Carolyn Davis Cockey

is executive editor of

AWHONN Lifelines.

risk of developing hypertension during their

remaining years.

Framingham research has also shown that

the risk of cardiovascular disease associated

with high blood pressure increases gradually—

even before hypertension occurs. The approxi-

mately 23 million adults in the U.S. with high-

normal blood pressure levels (systolic pressure

of 130-139 mm HG and/or a diastolic pressure

of 85-89 mm HG) are 1.5 to 2.5 times more

likely to have a cardiovascular event or to die

within 10 years, compared to those with opti-

mal blood pressure (systolic pressure of less

than 120 mm HG and diastolic pressure of less

than 80 mm HG). Normal blood pressure lev-

els are 120-129 mm HG systolic and 80-84 mm

HG diastolic.

“Epidemiological data suggest that if we

could lower the average systolic blood pressure

among Americans by 5 mm HG, we’d see a 14

percent drop in deaths from stroke, a 9 percent

drop in heart disease deaths, and a 7 percent

drop in overall mortality,” researchers said. “A

reduction as small as 2 mm HG in the average

American’s systolic blood pressure could save

more than 70,000 lives per year.”

Proven behavioral changes can lower one’s

blood pressure and reduce the risk of a cardio-

vascular event. The report cites one study, for

example, that found that people with normal

blood pressure levels who increased the

amount of regular physical activity lowered

their systolic blood pressure by more than 4 mm

HG. In another study, overweight participants

with normal blood pressure levels significantly

lowered their systolic blood pressure by losing

weight (fewer than 8 pounds); in addition, the

percentage of participants in this group who

had high blood pressure seven years later was

less than half of the percentage of the control

group who remained overweight.

The clinical trial known as Dietary

Approaches to Stop Hypertension, or DASH,

has demonstrated the critical role of nutrition

in controlling blood pressure. Based on the

results of DASH, the NHBPEP now recom-

mends an eating plan that is rich in fruits, veg-

etables and low-fat dairy products and that has

limited saturated and total fat.

Furthermore, limiting daily dietary sodium

intake to less than 2,400 mg of sodium (about

1 teaspoon of salt) per day helps lower or con-

trol blood pressure. In one study, older

patients with hypertension significantly low-

ered their systolic blood pressure and

decreased their need for medications by mod-

erately reducing how much sodium they con-

sumed. The advisory highlights that although

limiting the amount of salt added during

cooking and at the table is important, three-

fourths of the average individual’s total intake

of salt and sodium comes from sodium added

during processing and manufacturing.

Therefore, NHBPEP urges food manufacturers

to lower the amount of sodium in the food

supply—and to offer these products at equi-

table prices.

Other behavioral changes for people with

blood pressure above optimal levels include

consuming more than 3,500 mg of dietary

potassium per day—an approach especially

important for individuals with high sodium

intake—and limiting alcohol consumption to

no more than 1 ounce of ethanol (e.g., 24 oz

beer, 10 oz wine, or 2 oz 100-proof whiskey)

per day in most men and to no more than 0.5

ounce per day in women.

These lifestyle factors are essential for sen-

iors and others who are more likely to develop

high blood pressure, such as those with high-

normal blood pressure or a family history of

hypertension; those who are African American,

overweight or obese, or inactive; and those

who consume more than the recommended

amounts of dietary sodium or alcohol, or

insufficient amounts of potassium.

The report advises, however, that efforts to

prevent blood pressure from rising in children

are also important. School administrators can

help by offering heart-healthy foods in their

cafeterias and health education programs in

their classrooms.

Trend Watch:Soy Sales Boom

Thanks in large part to women’s worries

about taking hormones, soy, which

contains plant estrogens, is soaring in popu-

larity, the national newspaper USA Today

reports. With retail sales of soyfoods in the

U.S. expected to surpass $3.5 billion this

year, soy is being widely touted as helpful to

relieve hot flashes for women undergoing

490 AWHONN Lifelines Volume 6 Issue 6

menopausal and postmenopausal

problems.

The soy boom follows a July

announcement warning against one

form of hormone replacement therapy.

A study, the Women’s Health Initiative,

found that health risks increased

among women using a combination of

the hormones estrogen and progestin.

Gene Identified in Cleft Lip, Palate

Scientists have discovered the

gene that causes Van der Woude

syndrome, the most common of the

syndromic forms of cleft lip and

palate. The term “syndromic” means

babies are born with cleft lip and

palate, in addition to other birth

defects.

According to the scientists, the dis-

covery could very possibly direct them

to genes involved in “nonsyndromic”

cleft lip and palate, one of the most

common birth defects in the world.

Among Caucasians, nonsyndromic

cleft lip and palate occurs in an esti-

December 2002 | January 2003 AWHONN Lifelines 491

Anew study confirms earlier reports that Depo-

Provera, an injectable contraceptive popular

among young and low-income American women, is

strongly associated with bone density loss. The study,

funded by the NICHD, also found that bone loss associ-

ated with Depo-Provera use appears to be largely

reversible once the injections are stopped.

Bone density loss increases the risk for osteoporosis, a

disease primarily of old age in which bones become frag-

ile and are more likely to break. Women who use Depo-

Provera are at risk for loss of bone density, although this

study provides evidence that Depo-Provera’s effects on

bone density appear to be largely reversible.

However, women with risk factors for osteoporosis

(for example, smoking, thin or small frame, prior broken

bones, Caucasian or Asian ancestry, family history of

osteoporosis, diet low in calcium) should discuss the

issue of bone loss with their health care providers when

considering this form of contraception. The findings

appear in the September issue of Epidemiology.

Some earlier studies found an association between

Depo-Provera use and decreased bone density, while

others did not. However, many previous studies of

Depo-Provera use and bone density only measured sub-

jects’ bone densities at one point in time, rather than at

several points over the course of an extended time peri-

od. Furthermore, only one previous study looked at the

effects of discontinuing Depo-Provera use on bone

density.

This study was conducted between 1994 and 1999.

The researchers examined women enrolled in Group

Health Cooperative, a health maintenance organization

in the state of Washington. They compared hip and spine

bone density measurements taken in 182 reproductive-

age women (ages 18 to 39) receiving Depo-Provera injec-

tions to those of 258 comparable women not receiving

the injections. Bone density measurements were taken at

the start of the study and every six months for up to

three years.

Depo-Provera users lost markedly more bone density

than did non-users throughout the three-year follow-up

period. Based on their findings, the researchers estimated

that women who use Depo-Provera continuously for four

years would experience bone loss comparable to that

which occurs during lactation (breastfeeding) or

menopause. Specifically, Depo-Provera users experienced

a loss of bone density at the hip of 1.12 percent per year,

compared with a 0.05 percent per year loss among non-

users. The comparable figures for spine bone density

were a loss of 0.87 percent per year for the Depo-Provera

users and a gain of 0.40 percent per year for the non-

users. The researchers also noted that 18- to 21-year-old

Depo-Provera users had much lower bone densities at

the beginning of the study than did 18- to 21-year-old

non-users.

Women who discontinued the use of Depo-Provera

during the course of the study showed marked increases

in bone density following discontinuation, although bone

density returned at the hip more slowly than at the spine.

In fact, two and a half years after stopping Depo-Provera

injections, the average bone density values for previous

users were similar to those of non-users. The only excep-

tion occurred among women between the ages of 18 and

21, whose bone density values continued to lag behind

those of non-users even two and a half years after stop-

ping Depo-Provera. The authors of the study attribute

this finding to the 18- to 21-year-old users’ large bone

density deficits at the beginning of the study.

BBoonnee LLoossss FFrroomm DDeeppoo-PPrroovveerraa RReevveerrssiibbllee