Hypertension: the hidden risk and the debate on how to measure it properly

Regularly monitoring your blood pressure is essential, but are you doing it right? New research suggests that lying down to take your readings may be more helpful.

Hypertension is one of the leading preventable and treatable causes of premature death worldwide. Measuring blood pressure at home on a daily basis is one of the most successful ways of controlling it. However, according to a new study, most people are not doing it correctly.

In fact, there has been a surprising disagreement on the best way to measure blood pressure. The controversy began several years ago when some studies suggested that people in the recumbent position could have a greater blood pressure than in the upright position.

The study

Harvard researchers tracked participants in the Atherosclerosis Risk in Communities (ARIC) study for over 27 years, evaluating the correlation between blood pressure recorded in both the sitting and lying down positions, and cardiovascular disease. The study initially included over 13,000 adults, but the researchers excluded those who already had coronary artery disease, heart failure, or stroke at the beginning, which left 11,369.

The study revealed surprising results. Among participants, 16.4% of those without sitting hypertension had supine hypertension (blood pressure while lying down). Conversely, 73.5% of those who had sitting hypertension also had supine hypertension. In people who had only supine hypertension, the risk of cardiovascular events was similar to that in people who had hypertension in both positions.

For the study, high blood pressure was defined as systolic (the upper number) readings of 130 mm Hg or higher, or diastolic (the lower number) readings of 80 mm Hg or higher.

From these findings, the researchers pointed out that, compared with sitting-only hypertension, supine hypertension has greater risks for:

Coronary artery disease (60% greater risk)
Heart failure (83% greater risk)
Stroke (86% greater risk)
Fatal coronary artery disease (more than twice the risk)
Overall mortality (43% increased risk)

Although the study strongly promotes the supine hypertension consideration, it also raises more questions. Would targeted therapies for supine hypertension have salutary effects on outcomes? How does this condition connect to nocturnal hypertension? Future studies can follow these and other paths as well as improve approaches to blood pressure management under varying conditions.

Source: JAMA

The article draws upon studies published and recommendations from international institutions and/or experts. We do not make claims in the medical-scientific field and report the facts as they are. Sources are indicated at the end of each article.

Why does my dog chatter its teeth? Here’s what it means

Have you noticed that your dog is chattering his teeth? There are several causes that can cause a dog to grind and chatter his teeth. Some of these causes indicate some behavioral problem, but others suggest an underlying disease or physical disorder.

A strange behavior that will baffle dog owners is when a dog begins to chatter its teeth. This entails repeated banging of the mandible and jaw, so the teeth hit each other. There isn’t any specific reason in real life why it occurs. At times, it’s very normal, while in other cases, it may be a sign of an underlying condition.

Causes of a dog chattering its teeth

We can split the causes of a dog chattering its teeth into two general groups: behavioral causes and causes due to real diseases.

Behavioral causes:

Flehmen: It is an entirely normal behavior in which the dog sniffs very interesting odors using the Jacobsen organ (which humans don’t have). Also known as the vomeronasal organ, it allows the animal to perceive some odors more efficiently through both smell and taste. When the Flehmen response is initiated, the dog rhythmically slams its jaw and mandible to direct the odor particles towards the Jacobsen organ. This is typically seen in male dogs when they detect a female in heat, but it can also occur when they detect urine.
Over-excitement: If a dog becomes too excited, then it will clatter its teeth forcefully. This is a built-in, natural thing that the dog does automatically.
Cold: If a dog is chattering its teeth due to cold, the entire body will usually shake, not just the mouth.

Health-related causes:

Oral Disease Conditions: Diseases like tartar, periodontal disease, stomatitis, or even mouth tumor could be so painful in a dog that it chatters its teeth.
Object: in Mouth: Sometimes a stick or some other object stuck in a dog’s mouth may make it chatter teeth.
Neurological Conditions: This type of mouth tremor is normally preceded by other symptoms, such as drooping of the lips, eyelid drooping, or difficulty opening the mouth. It can also be an onset symptom of a seizure in some dogs.
Poisoning and Toxins: Tremors can be caused by some toxins. But when it comes to poisoning, the tremor does not only occur in the mouth but is generally generalized to the entire body.

What to do if your dog chatter its teeth?

What to do when your dog chatters its teeth depends on why it is doing so.

Flehmen or Over-excitement: Absolutely nothing needs to be done at all. It is normal behavior and the dog does not need to be punished or scolded.

If You Think the Dog is Cold: Bring the dog indoors, but watch out—owners mistakenly think over-excitement rather than cold.

If You Suspect a Health Problem: Start by calling your vet. After an examination, your vet will determine if there is a foreign body (in which case removal will be necessary), tartar with periodontal disease (in which case a dental cleaning, tooth extraction, and blood tests are necessary), or a neurological issue (in which case further blood tests, a specialist neurological examination, and possibly a CT or MRI scan will be necessary).