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  • Antidepressants Plus Common Painkillers May Raise Bleeding Risk | Health News

    Antidepressants Plus Common Painkillers May Raise Bleeding Risk | Health News

    By Steven Reinberg HealthDay Reporter

    (HealthDay)

    TUESDAY, Oct. 26, 2021 (HealthDay Information) — Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are a mainstay of despair remedy, but a new research warns that taking frequent painkillers together with SSRIs may possibly elevate the odds for intestinal bleeding.

    In a overview of 10 published experiments involving 6,000 people, researchers located that those people having SSRIs (these types of as Celexa, Paxil, Prozac and Zoloft) and soreness medicines termed nonsteroidal anti-inflammatory prescription drugs (NSAIDs) like Advil and Aleve had an increased danger for gastrointestinal bleeding.

    “When adding SSRIs to patients presently on NSAIDs, the odds of building an upper gastrointestinal bleed elevated by 75{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c},” said guide researcher Dr. Syed Alam, chief resident in internal medicine at Creighton University Faculty of Medication, in Omaha, Neb.

    The amplified danger of higher gastrointestinal bleeding is very likely because of to the interaction of the two sorts of prescription drugs, he mentioned. NSAIDs inhibit the generation of prostaglandin, which shields the gastrointestinal tract, and SSRIs inhibit the production of platelets, which are needed for clotting. This mixture, thus, will increase the danger for bleeding, Alam stated.

    “The threat of higher gastrointestinal bleed by adding an SSRI to an NSAID needs to be discussed involving the affected person and medical doctor,” he said. “When attainable, it is greatest to lower or discontinue NSAIDs prior to starting an SSRI in buy to minimize higher gastrointestinal bleed danger.”

    Dr. Elena Ivanina, director of neurogastroenterology and motility at Lenox Hill Healthcare facility in New York City, said that in addition to the influence on platelets, SSRIs boost stomach acidity, which can consequence in peptic ulcers, rising the risk of gastrointestinal bleeding.

    “Medical doctors and people should both of those be knowledgeable of the medicines that boost the possibility of gastrointestinal bleeding,” she claimed. “Individuals need to always talk about their drugs with their doctor. For instance, mainly because the possibility of gastrointestinal bleeding is drastically elevated when SSRIs are used with each other with NSAIDs like Motrin, medical professionals should really physical exercise warning and take into consideration substitute treatment plans to this mix.”

    Ivanina claimed that the signals of gastrointestinal bleeding can be clear or concealed.

    Gastrointestinal bleeding can result in vomiting of blood or blood in the stool or black stool, she reported. “Some bleeding, even so, may be microscopic and not witnessed thus, indicators of anemia these types of as fatigue, shortness of breath on exertion or lightheadedness may sign blood reduction as nicely,” Ivanina said.

    A different expert believes that because clients are significantly obtaining other antidepressants that also decrease pain, the hazard for interior bleeding tied to these medicines requires to be examined.

    Dr. Jeffrey Fudin, founder of Pharmacist Consulting Providers, claimed that it is very well-known that SSRIs improve bleeding risk.

    “Sufferers should really also be conscious that aspirin and anticoagulants elevate the threat of gastrointestinal bleed with or with out NSAIDs,” he said. This is simply because serotonin located in platelets, dependable for clotting, is inhibited by SSRIs, which impair platelet perform.

    For the reason that numerous doctors are shying away from prescribing opioids, many people are now becoming provided serotonin-norepinephrine reuptake inhibitors (SNRIs), this sort of as duloxetine (Cymbalta) or milnacipran (Savella), equally of which are U.S. Food stuff and Drug Administration-authorised as antidepressants and also for ache, he said.

    “While much less reports have examined the bleeding hazards of SNRIs, it is rational to hope SNRIs will have an effect on bleeding hazard, albeit to a lesser extent than SSRIs,” Fudin reported.

    The findings have been offered Sunday at the American College of Gastroenterology annual conference, which is becoming held in Las Vegas and on-line. Findings introduced at clinical meetings are regarded preliminary until published in a peer-reviewed journal.

    Resources: Syed Alam, MD, chief resident, inner drugs, Creighton College Faculty of Medicine, Omaha, Neb. Elena Ivanina, DO, MPH, director, neurogastroenterology and motility, Lenox Hill Hospital, New York Metropolis Jeffrey Fudin, PharmD, founder, Pharmacist Consulting Companies, Albany, N.Y. Oct. 24, 2021, presentation, American University of Gastroenterology annual conference, Las Vegas and on-line

    Copyright © 2021 HealthDay. All rights reserved.

  • Older women, younger men may be at risk

    Older women, younger men may be at risk

    blood pressure monitor seen from up closeShare on Pinterest
    Older women and younger men in the U.S. may be at risk of uncontrolled hypertension, according to a new study. Bowery Image Group Inc./Stocksy
    • Controlling blood pressure is a major challenge for close to half of all adults in the United States.
    • Researchers say that older women and younger men are more likely to have uncontrolled hypertension, even with blood pressure-lowering medications.
    • Health experts say that lifestyle choices and a low tolerance for certain medications can make it hard to manage hypertension.

    Hypertension, or high blood pressure, elevates people’s risk of several illnesses, including cardiovascular and kidney disease, stroke, and complications from COVID-19.

    More than 92 million adults in the U.S. do not have their blood pressure under control.

    Until now, studies have barely explored how uncontrolled hypertension affects men and women at different ages.

    Aayush Visaria, M.D., M.P.H., who is a postdoctoral research fellow at Rutgers Institute for Health, Health Care Policy and Aging Research in New Brunswick, NJ, led a study examining this issue.

    Dr. Visaria presented the study’s results at the Hypertension Scientific Sessions 2021, which the American Heart Association (AHA) ran.

    Dr. Visaria and his cohorts examined data from the 1999–2018 National Health and Nutrition Examination Surveys.

    These included more than 13,200 adults aged 20 years and older, all of whom had received a diagnosis of hypertension and were on blood pressure-lowering medication.

    The average age in the cohort was 57 years. Women made up 52{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the participants, 71{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of whom were white.

    The researchers separated the participants into 10-year age groups and compared the rates of uncontrolled hypertension between men and women.

    They looked at rates of hypertension control using older and newer definitions of high blood pressure. The 2014 Joint National Commission (JNC) guidelines define high blood pressure as 140/90 millimeters of mercury (mm Hg) or higher, whereas the 2017 AHA/American College of Cardiology (ACC) guidelines define it as 130/80 mm Hg or higher.

    The researchers adjusted their data for comorbidities and metabolic, social, behavioral, and demographic factors.

    The authors noted that 34{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the 13,253 participants had uncontrolled hypertension. Women and men aged 50–69 years showed similar odds of having this condition.

    However, the researchers observed these differences among other age groups:

    • Among those aged 20–29, men showed a 59{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} greater chance of uncontrolled hypertension than women.
    • Among those aged 30–39, men had a 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} increased risk of uncontrolled hypertension compared with women.
    • Among those aged 40–49, men were 47{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} more likely to have uncontrolled hypertension than women.
    • Among those aged 70–79, women had a 29{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} greater chance of uncontrolled hypertension compared with men.
    • Among those aged 80 and older, women were 63{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} more likely to have uncontrolled hypertension than men.

    These results are based on the AHA/ACC guideline definition of hypertension. However, using the JNC definition produced similar findings.

    Derek M. Griffith, Ph.D., is the founding co-director of the Racial Justice Institute, founder and director of the Center for Men’s Health Equity, and professor of health systems administration and oncology at Georgetown University in Washington, D.C.

    In an interview with Medical News Today, Dr. Griffith commented:

    “It is great to see the American Heart Association begin to look at these issues by gender. We have long known that men under 50 have particularly poor health profiles, despite middle-age being portrayed as the prime of life. From age 35 and up, heart disease is one of the top two leading causes of death for men, and much of heart disease mortality is due to uncontrolled hypertension.”

    Dr. Griffith cited a 2018 study suggesting that men aged 45–64 years had a higher risk of stroke than women in both Black and white populations.

    He believes that young and middle-aged men struggle with heart health “because of the multiple role demands and financial pressures that cluster in middle-age.”

    Dr. Griffith further explained:

    “The current generation of young adults have tended to delay pursuing key adult roles and responsibilities, [such as] marriage, homeownership, and beginning careers. [They have] faced considerable student loan debt, stagnant wages, increased social isolation, and sedentary behavior associated with technology use — [for example,] social media, video games, [and] binge watching shows and movies. These factors are sources of stress that may raise blood pressure and stimulate unhealthy eating, sugar sweetened beverage consumption, smoking, alcohol use, and other behaviors […]. These stress-coping behaviors can lead to high blood pressure.”

    In middle age, he added, physical decline often results from lifestyle choices and experiences up to that point.

    Jennifer Wong, M.D., FACC, is a cardiologist and medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

    In an interview with MNT, Dr. Wong remarked that the findings matched her own anecdotal observations. She mentioned several factors contributing to higher incidences of uncontrolled hypertension in young men:

    “I think for younger patients, it could be an element of noncompliance: not going to doctors, not taking medications — […] especially young men.”

    She has seen that hypertension in some of her young male patients is more resistant to medications. Younger individuals “also tend to be more sensitive to medications.”

    Moreover, Dr. Wong said, young patients often do not tolerate beta-blockers, a common blood pressure-lowering medication.

    According to Dr. Visaria and his co-authors, “[…] women tend to have an accelerated increase in blood pressure and cardiovascular disease risk after menopause.”

    For Dr. Wong, treating some older women with uncontrolled hypertension presents a challenge.

    She has observed: “[O]lder women tend not to tolerate lower blood pressures, so [it’s] difficult to treat the high blood pressures without running into lower blood pressure where they feel underperfused.”

    Dr. Wong expressed concern that society underestimates the prevalence and severity of cardiovascular disease in women.

    Although men are more likely than women to develop heart disease, this illness “is still the number one killer in women, more than breast cancer.”

    The study did have some limitations. For instance, the researchers’ health data provided only one blood pressure reading at one time point for each participant. This single reading could not accurately quantify blood pressure, which normally fluctuates throughout the day.

    Dr. Visaria also expressed the need for further research to discover the mechanisms behind these differences in uncontrolled hypertension.

    He suggests: “In order to really determine whether uncontrolled hypertension rates are changing in women vs. men across age, a prospective study where blood pressure measurements are tracked over time in women and men with hypertension is ideal.”