RSV Vaccine Side Effects: What Older Adults Should Know Before the Shot
Hypertension: Here Are 7 Most Overlooked Causes Behind It
Do you know hypertension or high blood pressure can lead to serious health complications like heart disease, stroke, and kidney failure? Yes, hypertension can have some serious impact on your health. Several factors like age, and certain medical conditions are well-known contributors to hypertension, there are several often-overlooked causes that can also elevate blood pressure levels. Here are seven lesser-known factors that can contribute to the development of hypertension:
Sleep ApnoeaSleep apnoea is a disorder characterised by interrupted breathing during sleep, which can lead to repeated awakenings and reduced oxygen levels.
"Sleep apnoea if left untreated can cause a variety of health issues, including hypertension, heart disease, stroke, and diabetes. The severity of OSA might vary greatly. Lifestyle changes can help ease symptoms in moderation cases, but in more severe cases, medical attention may be required," said Dr Viswesvaran Balasubramanian, Consultant, Interventional Pulmonology and Sleep Medicine, Yashoda Hospitals, Hyderabad. This condition is linked with higher nighttime blood pressure and greater variability in blood pressure, both of which can contribute to the development of hypertension.
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Intake of High sodium Through Pre packaged mealsWhile it's commonly known that a diet high in salt can raise blood pressure, many people may not be aware of just how pervasive sodium is in their diet. Beyond table salt, high levels of sodium can be found in processed foods, canned goods, and pre-packaged meals, making it easy to consume excess sodium without realising it.
The American Heart Association recommends no more than 2,300 milligrammes of sodium per day, with an ideal limit of 1,500 mg per day for most adults, particularly those with high blood pressure. Even reducing intake by 1,000 mg per day can enhance blood pressure and heart health.
Insufficient Potassium IntakePotassium helps balance the amount of sodium in your cells, and not getting enough can lead to high blood pressure. A diet low in fruits, vegetables, and other potassium-rich foods can significantly affect your blood pressure.
Excessive Alcohol ConsumptionRegular, heavy consumption of alcohol can raise blood pressure over time. Drinking more than moderate amounts of alcohol can dramatically raise blood pressure and also reduce the effectiveness of hypertension medications.
While stress itself can cause temporary increases in blood pressure, long-term stress can contribute to chronic hypertension. According to the National Library of Medicine, high fat and high sugar foods are highly palatable which may possess addictive qualities. Stress has a significant role in the development of addiction and it may raise the risk of obesity and other metabolic diseases.
Certain MedicationsVarious prescription and over-the-counter medications can raise blood pressure. These include certain antidepressants, hormonal contraceptives, nonsteroidal anti-inflammatory drugs NSAIDs. CAbove all other factors, exposure to heavy metals like lead and cadmium can affect blood pressure. Residents in areas with higher pollution levels or those who are exposed to these metals in their workplace may have an increased risk of hypertension.
Also read: Sleeping With Lights On May Increase Risk of High BP, Obesity and Diabetes
Addressing These CausesUnderstanding and addressing these overlooked causes can help manage or even prevent high blood pressure. Here are a few strategies:
By paying attention to these often-overlooked factors, you can take more comprehensive steps towards managing your blood pressure and improving your overall cardiovascular health.
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Is Your Workstation Working Against You?
Dr Sumbulu points out that back and neck pain are among the more noticeable complaints of desk-bound work, but this can result in a heightened risk of muscle and spine ailments in the long term.
LIFESTYLE NEWS - Desk-bound individuals who spend most of their workdays seated need to prioritise posture and regular body breaks or risk spinal injury, chronic disease and mental health issues, among numerous other serious concerns.
According to Dr Bonke Sumbulu, a general practitioner at Netcare Medicross The Berg in Bergbron Johannesburg, 'sitting is the new smoking' may not be an accurate comparison. However, the dangers of continued sitting for long periods are cause for very real concern.
"The effects of sitting at your desk all day may not be immediately apparent, but over time, ongoing sedentary behaviour impacts various vital functions of the human body, which requires movement to maintain health," she says.
Musculoskeletal risks
Dr Sumbulu points out that back and neck pain are among the more noticeable complaints of desk-bound work, but this can result in a heightened risk of muscle and spine ailments in the long term.
"Sitting for extended periods can cause certain muscles to weaken while others become tight, leading to imbalances that contribute to stiffness and discomfort, particularly if you are sitting incorrectly. Adjusting chair height, desk height, the position of the monitor and keyboard, and the placement of the mouse are essential for supporting neutral body postures and reducing strain.
"Repetitive strain and poor posture, on the other hand, can increase the risk of discs slipping or herniating, causing pain, numbness, or weakness in the back and neck. These symptoms can also occur with spinal stenosis or the narrowing of the spinal canal.
"Furthermore, spinal discs can become permanently damaged, with continuous pressure accelerating wear and tear and resulting in Degenerative Disc Disease. Likewise, neck arthritis, or cervical spondylosis, involves the degeneration of the vertebrae in the neck. Both conditions lead to chronic pain and limited movement."
Dr Sumbulu notes that lack of movement can result in muscle atrophy and weakness, particularly in the muscles of the legs, core, and back. This reduces spinal and joint support, further increasing the risk of musculoskeletal pain, injuries, and postural problems.
"Regular breaks from sitting and exercises to strengthen the muscles and the spine can help to prevent these conditions. Weight-bearing exercise helps maintain bone density and strength, an important preventative step against bone loss and osteoporosis later in life," she says.
Chronic disease
"Prolonged sitting reduces calorie burning, which can lead to weight gain and obesity, both risk factors for hypertension as well as diabetes.
"A sedentary lifestyle is linked to metabolic changes, such as insulin resistance and the imbalance of lipids such as cholesterol, which can further increase the risk of diabetes and heart disease. Lack of physical activity also affects blood circulation and overall cardiovascular health, further contributing to the development of these conditions and others, such as blood clots and deep vein thrombosis (DVT). Poor blood circulation may also lead to varicose veins and leg swelling," says Dr Sumbulu.
According to Dr Sumbulu, physical activity is crucial for regulating metabolism and managing blood sugar levels. "Reduced metabolic rate can, over time, increase the risk of obesity, insulin resistance, and type 2 diabetes."
"A lack of movement can impair lymphatic circulation, increasing the risk of infections and inflammation. Remaining seated for extended periods on an ongoing basis may also contribute to digestive issues such as constipation and bloating," she says.
Mental health
Dr Sumbulu highlights that physical activity is likewise important for mental health. "Being active releases endorphins, our 'feel-good' hormones, and can boost serotonin—a neurotransmitter that helps regulate mood, sleep, and appetite. Physical activity has also been proven to reduce levels of stress hormones, such as cortisol and adrenalin, and to promote relaxation.
"Overall, a lack of physical activity can disrupt the delicate balance of factors that influence mood regulation, leading to feelings of lethargy, irritability, and low mood. Incorporating regular exercise into one's routine can help promote emotional well-being and improve overall quality of life. Team sports have the added benefit of social connection, which has been shown to have a positive impact on mood.
Get proactive on your wellness at work
Dr Sumbulu suggests incorporating activities like stretching, walking meetings, standing desks, and desk exercises such as squats or leg lifts to counteract the adverse effects of sitting all day. She notes that regular physical activity outside work hours is also crucial for overall health.
"By prioritising good desk health, you can mitigate the adverse effects of sedentary desk work. A good place to start is to utilise a suitable chair, maintain proper posture, incorporate regular walks and stretches, take the stairs over the elevators or escalators, and cultivate a healthy office environment with ample fresh air and sunlight whenever feasible," she concludes.
Dr Bonke Sumbulu
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Professional Investors' Biggest Mistakes – And How To Avoid Them
When discussing how to invest in the stock market, the professionals often sound as though they are dishing out relationship advice. "Know when to move on from things that have been really good for you," one advises sagely. "Don't make big decisions in a heightened emotional state," another adds. "And don't fall in love," concludes an industry veteran (to confirm, he is warning against companies rather than people) .
Stock picking, it is clear, requires emotional vigilance as well as intellectual nous, just as behavioural finance would suggest. Even the smartest asset managers slip up, however, and there is plenty to be learnt from their mistakes. Starting with…
Hold your nerveA common lament among experts is that they let go of a winning stock too early. "It's a glib response, but you can only lose 100 per cent of your investment if you pick a stock that goes wrong. You can lose far more than that by selling too soon," says William Tamworth, fund manager at Artemis.
Charlie Huggins, head of equities at Wealth Club, knows this all too well. "I think one of the biggest mistakes people make – and I've made in the past – is selling a great business in a crisis," he says. "I did this during the pandemic, when I was running money at my previous employer and I sold the luxury goods company LVMH (FR:MC)."
Huggins was worried about store closures and short-term sales during lockdown, but didn't have any great concerns over the long-term health of the business.
"Any investor should always be very wary of trading during volatile markets," he says. "When something happens, like Covid-19 or the financial crisis, there's a big temptation to do something. In those times, you're normally in a heightened emotional state, your time horizon narrows, and you're more likely to do something stupid."
Huggins is similarly reluctant to make big buy calls in the heat of the moment. There are often opportunities in a crisis, he argues, but they tend to last a few months or even longer. "Do nothing, just sit on your hands – even though every bone in your body will want to do something."
As with so many things in life, however, this is a balancing act, as Terry Smith acknowledged in our Big Read last week.
Abby Glennie, deputy head of smaller companies at Abrdn, said clinging onto once-loved holdings was a classic error.
"With every single stock there comes a point where either you need to reduce your exposure or step away from it totally," she says, citing magazine publisher Future (FUTR). "We were reasonably early into the success of that stock, and it was a great company for us. But we held onto it for too long."
Deciding to sell is sometimes even trickier than doing nothing, but there are some key signals to watch for. One is earnings momentum. Is the company still consistently beating expectations?
"With the type of stocks that we hold, often that [metric] is what has driven them to continue to do really well in share price terms," Glennie says.
Momentum can quickly kick into reverse if performance starts to disappoint. When a company's earnings forecasts drop, its share price will usually fall too, thus sustaining a stable forward price/earnings (PE) ratio. Declines are often compounded, though, by a change in sentiment. Once-enthusiastic investors may downgrade the PE multiple attached to the stock, further depressing the share price. This appears to have been the case at Future.
A change in management can also be a warning sign, according to Glennie. "The ones that I worry about in particular are where a founder or a long-term chief executive has retired or moved away from the business," she says.
"They know their business better than anyone else – and it's always going to be hard to make that decision to step away. I think they're often the best judge of knowing when the top is."
The UK's recruitment giants attest to this theory. In March 2023, the eponymous founder of Robert Walters (RWA) announced his retirement amid record earnings. His was the third such announcement in just a handful of months, following the long-serving heads of Hays (HAS) and PageGroup (PAGE). Since then, profitability has collapsed at these companies as a result of difficult labour markets.
Specialist equipment maker Halma (HLMA) is another stock to monitor in this context. The FTSE 100 group has an incredibly robust track record, with 20 years of consecutive adjusted profit growth and 44 years of consecutive dividend growth under its belt. In 2023, however – after 18 years of managing an effective buy-and-build strategy – chief executive Andrew Williams stood down. There have been no obvious ill effects yet and trading remains on track, but more will be revealed once the latest round of acquisitions take root. The shares' recent trajectory suggests investors are cautious.
Beware boardroom anticsA lack of attention to management more generally is a rich source of blunders. Nick Greenwood, who manages the MIGO Opportunities Trust, recalled a time 20 years ago when he went to meet the finance officer of UK Safety, a firm that made protective boots.
"When I turned up at reception, no one had ever heard of him. And then, when they had found him, he couldn't find the keys to the meeting room. What I should have been thinking is 'if this bloke can't even organise a meeting, how's he going to run a company?' which would have been the correct assessment."
Private investors clearly have less access to boardrooms than professional fund managers. However, many details relating to governance can be found in the accounts.
"When you look at the CV of a chief executive, you can get a degree of confidence that they're in the right place at the right time, and the company is appropriate for them," says Fidelity fund manager Leigh Himsworth.
Auditors and brokers should also be recognisable and, crucially, based in a suitable location. Himsworth flags the case of software group Autonomy, which ended up embroiled in what US prosecutors this year labelled the biggest fraud in Silicon Valley history. Despite being a FTSE 100 group at the time, Autonomy dealt with the small Cambridge office of Deloitte, rather than its London base.
Director deals and incentive plans are also revealing, and the latter is worth bearing in mind when considering Domino's Pizza (DOM).
Domino's has long struggled to retain chief executives and finance officers and recently said that recruiting senior talent was "challenging" because the US offers higher pay. As a result, it has changed its remuneration policy to include the one-off grant of premium-priced options. This allows the new chief executive to receive a total pay packet of up to £6.8mn, should Domino's meet the upper end of earnings per share (EPS) targets.
Shareholders were wary, with almost a quarter objecting to the change at the general meeting last summer. Their caution was not necessarily unfounded. One way to boost EPS metrics is to buy back shares, and Domino's has bought back £256mn-worth since March 2021.
Returning cash to investors is no bad thing, but the incentives here are not necessarily aligned. In years gone by, analysts have warned that buybacks at Domino's have not created long-term value, suggesting they have done more for management than anyone else. This cloud of doubt has not been entirely dispersed, particularly given that the money spent on buybacks could instead be used to deal with the company's debt pile – more of which later.
When it comes to governance, however, it's not always money that trips shareholders up.
Insulation specialist Kingspan (IE:KRX) was a longstanding holding in Quilter Cheviot's Climate Assets strategy. However, the Grenfell Tower fire showed that, for investors such as Quilter, there can be a gap between what a company does and how it does it (Kingspan's K15 insulation boards were installed as part of Grenfell's cladding system, but the group said it had no knowledge that its products were used in the tower until after the fire had occurred).
"This is a good example where a company may provide a solution to an environmental problem, like reducing energy consumption with building insulation, but [subsequently] fails our responsible investment analysis, and thus we do not invest or, in this case, we divest," said Claudia Quiroz, head of sustainable investment at Quilter Cheviot.
For fund managers – and even more so for retail investors, who mainly deal with companies at arm's length – it is useful to remember that humans are at the heart of every enterprise. "It's as much a people business as a numbers business," concludes Himsworth, a former accountant.
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Numbers can still trip you up, of course – as Artemis's Tamworth discovered.
He cites Videndum (VID) as one of his key investment mistakes. Videndum – formerly Vitec – makes products for the content creation market, such as microphones, tripods and lighting. It suffered a number of misfortunes last year, including the Hollywood writers' strike, retailer destocking and a consumer slowdown. Tamworth doesn't blame himself for not predicting these events, saying they were largely unforeseen by the market.
He did, however, miss something else.
"When we bought into Videndum it had a strong balance sheet," he says. "But post-Covid, management spent £100mn on three acquisitions, and stretched the balance sheet." As a result, net debt rose from £96mn in December 2019 to £216mn in June 2023.
The temporary loss caused by unforeseen factors was thus converted into a permanent loss, with Videndum forced to issue £125mn of equity at a very depressed price at the end of last year.
"We're actually quite optimistic about how shares will recover this year," says Tamworth. "You've got the catch up after the writers' strike. They will also benefit from the Olympics and presidential elections. But that bounceback won't be anything like as strong as it would have been because you've got twice the number of shares."
With interest rates at painful levels, the danger of debt has increased and a host of companies are now in hot water. Superdry (SDRY), which is now fighting to stay afloat, paid almost £10mn in interest in the first half of 2024, against £27mn of cash generated from its operations.
Fast fashion retailer Asos (ASC) is in a similarly tight spot, having plunged from a comfortable net cash position in the summer of 2020 to net debt of almost £350mn today.
Richard de Lisle, manager of the VT De Lisle America Fund, has taken note.
"Warren Buffett says that debt just speeds things up and so it does – unless you spin-off," he says. "Today we run a value-based fund [looking at low price/earnings ratios] in the US market... While we like cheap, we don't like debt."
Don't be stingy – or spendthrift"Cheap" stocks must be handled with care, however. Several fund managers have flagged occasions when they invested in companies that looked better value than peers, only to lose out.
Eric Burns, lead manager of the CFP SDL Free Spirit Fund, describes a group that seemed to have "some attractive characteristics", a good track record and an experienced chief executive.
"The reason we ended up down this track was that we'd looked at one of its larger, more established peers but could never get comfortable with the valuation. At the time, the higher-quality name traded on a price/earnings ratio of about 27 times whereas this business traded on under 20 times.
"It was of course a value trap. The lesser business subsequently warned on profitability, and, completely out of the blue, the long-serving chief executive got the boot."
Quality businesses with proven long-term records "rarely sell on the cheap", he concludes. The performance of stand-out groups such as Relx (REL), Diploma (DPLM) and Ashtead (AHT) – all of which have traded on multiples of nearly 30 times in recent years – suggests he might be right.
Yet sometimes the opposite force can take hold, and markets get temporarily swept up in short-lived trends. Georgina Brittain, a senior portfolio manager at JPMorgan Asset Management, has been stung by such "hypes".
"This is something we experienced in the video games sector," she says. "Historically we have invested very successfully in this sector, having been quick to notice the changing dynamics of the industry and the underestimated growth in demand."
Having previously bought three IPOs that performed well, she was quick to invest in two more when they came to market. However, both companies ran into profit warnings and were quickly sold.
A number of artificial intelligence stocks could yet endure a similar fate, with some fund managers worrying that the sector is getting too hot. Companies that make electric vehicles are also under pressure, with Tesla (US:TSLA) poised to cut a tenth of its workforce amid a global slowdown and brutal price war.
Fidelity's Leigh Himsworth advises setting a target for when you want to get out of any investment. "When I buy into a company, I document why I'm getting into it, then what I'm looking for as the exit point. Don't fall in love with companies."
He ruefully cites the packaged salad specialist Bakkavor (BAKK). "It was one of those stocks that got way too expensive for where it should have been. I needed to step back and think 'actually, this is just a food company'. They're not trying to land something on the moon.'"
Know the business inside outPerhaps the biggest hurdle for any investor, however, is getting to grips with what a company actually does. Himsworth discovered this challenge early in his career when he invested heavily in a pharma group called BTG – since acquired by a US firm – which had devised a treatment for varicose veins. Not long after he invested, the group posted disappointing results in an important trial and shares tumbled.
This is a particular problem for biomedical sector. "It's really difficult to verify anything, either the efficacy of the actual drug or even the potential market size," says Himsworth.
"It's much easier to look at an industrial or retail or media company and grasp what's going on. And maybe as a consequence, I'm less inclined to look at biotech stocks, just because they are just so difficult to grasp."
The central pillar of a company doesn't need to collapse to cause problems, however.
Brendan Gulston, fund manager at Gresham House, once had a stake in technology retailer Currys (CURY). "We had a very specific investment case. We knew about the potential challenges within bigger-ticket consumer areas, and had looked at the physical store estate and the lease length. We flagged the obvious reasons why the stock was cheap."
What he underestimated, however, were the bits around the edges. "We looked at the Nordics business and the other non-UK parts of the company, but they were small," Gulston says.
In 2023, however, Currys was forced to pull its final dividend on the back of Scandinavian trading troubles and the market wasn't happy. "The wider learning for us was around overall complexity, and the ability of a non-core part of a business to derail the entire investment case," adds Gulston.
"We have since [looked] across the rest of our portfolio and tried to find other companies that might be at risk."
This feels like an appropriate place to end the whistle-stop tour of investment clangers. The asset management industry is sure to harbour many, many more, but Gulston's proactive attempts to ward off future problems is heartening. No one is immune from lapses in concentration, emotional decision-making, overconfidence, tunnel vision and balance sheet blunders. The important thing is to avoid walking into the same traps repeatedly.
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