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MONDAY, Aug. 29, 2022 (HealthDay News) — It doesn’t seem to matter what time of day or night you take your blood pressure medication, a new study finds.

The results of a randomized trial of more than 21,000 patients with high blood pressure who were followed for over five years show that protection against heart attack, stroke and vascular death is not affected if the drugs are taken in the morning or evening.

These findings contradict previous research that suggested a large benefit when the medications are taken at night.

For the study, men and women were randomly assigned to take their blood pressure drugs in the morning or evening. The researchers then looked for hospitalization for heart attack, stroke, or death from cardiovascular disease.

Over a median of five years, 3.4% of those who took their medication at night and 3.7% of those who took their medication in the morning were hospitalized for heart attack, stroke or died from cardiovascular disease.

The findings were presented Friday at the annual meeting of the European Society of Cardiology, in Barcelona. Research presented at medical meetings is considered preliminary until published in a peer-reviewed journal.

The study “was one of the largest cardiovascular studies ever conducted and provides a definitive answer on the question of whether blood pressure-lowering medications should be taken in the morning or evening,” said researcher Thomas MacDonald, a research professor at the University of Dundee in Scotland.

“The trial clearly found that heart attack, stroke and vascular death occurred to a similar degree, regardless of the time of administration,” MacDonald said in a meeting news release. “People with high blood pressure should take their regular antihypertensive medications at a time of day that is convenient for them and minimizes any undesirable effects.”

More information

For more on high blood pressure, see the American Heart Association.

MONDAY, Aug. 29, 2022 (HealthDay News) — Gen Zers and millennials are about twice as likely to develop high blood pressure during pregnancy than women from the baby boom generation were, a new study finds. This includes conditions such as preeclampsia and gestational hypertension.

It’s usually believed that the odds of developing high blood pressure during pregnancy rise with the age of the mother, but after taking age into account, researchers discovered that women born in and after 1981 were still at greater risk.

“While there are many reasons for the generational changes observed, we hypothesize that this is, in large part, due to the observed generational decline in heart health,” said study co-author Dr. Sadiya Khan, an assistant professor at Northwestern University Feinberg School of Medicine in Chicago. “We are seeing more people in more recent generations entering pregnancy with risk factors such as obesity.”

She emphasized that the stakes are high.

“High blood pressure during pregnancy is a leading cause of death for both mom and baby,” Khan said in a school news release. “High blood pressure during pregnancy is associated with increased risk of heart failure and stroke in the mother and increased risk of the baby being born prematurely, being growth restricted or dying.”

The researchers drew numbers from the National Vital Statistics System Natality Database. The study, which included data from more than 38 million women, focused on first pregnancies that occurred between 1995 and 2019.

These numbers allowed them to match high blood pressure-related disorders during pregnancy with mothers’ birth year and race or ethnicity.

They found that the highest rates were among American Indian, Alaskan Native and Black women.

“This is the first multi-generational study that moves beyond the age of the mom or the calendar year of the delivery to understand patterns of hypertension in pregnancy,” Khan said.

“This is especially important when we look at the legacy of substantial racial and ethnic disparities in this high-risk condition that affects not only the mom but also the baby,” she said. “This sets up a vicious cycle of generational health decline by starting life with poorer heart health.”

Co-author Dr. Natalie Cameron, an instructor of medicine at Northwestern, said the findings call for a new approach to screening.

“The public health and clinical message from this work is the need to broaden our perspective on screening and expand our focus on prevention in all age groups before and during pregnancy, particularly among younger people who have traditionally not been considered at high risk,” Cameron said in the release.

Khan agreed. “Prevention and earlier identification can be lifesaving and improve the health of future generations beginning at birth,” she said.

The study was published online Aug. 24 in JAMA Open Network .

More information

The U.S. Centers for Disease Control and Prevention has more about high blood pressure during pregnancy.

Aug. 29, 2022 — The nurse practitioner called me before my virtual consult with my doctor with a few quick questions. “Have you felt depressed lately?” Nope, I said confidently, even though I’d been white-knuckling this parenting-two-little-kids-during-a-pandemic thing. “Great! That’s what we like to hear!” she replied.

In that moment, I felt proud – She’s so pleased with me! But why was I so quick to tell such a bald-faced lie?

The issue of lying about our health runs deep. Truth be told – no pun intended! – medical and health lying take multiple forms and they have different motivations and consequences.

Harmless Fib or Serious Problem?

A lot of us hide things during medical appointments, says Angie Fagerlin, PhD, population health sciences professor at the University of Utah.

“From our research, we know people aren’t telling their doctors the truth,” she says. Fagerlin and colleagues have published two papers about the phenomenon, with one more forthcoming about our COVID fibs.

One study, co-authored by Fagerlin and published in JAMA Network Open in 2018, analyzed survey responses from over 4,500 U.S. adults and their honesty surrounding common questions on their health habits, medical treatments, and experiences with their provider.

Most commonly, people admitted to lying to their provider when they either disagreed with their treatment recommendation or even when they didn’t understand what the doctor was saying in the first place.

Other reasons? They weren’t taking prescription meds as directed, didn’t exercise, ate an unhealthy diet, or were popping someone else’s prescription.

So why weren’t people fully fessing up?

“The number one most common response from 82% of patients is that they didn’t want to be judged or lectured about their behavior,” Fagerlin says. What’s more, 76% said they didn’t want to know that what they were doing was harmful, while 61% said they were embarrassed. Some patients even said they also didn’t want to come across as difficult or take up more of the doctor’s time.

Another study from Fagerlin and colleagues, published in 2019, analyzed disclosure of extreme and sometimes life-threatening challenges, such as depression, suicidal tendencies, abuse, and sexual assault. One quarter didn’t tell their provider largely because of embarrassment, fear of being judged, not wanting to pursue help (e.g., see a therapist), trying to avoid it being included on their medical record, or assuming their provider couldn’t help.

But this is counterintuitive – and counterproductive: We actively seek medical help and then actively prevent our physicians from providing proper, comprehensive care because we’re concerned about how we’re perceived.

Fagerlin agrees it can be mind-boggling, but it’s common.

“People tend to respect their providers and want them to think well of them. They don’t want to do something to harm that relationship or perception,” she says.

Meanwhile, your doctor won’t know to change your meds if you’re having problems, won’t know to look for drug interactions if you’re taking someone else’s prescription, or won’t be able to refer you to a mental health professional if they don’t know you’re struggling, Fagerlin says.

It’s not like we don’t want to be truthful. Quite the opposite. Research shows that people are willing to be open and honest, particularly about their mental health, when they thought they were talking to an online bot run by a computer, according to past research in Computers in Human Behavior.

“People shared more about their symptoms with the computer when they thought that there was no human involved compared to when they thought they were speaking with a person over technology,” says Gale Lucas, PhD, a research assistant professor at the University of Southern California.

Again, fear of being stigmatized or having a doctor think negatively of you were what fed the fibs, Lucas says. A computer won’t judge you, and we find that more comforting than being face-to-face with someone who might.

There’s Lying … and Then There’s Lying

Sometimes falsehoods go over the edge. These are the reports we often hear about people making up cancer diagnoses, repeatedly checking into hospitals, or self-inducing medical problems. Factitious disorder (once called Munchausen syndrome) is a mental illness in which one “feigns, exaggerates, or self-induces a medical problem in order to get attention, care, or concern that they feel unable to get any other way,” says Marc Feldman, MD, clinical professor of psychiatry at the University of Alabama and author of Dying to Be Ill.

About 1% of patients admitted to general hospitals are faking their symptoms, making it uncommon but not rare, Feldman says. Still, most in this group are those with stable jobs and relationships with loved ones and lie in this way off and on “when they can’t cope with the stress in their life and they need sympathy,” he says.

Having a high-status health care professional hang onto your every word is satisfying and brings a hint of belonging. And generally speaking, doctors are not taught to question patients, he says. Sometimes this sympathy can be gotten from family, friends, or fellow members of the community, and that can be sufficiently satisfying so that they don’t have to seek out a doctor at all.

Fewer people with factitious disorder make up this web of lies chronically, but some do, and weaving medical lies becomes a way of life.

“There are varying motives, but in my experience, the search for nurturance is number one. Others feel as if they don’t have control over their own lives, and manipulating professionals allows them to feel in control,” Feldman says.

Still, for some, it’s an underlying personality disorder driving chronic deceit. But for others, it’s profit. Some people make big money from their health fabrications, and experience big consequences in the bargain.

A California woman recently received 5 years in prison for wire fraud when her fake cancer diagnosis led to more than $100,000 in ill-gotten crowdfunding donations.

And earlier this year a writer for the TV show Grey’s Anatomy lost her job and reputation when her entire medical history – from a rare form of bone cancer to having an abortion while undergoing chemotherapy – was exposed as false. She fabricated all of it to fuel her writing career on the show and in national magazines.

For those who need genuine mental health care, help for factitious disorder is layered and complex, and there is a lack of providers with this type of expertise, Feldman says. Reduction strategies (including distraction when one has the urge to go to the hospital, for example) is one way mental health experts treat this condition, and simply talking to a therapist can help patients come to terms with the fact that their condition is psychological and not physical.

How to Fess Up – Not Fib

Part of the solution is realizing that lying about your health, on some level, provides you with a psychological reward – whether you’re under-reporting your wine consumption for brownie points or awash in sympathy from suggesting to a co-worker you have cancer.

But is that reward worth the consequences?

It can be tough to be vulnerable when owning up to medical truth, especially in a clinical environment where the balance of power seems skewed away from you. But avoiding the tough talks, and – even if they are small – the seemingly harmless fibs, can impact your ability to be successfully treated for a condition or stand in the way of making changes to daily habits that can benefit your health in the long term.

Knowing that you’re apt to lie or not tell the entire truth is the first step.

“Our research suggests that it’s a fear of evaluation that’s driving the choice not to open up. Awareness of that can potentially give you the power to make the difficult decision to share with providers,” Lucas says.

Another possibility: Talk frankly to your doctor about the difficulties, for example, of leading a healthy lifestyle. Most doctors will acknowledge and sympathize with that – “Hey, I know it’s tough to exercise regularly; it’s hard for me, too.” – and it becomes easier for patients to be truthful about their own habits and struggles. When a healthy lifestyle is made the default, almost all of us fall short.

“Going against the default is difficult for humans to do and admit to,” Fagerlin says. But know that “people who go into the medical profession want to help you live your best, healthiest life. They can’t do that if they don’t know the whole story.”

Aug. 29, 2022 – Nearly 123,000 cancer deaths – or almost 30% of all cancer deaths – in the United States in 2019 were linked to cigarette smoking, a new analysis suggests.

That corresponds to more than 2 million person-years of lost life and nearly $21 billion in annual lost earnings.

“During the past few decades, smoking has substantially declined in the U.S., followed by great declines in mortality from lung cancer and some other smoking-related cancers,” says lead author Farhad Islami, MD, senior scientific director of cancer disparity research at the American Cancer Society.

Despite this “remarkable progress, our results indicate that smoking is still associated with about 30% of all cancer deaths and substantial lost earnings in the U.S., and that more work should be done to further reduce smoking in the country,” he says.

The study was published online Aug. 10 in the International Journal of Cancer.

Islami and colleagues had found that lost earnings from cancer deaths in 2015 came to nearly $95 billion. Other research showed that a substantial portion of lost earnings from cancer deaths could be traced to cigarette smoking, but estimates were more than a decade old.

To provide more recent estimates and help guide tobacco control policies, Islami and colleagues estimated person-years of life lost (PYLL)and lost earnings from cigarette smoking-related cancer deaths in 2019.

Of the 418,563 cancer deaths in adults ages 25 to 79 years, an estimated 122,951 could be linked to cigarette smoking. That corresponds to 29.4% of all cancer deaths and roughly 2.2 million PYLL. Translated to lost earnings, the authors estimated $20.9 billion total, with average lost earnings of $170,000 per cancer death linked to smoking.

By cancer type, lung cancer accounted for about 62%, or $12.9 billion, of the total lost earnings linked to smoking, followed by esophageal cancer (7%, or $1.5 billion), colorectal cancer (6%, or $1.2 billion), and liver cancer (5%, or $1.1 billion).

Smoking-related death rates were highest in the 13 “tobacco nation” states with weaker tobacco control policies and a higher rate of cigarette smoking. These states are Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.

The lost earnings rate in all 13 tobacco nation states combined was about 44% higher, compared with other states and the District of Columbia combined, and the annual PYLL rate was 47% higher in tobacco nation states.

The researchers estimated that if PYLL and lost earnings rates in all states matched those in Utah, which has the lowest rates, more than half of the total PYLL and lost earnings nationally would have been avoided. In other words, that would mean 1.27 million PYLL and $10.5 billion saved in 2019.

Ending the ‘Scourge of Tobacco’

To kick the smoking habit, health providers should “screen patients for tobacco use, document tobacco use status, advise people who smoke to quit, and assist in attempts to quit,” Islami says.

Getting more people to screen for lung cancer in the U.S. is also important, given that only 6.6% of eligible people in 2019 received screening.

In a statement, Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said this report “further demonstrates just how critical reducing tobacco use is to ending suffering and death from cancer.”

To end the “scourge of tobacco,” local, state, and federal lawmakers need to pass proven tobacco control policies, she said.

These include regular and significant tobacco tax increases, thorough statewide smoke-free laws, and enough funding for state programs to prevent and stop smoking. It also means ensuring all Medicaid enrollees have access to all services that can help smokers quit as well as access to all FDA-approved medications that help users stop smoking.

“We have the tools to get this done, we just need lawmakers to act,” Lacasse said.