD. – Being overweight is an additional burden on the body, including the heart. – In addition, gradually accumulating in the body, fat can be deposited on the walls of the arteries.

Diabetes Type II diabetes (not dependent on insulin) can contribute to the development of hypertension.In diabetes, the body begins to synthesize a large amount of insulin, but the content of excess sugar in the blood does not react to it in any way, against the background of which the walls of blood microvessels are covered with sugar. At the same time, the threat of CVD development increases tenfold in comparison with healthy people.

Heredity Approximately about twenty-five percent of the world’s population has a genetic predisposition to developing myocardial infarction. Most likely, this is due to a congenital defect of the arteries, because for the most part these people do not belong to the risk group (they do not smoke, go in for sports, the pressure never reached the mark above normal).

Stress- Long-term stressful conditions cause the body to produce adrenaline, due to which the blood density increases, which increases the risk of thrombus formation. the development of the first stage of atherosclerosis.

Salt Sodium is the main constituent of salt. The balance of potassium and sodium in the body maintains the level of water inside the cells, is responsible for the absorption and release of nutrients, as well as the elimination of waste products.Additional salt intake with food disturbs this balance, which contributes to an increase in blood pressure.

Menopause During this period, a woman’s risk of developing cardiovascular diseases increases significantly. This is due to the fact that with age, due to a decrease in estrogen levels, their protective effect on the cardiovascular system disappears. Risk factors for the development of cancer

Internal risk factors for oncological diseases

Complicated heredity can be a risk factor for the development of cancer of the breast, prostate, skin, colon.

Genetic mutations due to hormonal changes and a deficiency of the immune system. External risk factors for cancer Smoking (including passive smoking) is the most significant risk factor for developing lung cancer. In addition, smoking plays a significant role in the development of cancer of the bladder, breast, cervix, esophagus, colon, oral cancer, pancreas, and leukemia. Nutritional quality: According to scientific research, many dietary factors are associated with a high risk of developing various types of cancer.- Foods that are high in fat can increase the risk of breast, colon, prostate, pancreas, ovarian and uterine cancers – Insufficient fiber in food can be a factor in the risk of developing certain types of cancer. This also applies to insufficient consumption of vegetables and fruits. According to some data, the risk of developing cancer of the respiratory and gastrointestinal tract in people who have a lack of vegetables and fruits in their diet is twice as high as in those who eat enough of them.- Eating meat that is fried at high temperatures is a risk factor for developing cancer. Recent studies have shown that people who eat fried meat more than 4 times a week are at twice the risk of developing stomach cancer than those who rarely eat meat. In addition, it was found that the consumption of fried meat increases the risk of developing other localizations of cancer (colon, pancreas, breast). Alcohol Plays a significant role as a risk factor for the development of cancer of the esophagus, breast and oral cavity.Obesity Risk factor for developing breast cancer in postmenopausal women, cancer of the uterus, colon and pancreas. A sedentary lifestyle plays an important role as a risk factor for the development of colon and pancreatic cancer. Combined hormone replacement therapy (estrogen-progestin) is associated with a high risk of breast and ovarian cancer in postmenopausal women. Estrogen replacement therapy is a risk factor for uterine cancer.Infectious agents also act as risk factors – Helicobacter pylori – a risk factor for stomach cancer – Human papillomavirus – a risk factor for cervical cancer – Hepatitis B and C viruses – risk factors for liver cancer – Epstein-Barr virus is considered as a possible risk factor for lymphoma and nasopharyngeal cancer. – HIV is a risk factor for the development of Kaloshi’s sarcoma. Age is essential as a risk factor for malignant diseases. It has been reliably established that with age, the incidence of certain types of cancer (cancer of the prostate, breast, colon, ovary) increases significantly.Harmful occupational factors are associated with the development of cancer: – lung (working with arsenic, some organic chemicals, radon and asbestos), – breast, skin (coal tar, asphalt, creosote, arsenic, radium), – bladder (dyes, rubber production , leather production). Environmental factors – Solar radiation (UV rays) may increase the risk of lip and skin cancer – Ionizing radiation, especially at a young age, contributes to the development of breast cancer as well as leukemia.- Some pesticides (for example, DDT) can influence the occurrence of some types of cancer. Air pollution, especially in urban environments: The products of fuel combustion and exhaust from various industrial facilities are carcinogenic and suspected to be a risk factor for lung cancer. Water pollution: There are indications that long-term consumption of chlorinated water may contribute to the development of bladder swelling. Water contaminated with inorganic arsenic can cause skin cancer.Race plays a role in some cancers. Thus, the incidence of prostate cancer is significantly higher among the black population, among whites it is at the average rates and much lower among the Japanese. Anticancer drugs used to treat one type of cancer can contribute to the development of another.