Ranbaxy posts Q3 loss of Rs 454 cr on forex woes

Drug major Ranbaxy Laboratories has posted a consolidated net loss of Rs 454.16 crore for the third quarter ended September 30, due to foreign exchange charges and one-time provision made for the Mohali plant, which has come under the USFDA scanner.

The Gurgaon-based company had posted net profit of Rs 754.17 crore during the same period of the previous year.

The depreciation of rupee against the dollar, though favourable to Ranbaxy's export business, had an adverse impact on the company mainly due to applying of accounting standards that require marking-to-market the entire derivatives and foreign currency denominated loans outstanding, Ranbaxy Laboratories said in a statement.

"There was a charge of Rs 360 crore during Q3, 2013 and Rs 760 crore during YTD (September 13) on account of these forex items mentioned above," it added.

During the period under review, the company also made a provision for Mohali stock write-off and other costs amounting to Rs 70 crore, it said. The company's SEZ unit in the city had received an import alert from USFDA and cannot export drugs made in this plant to the US market.

Net sales of the company rose to Rs 2,750.17 crore during the third quarter, compared to Rs 2,668.52 crore in the same period of the previous year.

The company is confident that it will satisfactorily address the increasing standards of quality and manufacturing processes to uphold the high level of trust that doctors, patients, regulators and other stakeholders expect from the company, Ranbaxy CEO and Managing Director Arun Sawhney said.

The company continues to grow in its focus branded markets in Asia, East Europe, CIS and Africa, he added.

"In India, however, the announcement of the pricing policy caused some uncertainty in the market, during which our sales in the home market faced some disruptions," Sawhney added.

The central government had last year brought 348 essential drugs and price regulatory mechanism.

On the the outlook, the company said it expects to achieve sales of Rs 13,000-Rs 13,500 crore for 15 months period ending March 31 2014.

"This does not consider any sales accruing from first-to file (FTFs) which shall be accounted for as they materialise," the company said.

Ranbaxy's board, which met on Tuesday, decided to change the financial year of the Ranbaxy as April-March effective April 1, 2014. In view of this, the current financial year (January-December) will be for a period of 15 months - January 2013 to March 2014, the company added.

US to hike fees for generic drugmakers; Indian firms to be hit

Many Indian drugmakers will soon have to bear higher costs for sale of products in American markets, as the US health regulator FDA is hiking the fees for generic drugmakers by up to 48 per cent from October.

India is the second largest drug exporter to the US, according to the Food and Drug Administration (FDA).

Indian drugmakers mostly specialise in manufacturing of generic versions of innovative drugs at a fraction of cost after their patent expiry and are estimated to command 10 per cent share in the $30-billion US generic drug market.

The US regulations require the companies to pay user fees to supplement the costs of reviewing generic drug applications and inspecting facilities.

However, the FDA's proposed hike in fees for generic drugmakers is expected to push up the overall costs for companies from India and other countries, including US itself.

The FDA said it is aware that industry is adjusting to the new requirements and fees, and it has minimised the increase in fees "as much as possible".

The increased fees have been published in the Federal Register -- the official journal of the US government -- are would be effective from October 1, 2013. The fees would be reviewed after a year.

The new Abbreviated New Drug Application (ANDA) fee has been fixed at $63,860, which is around 24 per cent higher than the existing $51,520.

An ANDA contains data which when submitted to FDA's Center for Drug Evaluation and Research, Office of Generic Drugs, provides for the review and ultimate approval of a generic drug product.

Similarly, the Prior Approval Supplement (PAS) fees for fiscal year 2014 (from October 1, 2013 to September 30, 2014) has been hiked by 24 per cent to $31,930. The PAS application includes change to be made to approved products.

The steepest increase has been made in Drug Master File (DMF) fees, which has been hiked by 48 per cent to $31,460.

A DMF submission is required to be made to the USFDA to provide detailed information about facilities, processes, or articles used in the manufacturing, processing, packaging, and storing of one or more human drugs.

The annual facility fees for finished dosage forms (FDF) have been increased by about 25 per cent. The domestic FDF facility fee has been revised to $220,152 and foreign FDF facility fee to $235,152.

However, the FDA has lowered the annual active pharmaceutical ingredient (API) fees for both domestic and foreign API facilities.

FDA says that these fees help it reduce the backlog of pending applications, cut the average time required to review generic drug applications for safety, and improve the risk-based inspections.

Don't Routinely Test for Kidney Disease in Those Without Symptoms: Experts

TUESDAY Oct. 22, 2013 -- Screening for chronic kidney disease is not recommended for adults with no symptoms or risk factors such as diabetes, high blood pressure and heart disease, according to new guidelines from the American College of Physicians (ACP).

The group explained there isn't enough evidence to justify screenings for these people because the risks and potential problems of testing would outweigh any benefit.

"There is no evidence that evaluated the benefits of screening for stage 1-3 chronic kidney disease," ACP president Dr. Molly Cooke, said in a news release issued by the group. "The potential harms of all the screening tests -- false positives, disease labeling, and unnecessary treatment and associated adverse effects -- outweigh the benefits."

In its new clinical practice guidelines published in the Oct. 22 Annals of Internal Medicine, the group also advised against testing for high levels of protein in the urine in adults with or without diabetes who are taking certain heart drugs, such as an ACE inhibitor or an ARB.

The ACP also recommended treating patients with high blood pressure and stage 1-3 chronic kidney disease with either an ACE inhibitor or an ARB, and they urged the use of statin therapy to manage high LDL ("bad") cholesterol levels in patients with stage 1-3 chronic kidney disease.

Although studies have shown no difference in outcomes between ACE inhibitor or ARB use, the guidelines cautioned that the risk of adverse effects are much higher with a combination therapy involving an ACE inhibitor and an ARB. Those side effects include cough, unhealthily high potassium levels, low blood pressure, and even acute kidney failure requiring dialysis.

The ACP guidelines also stated there is insufficient evidence to support periodic lab monitoring of patients with stage 1-3 chronic kidney disease. The group advised doctors to avoid unnecessary tests.

"Ordering lab tests is not going to have any impact on clinical outcomes of asymptomatic patients with chronic kidney disease without risk factors, but will add unnecessary costs to the health care system due to increased medical visits and unnecessary tests," Cooke explained.

More information

The U.S. National Institutes of Health provides more information on chronic kidney disease.

Govt refutes Novartis' allegations on patents

Tearing into the allegations made by Novartis on India's 'discriminatory' patent practices, the government has said global firms, including the Swiss drug major, have benefited more from the country's rules cornering over 80 per cent of the patents granted.

"You would appreciate that more than 80 per cent of patents registered in India are attributed to non-Indians," Commerce Secretary S R Rao has said in a letter to Novartis AG CEO Joseph Jimenez.

Responding to a letter sent by Jimenez to Commerce and Industry Minister Anand Sharma, Rao further said: "Multi-national pharma companies such as Novartis have been major beneficiaries of India's patent regime which is evident in the fact that Novartis has 147 patents registered in its name in India."

Earlier, Jimenez in his letter to Sharma had alleged that India's intellectual property (IP) protection environment is deteriorating and Indian government follow discriminatory practices in several sectors including pharmaceuticals.

"In terms of IP protection for pharmaceuticals specifically, it is disturbing that there has been a series of patent revocations/refusal to grant patents for well-established innovative medicines, including our own product Glivec," Jimenez had said.

Rao, however, said companies like Novartis have had a long association with the Indian market and the company should not create an unfair impression about India.

"I would suggest a balanced and objective approach of appreciating the mutually constructive role that we can play together rather than isolating one instance to create an unfair impression," Rao said in the letter.

He also asserted that issuance of compulsory licences (CL) by India is perfectly within its rights and domestic legislation which is in conformity with the multilateral law.

Unlike developed countries, he said, "India has never ever used 'executive discretion' to issue compulsory licenses...I suggest that opinions should be formed on the basis of facts and not on speculation".

The Supreme Court had rejected the company's plea for a patent on cancer drug Glivec in April. Last year, India also invoked CL on Bayer Corporation's anti-cancer drug Nexavar permitting Hyderabad-based Natco Pharma to manufacture and sell the drug at a price lesser by over 30 times charged by its patent-holder.

"India has a well defined and robust quasi-judicial process for issuing CLs. These decisions are subject to legal challenge in Indian High Courts and further appeals lie with the Supreme Court," Rao's letter added.

"Companies like Novartis have long association with Indian market and we do not see any reason for disillusionment or disappointment," it said.

India is one of the biggest exporters of generic drugs in the world and its pharma market size has increased from $6 billion in 2005 to $18 billion today and is expected to grow to $45 billion by 2020.

GlaxoSmithKline India hit by drop in bulk orders

GlaxoSmithKline's Indian business has been hit by a drop in sales which two industry sources said was linked to a protest by bulk buyers against a cut in their profit margins under a new government drug pricing policy.

GlaxoSmithKline Pharmaceuticals said on Monday bulk sellers in "major pockets" of India had stopped buying the company's drugs since September 15. It did not give a further explanation in the statement and a Mumbai-based spokeswoman for the Indian unit of the UK-based pharmaceuticals company declined to elaborate.

However, the two sources said wholesalers and retailers in many parts of India had stopped buying medicines from some companies in protest against a reduction in their profit margins under a new government pricing policy. They declined to be identified due to the sensitivity of the matter.

Under the recent policy change, the prices of 348 drugs deemed essential are now being regulated, compared with 74 previously. The move has curbed prices of costly brands sold by drugmakers in a market that already has rock-bottom medicine prices thanks to a large generics industry.

To compensate drugmakers, the government has reduced margins for wholesalers to 8 per cent from 10 per cent and for retailers to 16 per cent from 20 per cent, the sources said.

"The retailers are using pressure tactics by not purchasing drugs from companies who have reduced their margins to comply with the new directive," said one of the sources, adding that sales of both multinational and domestic companies had been hit.

The All India Organisation of Chemists and Druggists (AIOCD), a lobby group for pharmaceutical retailers and wholesalers, was aware of some members not buying from companies that have reduced the margins, its president, JS Shinde said.

"There is information saying that because companies have reduced their margins some of the stockists are not buying," Shinde told Reuters. "AIOCD has not declared any non-cooperation against Glaxo or anybody," he said.

USFDA cites hair in tablet behind Ranbaxy import ban

During a visit to a facility of leading Indian drugmaker Ranbaxy Laboratories last year, US inspectors found that a black fibre embedded in a tablet may have been a hair from an employee's arm, according to documents seen by Reuters.

That and other quality concerns led the US Food and Drug Administration to impose an "import alert" on its Mohali plant last week, saying the factory owned by India's biggest drugmaker by sales had not ensured manufacturing quality.

Ranbaxy, which is 63.5 per cent-owned by Japan's Daiichi Sankyo Co and gets more than 40 per cent of its sales from the United States, did not immediately respond to a request on Wednesday for comment on the FDA observations.

The FDA's action has dealt another blow to an Indian generic drug industry battered by a rash of American regulatory rebukes and as US demand for generics grows, especially under President Barack Obama's new healthcare programme.

The import alert issued to Ranbaxy prohibits it from making FDA-regulated drugs at the Mohali facility and selling them in the United States until its methods, facilities and controls are in compliance with good manufacturing standards.

The unexpected import ban on the Mohali facility sent shares in Ranbaxy plunging by one-third on Monday, and comes just a few months after it pleaded guilty to US felony charges related to drug safety and agreed to $500 million in fines.

It brings under sanction all three of Ranbaxy's plants in India dedicated to supplying the United States, and followed FDA inspections in September and December last year.

During one of the inspections, the FDA concluded that a black fibre embedded in a tablet was likely either "tape remnants on the nozzle head of the machine or a hair from an employee's arm that could be exposed on loading the machine", the documents showed.

Ranbaxy had on Tuesday said it would review the details of the FDA import alert and take "all necessary steps to resolve the concerns" at the earliest.

"The USFDA had conducted inspections at Ranbaxy's Mohali facility in 2012, resulting in certain observations," Ranbaxy said in the statement. "The company believes that it has made further improvements at its Mohali facility ... and remains committed to addressing all concerns of the USFDA."

LATEST BLOW

The Mohali plant, in the northern state of Punjab, had not been making US exports since last November, when it voluntarily recalled its generic version of cholesterol-lowering drug Lipitor in the United States due to the potential presence of glass particles in certain batches.

The FDA's ban of US shipments from the Mohali plant was unexpected as the facility is relatively new and accounted for 50 per cent of new generic drug filings by Ranbaxy, said Sarabjit Kour Nangra, a sector analyst at Angel Broking.

India produces nearly 40 per cent of generic drugs and over-the-counter products and 10 per cent of finished dosages used in the United States. In March, India allowed the FDA to add seven inspectors, which will bring its staff in India to 19.

In Ranbaxy's case, the FDA inspections in Mohali also found that a tablet was not within the specified weight limit, the FDA inspectors wrote.

Other findings by the FDA included use of dirty glassware, spots and abrasions on the surface of tablets and potential packaging line failure that resulted in unlabeled bottles sent to pharmacies.

The latest Ranbaxy import ban and a weak rupee may force Daiichi Sankyo to revise down full-year guidance when it announces first half earnings on October 31, Atsushi Seki, an analyst with Barclays Japan wrote in a report. "It appears Ranbaxy still has problems that need to be resolved," Seki wrote.

Ranbaxy has lost half its value from its highest level in 2008, when it was first hit by an import ban.

Sun Pharma suffers quarterly net loss of Rs 1,276 crore

A hefty exceptional charge from the Protonix litigation forced Sun Pharmaceutical Industries Ltd to post a net loss of Rs 1,276.1 crore for the April to June quarter of current financial year.
In the April-June quarter of 2012, the pharmaceutical giant had reported a net profit of Rs 795.5 crore
Sun Pharma, India's leading pharmaceutical firm by market capitalization, also announced that its net sales during the quarter under review jumped 31 per cent year-on-year to settle at Rs 3,482.2 crore, though earnings before interest tax & depreciation (Ebitda) margin dropped 200 basis points from the year-ago period to 44 per cent.
Dilip Shanghvi, managing director of Sun Pharma, however said the quarter results were in line with the company's expectations.
Speaking on the topic, Mr. Shanghvi said, "All our businesses continue to perform in line with our expectations and we remain focused on strengthening our existing businesses and developing a differentiated and specialty-driven product basket."
He also confirmed that 40 of the company's products would appear in the government's new Drug Price Control List.
Post the hefty payment for the Protonix patent infringement litigation, Sun Pharma's cash reserves stood at round Rs 6,000 crore. As of August 8, the company's market capitalization was recorded at Rs 1.05 lakh crore.

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Indian Pharma Market set "Significant" Growth

New Delhi, October 07, 2013: The Indian pharmaceutical market is predicted to more than double in size over the next seven years, despite an opaque regulatory system and weak patent rules.

Research and consulting firm GlobalData say the country's growing economy, along with greater uptake of health insurance and better access to healthcare facilities, will drive the market's value from an estimated $21bn in 2013 to $56bn by 2020.

Joshua Owide, director of healthcare industry dynamics for GlobalData, said: “India is an emerging healthcare market that has remained unsaturated due to the limited penetration of healthcare insurance and poor access to healthcare facilities, especially in rural areas.

“However, an increasing demand for high-quality services, affordability, and a growing medical tourism industry will provide the necessary momentum for the growth of the pharmaceutical market.”

The analysts note that the lack of transparency in the Indian drug regulatory system and weak patent laws are a major challenge for foreign multinational companies attempting to enter or expand in the Indian healthcare market.

Cancer drugs have been particularly problematic and in the last two months both Roche with Herceptin and GlaxoSmithKline with Tyverb have experienced patent problems.

But while pharma's patent issues in the country persist, improvements to its regulatory system may be on the horizon, with plans from the Ministry of Health and Family Welfare to create the Central Drug Authority (CDA).

This would replace the current Central Drug Standard Control Organization and, GlobalData said, “greatly improve the regulatory environment” for pharmaceuticals, medical devices and clinical trials in India.

But, although GobalData's forecasts put the market on course for a compound annual growth rate of 15 per cent to 2020, the firm cautions that this could be held back if India's rural healthcare infrastructure is not improved.

Righty? Lefty? Genes' Role Still Unclear

Genetics do not play a major role in determining whether people are right- or left-handed, a new study says.

About 10 percent of people worldwide are left-handed, but the reasons why people favor one hand over the other remain unclear.

In an effort to learn more, researchers conducted genetic analyses of nearly 4,000 twins in the United Kingdom, but were unable to find a strong genetic factor in determining handedness.

The study was published recently in the journal Heredity.

Even though they didn't find a strong genetic influence on handedness, the researchers noted that it is widely believed that handedness is not just the result of choice or learning. Therefore, it's likely that genetic factors play at least a minor role in determining handedness.

Another recent study, published in the journal PLoS Genetics, has found that genetics do play a part in handedness, along with environment.

"It is likely that there are many relatively weak genetic factors in handedness, rather than any strong factors, and much bigger studies than our own will be needed to identify such genes unambiguously," John Armour of the University of Nottingham, co-author of the latest study, said in a university news release.

"As a consequence, even if these genes are identified in the future, it is very unlikely that handedness could be usefully predicted by analysis of human DNA," he added.

More information

The Nemours Foundation has more about being left-handed.

Govt guided by market-driven forces: Supreme Court on drug pricing policy

The Supreme Court has raised a question on the new Drug Price Control Order (DPCO) of the Centre to fix the ceiling price of essential medicines on the basis of market-based pricing.

A bench headed by Justice G S Singhvi on Thursday said the Centre is being guided by market-driven forces and asked an NGO, which challenged the policy, to place before it statistics on comparativeanalysis of drug prices under the new policy and the existing market price.

"This DPCO will encourage profiteering of medicine brands prescribed by doctors," the bench said after senior advocate Colin Gonsalves, appearing for the NGO alleged that under the new policy the margin of profit for drug manufacturer and dealer has increased multiple times. "Government is being guided by market-driven forces," the bench said.

The court was hearing a PIL filed by NGO All India Drug Action Network, which contended that MBP (Market Based Pricing) is never used for any price regulatory purposes and under the new policy simple average ceiling prices are in many cases higher than the market leader price.

"Theoretically, you are right but you have to prove it from statistics. We are concerned about the patients," the bench said, asking the petitioner to place data by Tuesday when the case will be taken up for further hearing.

The NGO has sought direction to Centre to continue with cost-based ceiling prices of all essential drugs.

"Pursuant to orders of this court to the effect that government should bring all essential medicines under price control, Centre expanded the list of medicines to be brought under control. However, at the same time it has effectively undermined this court's directive that medicines should be made affordable for the common man. It has done this by making a pretence of price control by introducing MBP," the PIL said.

The NGO also contended that National List of Essential Drugs consists of only 348 drugs and left out many essential medicines from price control.

Meanwhile, Additional Solicitor General Siddharth Luthra submitted that there is nothing wrong in the policy and there is difference in retail and bulk price of the medicines.

Indian Pharma Market isn't going to be that rosy.....

fter consolidation in the last few years, the pharma industry continues to see a lot of changes. What are the challenges facing the industry today?

The pharmaceutical industry today is very global, and those players who exited were primarily India-focused. Once India started following GATT and patent laws, new product approvals got harder and more challenging, and these players did not see a future in their India business and probably that is why some of them exited.

Today, leading domestic pharma companies are global in nature. They have completely diversified their portfolio whereby India does not contribute more than 30 per cent of revenues. They are trying to build a global franchise.

The Indian market will be challenging for most pharma companies as competitive intensities are very high. There will be consolidation among the smaller and mid-size players as they do not have a global platform and are completely dependent on the domestic market. At least in the near-term, growth will continue to be challenging for the Indian pharmaceutical industry.

Among the main challenges, new product approvals contributed 4-5 per cent of India’s growth and that has completely disappeared due to the changing regulatory requirements. The increased centralization and need for approvals take longer.

Secondly, there is the push towards ‘genericization’, and thirdly, competitive intensity has increased because everybody is launching everything. Big pharma is now getting into branded generics. The industry dynamic is changing and all that is having a bearing on the growth of the market. I do not think the Indian market per se is going to be that lucrative or rosy for companies.

The new Drug Price Control Order (DPCO) 2013 is an example of increased government intervention in the pharma sector. Is this intervention welcome or is it hindering growth?

That is another aspect which is impacting growth and will impact growth. As things stand, the DPCO has not taken full effect yet because the government is still figuring out prices and so on. But that will also have an impact on growth.

Government intervention or involvement has gone up significantly in the recent past—whether it is by way of DPCO, new product approvals, clinical trials etc.

But in my view, it is something essential to bring India up to global standards. So, from that perspective, it is the right move but in the near-term, there will be pain. To get to global standards in the long-run, it is the right step. The challenges will continue for some time.

There is a need to ramp up the innovation and R&D efforts in India to move on from the generics model as it is considered unsustainable. What holds back Indian R&D other than its capital intensive nature?

At Glenmark, we strongly believe in innovation and have continued to invest aggressively over the last 13 years. From an industry perspective, India has its share of challenges on innovation. It calls for long gestation periods and a long-term vision, and I think a lot of that will take time to develop in India.

Some companies are making headway in innovation but it is still a long way off to benchmark or set a global level.

Most players have had decent visibility for the next 5-7 years on the generics side and at some point people have to look at what next. There are different models that companies are following in that respect. Some are venturing into areas such as biosimilars or different lines of business such as OTC (over the counter) or different sources of revenue such as animal health or NME (new molecular entities).

Some of the strategies are heavily R&D intensive and require a lot of capital and some are relatively easy to get into. High capital investment is always a hindrance and although rising as an absolute number, investment in innovation has been flat as a percentage of revenue. It is 5-7 per cent for the industry and for us it has gone up from 6 to 9 per cent.

What is your take on the issues that have been raised by US Food & Drug Administration (FDA) regarding quality and compliance of exports. We are also seeing increasing emergence of patent disputes involving Indian players.

The US FDA is unbiased and there is no bias in terms of country of origin. It is very rational and consistent in how it approaches things across the globe. That is quite clear.

As India is exporting a lot more to the U.S. now, it is risk-based and automatically the vigilance has increased because of the sheer amount of products that we sell to the U.S. I think people are reading too much into it. But we have to maintain the highest standards at all times, especially when you become larger and larger. As regards patent disputes, they are common across the world.

In India now, the implementation of patent law will evolve. This is the process of evolution where Indian courts will get more educated about patent law and get more robust over time. Patent disputes are not going away and are going to continue and it will become commonplace.

After all, that is what keeps the generic and branded players at play. The objective of the branded player or big pharma is to get as much patent life as possible while that of the generic player is different and that has to be validated by the courts.

Frankly, there is a lot of noise in the global environment and India about patents but in my view, all that will settle once courts get more robust in terms of how they rule on patents and once there is a precedent that has been set.

Glenmark earns a lion’s share of revenues from exports. What has been the impact of rupee devaluation in light of the fact that the company has a long-term foreign currency debt of around $480 million?

On a net basis, we will gain due to the depreciation. Over 60 per cent of our actual earnings are in dollars and so we have a natural hedge versus the debt.

We gain on the P&L substantially due to rupee depreciation and margin expands. On the debt side, that is marked up by the mark-to-market debt.

What does the future hold for the industry and what factors would determine success for a player in this market?

It depends on what perspective you take. For the industry, it is going to be challenging for the next 3-5 years. That has been recognized by the leaders and that is why they are targeting the global market. For the consumer, it is going to be great because they will have low cost medications and a lot of options. Insurance will come in some day and that too will help. As to what will determine success, is a tough question in today’s environment. It is products—patented and innovated products that can give a company the delta. If you take a five year view, only patented and innovative products can give that increased delta because in everything else there is just so much competition. 

More Evidence That Exercise Can Help Prevent High Blood Pressure

Exercising during your leisure time could help prevent high blood pressure, but being physically active at work doesn't seem to provide the same benefit, according to a new review.

Researchers analyzed the findings of 13 studies that examined the effects of physical activity on blood pressure. The studies included a total of nearly 137,000 people in the United States, Europe and East Asia who initially had healthy blood pressure. During follow-up periods ranging from two to 45 years, more than 15,600 of the participants developed high blood pressure.

Compared to people who exercised less than one hour a week during their leisure time, the risk of developing high blood pressure was 11 percent lower among those who exercised one to three hours per week, and 19 percent lower among those who did more than four hours of recreational exercise a week, according to the study published Sept. 30 in the journal Hypertension.

The results suggest that the more leisure-time exercise you do, the lower your risk of developing high blood pressure.

However, the researchers did not find a solid link between physical activity at work and high blood pressure risk. Physical activity on the job, such as farm or industrial work, can involve heavy lifting, prolonged standing and repetitive tasks.

Exercise guidelines don't distinguish between physical activity at work or during leisure time, but "given the new findings, perhaps they should," study co-author Dr. Bo Xi, a lecturer at the Shandong University School of Public Health in Jinan, China, said in a journal news release.

Recreational exercise may help reduce the risk of high blood pressure by preventing weight gain, improving poor insulin sensitivity or reducing the blood vessels' resistance to blood flow, the researchers suggested.

But they noted that their findings don't show that leisure-time exercise actually prevents high blood pressure. People who exercise for fun may just have healthier lifestyles, Xi explained.

About 78 million U.S. adults have high blood pressure, which is a risk factor for heart and kidney disease.

Stressful Middle Age Tied to Higher Alzheimer's Risk in Women

TUESDAY Oct. 1, 2013 -- Women who deal with a lot of day-to-day stressors in middle-age may have a somewhat higher risk of developing Alzheimer's later in life, a new study suggests.

The findings, published online Sept. 30 in BMJ Open, do not prove that your job or your family are raising your dementia risk. But experts said they add to evidence that chronic stress may contribute to the development of Alzheimer's disease in some people.

No one is sure why, but there are theories, according to Robert Wilson, a professor of neurological sciences and psychology at Rush University Medical Center, in Chicago.

It's possible that chronic stress, via effects on certain hormones, may reduce the efficiency of people's "brain circuitry," explained Wilson, who was not involved in the new study. And that could leave some people more vulnerable to the impact of Alzheimer's-related brain changes later in life.

But past studies have generally focused on the possible effects of stress from more-severe traumas. The new study looked at "common" stressors, said lead researcher Lena Johansson, of the Sahlgrenska Academy at Gothenburg University, in Sweden.

Her team studied data from 800 Swedish women who were followed for nearly four decades, starting when they were in their late 30s to early 50s. The women underwent periodic psychiatric exams and answered questions about everyday stressors -- such as divorce, job strain and family members' health issues.

Over 37 years, 19 percent of the women developed dementia -- most often Alzheimer's disease. And the risk climbed in tandem with the number of life stressors that the women had reported four decades earlier. For each stressor, the risk of Alzheimer's crept up 17 percent.

That doesn't prove that a stressful life is to blame, said Dr. Marc Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y.

But, he noted, the researchers did account for a number of other explanations for the link -- including whether the women had high blood pressure or diabetes, were overweight or had low incomes.

Other studies have tied heart disease risk factors, such as high blood pressure, to Alzheimer's, and lower income and education levels have also been linked to the disease.

Still, Johansson's team found, stressors themselves were connected to an increased risk of Alzheimer's.

Gordon, who was not involved in the study, agreed that it's "biologically plausible" that chronic stress could contribute to dementia. But a big unanswered question is whether any efforts to reduce stress in your life can also trim the risk of Alzheimer's later on.

"This type of study can't tell us if there's an intervention that can affect people's outcomes," Gordon said. "We can't make any recommendations based on this alone."

An interesting finding, Rush University's Wilson said, was that the number of stressors in a woman's life seemed to matter, regardless of whether she felt "stressed out" by them.

Women in the study were asked about their typical "distress" levels -- including tension, fear or sleep problems related to work, family or their health. Women with "longstanding" distress were at increased risk of Alzheimer's. But so were women with a greater number of life stressors.

That suggests that stressors can take a toll, even if you do not feel overwhelmed, according to study author Johansson.

"These are the kinds of stressors that grate on people day to day," Wilson noted. And this study, he said, suggests that these issues should not "just be brushed off." He agreed, though, that the question remains: Could stress reduction make a difference in people's Alzheimer's risk?

Zucker Hillside's Gordon said more studies are also needed to confirm these results in other groups of people, since this focused on white women. And even if common types of stress are linked to Alzheimer's risk, any effect on an individual could be small.

No one is sure what causes Alzheimer's, but Gordon said it's thought to be a mix of genetic factors, family history and environmental influences.

"This would be only one of many potential factors," Gordon noted.