Why is it important to control blood pressure?

Maintaining a healthy blood pressure is crucial for overall health. When we measure blood pressure, we assess the pressure exerted by blood against the artery walls. Elevated blood pressure can strain the heart, leading to reduced heart strength, while the forceful blood flow can damage blood vessels. Besides the heart and blood vessels, prolonged high blood pressure can result in damage to other essential organs, like the kidneys, eyes, and brain. It’s noteworthy that high blood pressure stands as the foremost controllable risk factor for stroke, contributing to 54% of strokes worldwide.

What are my blood pressure goals?

Individuals who have not been diagnosed with high blood pressure should have a blood pressure less than 120/80. Meaning that the systolic (top number) is less than 120 AND the diastolic (bottom number) is less than 80.

For most people who have been diagnosed with high blood pressure, the goal is less than 130/80. Meaning the systolic should be less than 130 AND the diastolic less than 80. These numbers have been chosen because research has shown that keeping blood pressure below this level significantly reduces the risk of health problems, including heart attack and stroke.

If your systolic (top) number is ever higher than 180 or if your diastolic (bottom) number is ever higher than 120, try to relax and then retake the reading. If it is still high, it is considered a hypertensive crisis. You need to call your doctor right away or go receive urgent care. 

How to accurately measure your blood pressure at home

Measuring blood pressure at home can be a great way to take charge of your health. Blood pressure can fluctuate throughout the day, taking your blood pressure at home and recording the readings in a log can be helpful for your doctor, especially if you are taking blood pressure medication.

Some tips recommended by the American Heart Association for accurate at home readings.

• Be Still – Sit still for at least 5 minutes before measurements. Don’t smoke, drink caffeinated beverages, or exercise within 30 minutes before measuring blood pressure
• Sit correctly – Sit with your back straight and supported in a firm chair. Keep feet flat on the floor and uncross legs. Support your arm on a flat surface, keeping your upper arm at heart level.
• Measure at the same time each day – Ideally, take a measurement around the same time each day, such as in the morning and evening.
• Proper placement – Proper placement of the cuff is important. Ask your pharmacist or doctor for help if you are unsure how to place the cuff.
• Take multiple readings – Each time you measure your blood pressure, take two readings one minute apart and record the results.
• Use arm blood pressure cuffs – more accurate than monitors that measure blood pressure at the wrist. 

Here are some other resources for at home blood pressure readings

• Printable blood pressure log
• Printable blood pressure monitoring tips

References:

1. Gaciong, Zbigniew et al. “Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses.” Current hypertension reports 15,6 (2013): 559-74. doi:10.1007/s11906-013-0401-0
2. Whelton, Paul K et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Hypertension (Dallas, Tex. : 1979) 71,6 (2018): e13-e115. doi:10.1161/HYP.0000000000000065
3. “Home Blood Pressure Monitoring.” Diabetes Access, diabetesaccess.org/home-blood-pressure-monitoring. Accessed 21 Nov. 2023.
4. “Monitoring Your Blood Pressure at Home.” Heart.Org, 17 Oct. 2023, www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home.

What is a stroke?

A stroke occurs when a blood vessel that supplies blood to the brain becomes blocked or ruptures. This results in insufficient blood flow to areas in the brain and quickly results in irreversible damage or death of those brain areas.

In the United States, stroke ranks as the fifth most common cause of death, contributing to one in twenty fatalities. Additionally, stroke stands as a significant contributor to long-term disability.

Fortunately, there are actions you can take to minimize the impact of a stroke and lower the likelihood of experiencing one.

Time lost is brain lost

Brain cells rely on a constant supply of oxygen-rich blood to survive. When the flow of blood to the brain is disrupted, brain cells start to die within minutes. In the case of an ischemic stroke, which is the most prevalent type, an estimated 32,000 brain cells die every minute, totaling 192,000,000 within an hour.

Every second counts. Recognizing the signs of stroke and immediately calling 911 is essential in minimizing the damage caused by a stroke. If there is uncertainty about whether you or someone you know is experiencing a stroke, it’s best to err on the side of caution and call 911.

Know the signs of a stroke

Knowing the signs of a stroke are essential to getting help fast. BE FAST is an acronym that can help you remember key symptoms of stroke so you know when to call for help.

Transient ischemic attack (TIA or “mini stroke”)

A transient ischemic attack (TIA), also known as a “mini stroke”, is a stroke that lasts for only a few minutes, with most symptoms disappearing after an hour. A TIA is a medical emergency, just like a major stroke. TIAs require emergency care and you should call 911 right away if you experience one. They are a warning sign of a future major stroke.

More than a third of people who have a TIA and don’t get treatment have a major stroke within a year. Up to 10% to 15% of people will have a major stroke within three months of a TIA.

Reducing Risk of Stroke

Knowing the signs of stroke is important; however, there are also things you can do to decrease your risk of stroke.

• Lower blood pressure
  • Having high blood pressure can double or quadruple your risk of stroke. Make sure you have a doctor monitor your blood pressure and take all blood pressure medications as directed.
• Lose weight
  • Obesity and the complications that can come along with it raise your risk of stroke. Studies have shown that even losing ten pounds can decrease stroke risk.
• Exercise more
  • Exercise can help with weight loss and blood pressure lowering. However, exercise has been shown to be an independent stroke reducer on its own. You should aim for 30 minutes of moderate intensity exercise at least five days a week.
• Decrease alcohol consumption
  • If you drink, moderation is important. Stroke risk increases when someone averages more than one drink per day.
• Treat atrial fibrillation (afib)
  • Atrial fibrillation, a form of irregular heart rhythm, increases the risk of stroke almost fivefold. If you have symptoms of heart palpitations, make sure to see your doctor. If you are on blood thinners for atrial fibrillation, make sure to take them as directed.
• Treat diabetes
  • High blood sugar can damage your blood vessels over time and increase your stroke risk. Keeping your blood sugar under control can decrease stroke risk.
• Quit smoking
  • Smoking significantly raises risk of stroke. Smoking cessation is one of the most powerful lifestyle changes that can help prevent a stroke.

References:

1. “About Stroke.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 May 2023, www.cdc.gov/stroke/about.htm.
2. “May Is Stroke Awareness Month.” Hennepin Healthcare, 2 Aug. 2023, www.hennepinhealthcare.org/blog/may-is-stroke-awareness-month/.
3. “Stroke Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 May 2023, www.cdc.gov/stroke/facts.htm.
4. Saver, Jeffrey L. “Time is brain–quantified.” Stroke 37,1 (2006): 263-6. doi:10.1161/01.STR.0000196957.55928.ab
5. “Transient Ischemic Attack (TIA).” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/health-information/disorders/transient-ischemic-attack-tia#:~:text=TIA%20symptoms%2C%20which%20usually%20occur,one%20side%20of%20the%20body. Accessed 17 Nov. 2023.
6. “7 Things You Can Do to Prevent a Stroke.” Harvard Health, 15 May 2022, www.health.harvard.edu/womens-health/8-things-you-can-do-to-prevent-a-stroke

Major depressive disorder (MDD) is a leading cause of disease, both in the United States and globally. In 2021, an estimated 21 million adults in the US had at least one major depressive episode, with 61% of those diagnosed receiving treatment in the past year.

Symptoms of MDD include:

• depressed mood
• decreased interest in pleasurable activities
• feelings of worthlessness or guilt
• lack of energy
• poor concentration
• changes in appetite
• agitation
• sleep disturbances
• suicidal thoughts

The goal for treatment of MDD is full remission, meaning minimal or no residual symptoms. However, the majority of patients do not achieve this with first line therapies.

In one study, only about one-third of patients achieved remission after a treatment trial with a selective serotonin reuptake inhibitor (SSRI), a commonly used type of antidepressant. About 10-30% of patients do not find depression relief after trying two different antidepressants. Given the significant decline in quality of life, functional impairment, and financial costs associated with MDD, the development of safe, effective, and fast-acting treatments is in high demand.

In August 2022, dextromethorphan-bupropion was approved for MDD by the Food and Drug Administration (FDA), marketed under the brand name Auvelity. Auvelity works differently than other oral antidepressants on the market. The unique way it works makes it an effective and fast-acting oral antidepressant treatment option. One clinical trial demonstrated improvement in patients’ depression in as early as one week. This is different from most other oral antidepressants, which can take up to four weeks before they begin to show symptom improvement.

One key thing for patients to note is that Delsym cough syrup, an over-the-counter medication that contains dextromethorphan, cannot be used to self treat depression at home. Without the bupropion, dextromethorphan does not last long enough in the body for depression treatment.

Dextromethorphan-bupropion also has good effectiveness compared to other oral antidepressants. One study showed that 53% of patients achieved clinical remission at six weeks. At twelve months, remission was sustained at 69%.

Studies have also shown that the medication is well tolerated, with the most common adverse events including:

• dizziness
• nausea
• dry mouth
• headache

The introduction of dextromethorphan-bupropion marks a significant advancement in the treatment of MDD. With a favorable safety profile, it may be a promising oral option for those who have not had success with other antidepressants. Every person is different, and every treatment option has pros and cons. If you notice you are experiencing symptoms of depression, make sure to talk with your doctor to find the right treatment options for you.

References:

This month, we are joined at Plain City Druggist by Sam Steele a fourth-year pharmacy student from The Ohio State University’s College of Pharmacy.

Sam will graduate in May 2024 with her PharmD degree and will then take the test to become a registered pharmacist. Sam will be with Tayler and the gang here in Plain City throughout November, so please stop by and meet her while she is here.

Here is what Sam tells us about herself:

Hello! My name is Sam Steele and I’m excited to be here at Plain City Druggist this month. I am originally from New York; however, I have lived in Ohio since 2016 when I came to Ohio State to complete my BS in Pharmaceutical Sciences. After completion of my bachelor’s degree, I continued on to pharmacy school with plans to graduate this spring with my PharmD and MS specializing in Clinical Pharmacology and Clinical Trial Design.

I have always enjoyed chemistry and biology, and I am fascinated by the human body and the science behind disease processes and how medications can work to alter them. I decided to pursue a career as a pharmacist in high school when I learned about the diverse range of career pathways pharmacists have to choose from. Whether in a community setting, in the pharmaceutical industry, or as a pharmacist in a hospital, I knew I would have many doors open to me.

My career interests lie in hospital pharmacy, and I have been a pharmacy intern at OSU Wexner Medical Center these past few years. I am currently in the process of applying for hospital residency programs with hopes to become a hematology/oncology specialist. I am also interested in research and have been able to work on a few projects at the medical center, with hopes for more opportunities during residency.

In the season of flu and RSV, it’s time to start thinking about getting your updated COVID-19 vaccine.

You may have encountered the term “booster” in the past few months for the COVID vaccine. However, major health organizations are moving away from that term in efforts to emphasize that this is an “updated COVID vaccine.”

Just like we receive an updated flu vaccine every year to guard against the most common influenza strain, it’s likely that we will eventually move towards a schedule where people can anticipate receiving an updated COVID-19 vaccine annually to safeguard against the most common COVID strain of that year.

Updates + Efficacy

The 2023-2024 formulation of the Moderna and Pfizer vaccines are based on an omicron subvariant, XBB.1.5. They are still effective against the variants that are causing a majority of COVID cases in the United States at this time, which includes emerging strains such as EG.5 (Eris), FL.1.5.1 (Fornax), and BA.2.86 (Pirola).

Vaccination continues to be the safest and most effective way to achieve protection against current variants.

Timing

If you’ve received the COVID vaccine before: Everyone aged 5 and older should get one updated COVID-19 vaccine at least two months after getting the last dose of any COVID-19 vaccine. However, in special circumstances, someone is eligible for additional updated doses.

If you’ve never received any COVID vaccine before: The same guidelines still apply! You are considered up to date on your vaccinations after receiving one dose of the updated ’23-’24 vaccine. If you have recently had COVID, you may have some protection against severe disease and reinfection. However, getting the updated COVID-19 vaccine is still recommended three to six months after experiencing symptoms or testing positive.

If you are considering other vaccines at this time: The flu shot and COVID vaccines are entirely safe to receive at the same time. As for RSV, studies are ongoing since this is the first season with the RSV vaccine. However, it is still believed that you can receive the RSV and COVID-19 vaccines together. They can be given two weeks apart if you prefer to receive only one vaccine at a time.

View official recommendations from the Centers for Disease Control and Protection (CDC) here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html 

Costs

COVID-19 vaccines were free for all Americans during the COVID-19 Public Health Emergency, which officially ended on May 11th, 2023. However, since vaccination is the most effective protection against severe disease, the updated COVID-19 vaccine should be covered under most private insurance and Medicare.

The CDC’s Bridge Access Program provides no-cost COVID-19 vaccines for uninsured or underinsured.

Visit http://www.vaccines.gov/ to find providers that offer these services. 

At Plain City Druggist and all three Happy Druggist locations, we will administer Moderna’s Spikevax (COVID-19 Vaccine, mRNA) (2023-2024 Formula) to anyone 12 years and older. Walk-ins are always welcome!

References:

CDC (2023). Use of COVID-19 Vaccines in the United States. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html

Rosen, A (2023). What to Know About the Updated COVID-19 Vaccine for Fall/Winter 2023. Johns Hopkins University, Bloomberg School of Public Health. https://publichealth.jhu.edu/2023/what-to-know-about-the-updated-covid-19-vaccine-for-fall/winter-2023

Images:

https://wecandothis.hhs.gov/resource/the-covid-virus-changes