Young Adults with Hypertension at Higher Risk of Stroke and Heart Failure

MedicalResearch.com Interview with:

Yuichiro Yano MD PhD Assistant Professor in Community and Family Medicine Duke University

Dr. Yano

Yuichiro Yano MD PhD
Assistant Professor in Community and Family Medicine
Duke University

MedicalResearch.com: What is the background for this study?

Response: New blood pressure guidelines, issued in 2017 in the US, lowered the blood pressure thresholds for hypertension from systolic blood pressure/diastolic ≥140/90 mm Hg to systolic/diastolic ≥130/80 mm Hg. This change increased the prevalence of hypertension two- to three-fold among young adults. The guidelines also newly defined elevated blood pressure as, 120-129 mmHg systolic blood pressure over 80 mmHg diastolic or less. However, no study investigated that high blood pressure, as defined by the new criteria, is something that younger people should be concerned about as a potential precursor to serious problems.

Our study is among the first to report that people younger than age 40 who have elevated blood pressure or hypertension are at increased risk of heart failure, strokes and blood vessel blockages as they age. Continue reading

Stage 1 Hypertension Associated With Higher Cardiovascular Risk Among Young Adults

MedicalResearch.com Interview with:

"Blood Pressure Monitor" by Medisave UK is licensed under CC BY 2.0Seulggie Choi MD, (one of the co-first authors)
Department of Biomedical Sciences
Seoul National University Graduate School
Seoul, South Korea

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) issued a new High Blood Pressure Management Guideline, in which the definition of hypertension was modified as blood pressure of 130/80 mmHg or higher. This new criteria for hypertension was based on a number of previous studies that demonstrated higher cardiovascular disease risk for participants in the systolic blood pressure of 130-139 mmHg and diastolic blood pressure of 80-89 mmHg range, which is now defined as stage 1 hypertension. However, there is a relative lack of evidence on whether this association of higher cardiovascular disease risk among those within the stage 1 hypertension category according to the 2017 ACC/AHA guidelines is also true among young adults aged 20-39 years.

Our study consisted of about 2.4 million young men and women aged 20-39 years from the Korean National Health Insurance Service claims database. Compared to those with normal blood pressure, young adults with stage 1 hypertension had higher risk for cardiovascular disease, coronary heart disease, and total stroke for both men and women. Moreover, among those who were prescribed anti-hypertensive medications within the next 5 years since blood pressure measurement, young adults with stage 1 hypertension had their higher cardiovascular disease risk attenuated to that of normal blood pressure participants.

Continue reading

Real-World Dosing of RAASi are Associated With Risk of Adverse Events in CKD

MedicalResearch.com Interview with:

Lei Qin

Lei Qin

Lei Qin MS
Director, Health Economics and Payer Analytics
AstraZeneca

MedicalResearch.com: What is the background for this study?

Response: Renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-recommended therapies for patients with chronic kidney disease (CKD), but are commonly prescribed at suboptimal doses, which has been associated with worsening clinical outcomes. The objective of our study was to estimate the real-world associations between RAASi dose and adverse clinical outcomes in patients prescribed RAASi therapies with new-onset CKD in the UK.

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Benefits of Treating Mild Hypertension Not Clear Cut

MedicalResearch.com Interview with:

James Sheppard PhD Population Health Scientist  Nuffield Department of Primary Care Health Sciences

Dr. Sheppard

James Sheppard PhD
Population Health Scientist
Nuffield Department of Primary Care Health Sciences

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The best quality evidence for making clinical decisions comes from clinical trials. Unfortunately there are occasions where trials have not been done, or are not possible and so we rely of ‘expert opinion’ from clinical guidelines. Treatment for low risk mild hypertension is an example of this.

In our study, we looked at the medical records of more than 38,000 patients over a period of 15 years. The patients we studied were aged between 18 and 74, had mild hypertension and had not received any previous treatment. We compared patients who went on to be treated to those who were not, and found no evidence of benefit (in terms of reduced risk of heart attack or stroke), but there was an increased risk of adverse events (such as hypotension [low blood pressure], fainting or kidney damage) over the follow-up period of 5-6 years. 

MedicalResearch.com: What should readers take away from your report?

Response: The benefits of treating patients with low risk mild hypertension are not clear cut. It is possible that some patients may suffer more harm than good, so doctors should be cautious when considering treatment in this population.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: It is likely that some patients with low risk mild hypertension would benefit from treatment, whilst others would not. Future research should focus on understanding which patients have the most to gain, using the wealth of information we now collect about our patients every single day.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study was not a clinical trial and therefore the results must be interpreted with caution. Observational studies such as this can sometimes give biased or unreliable results.

This work was funded by the Medical Research Council in the UK. I have no conflicts of interest to declare.

Citation: 

Shepard, J. P., Stevens, S., Stevens, R., Martin, U., Mant, J. W., Hobbs, R., & McManus, R. J. Benefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults. JAMA Internal Medicine https://doi.org/10.17863/CAM.27445

Nov 1, 2018 @ 12:27 pm

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Home Blood Pressure Readings of 130/80 Has Same Cardiovascular Risks as Office Readings

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Wanpen Vongpatanasin, M.D.
Professor of Medicine
Program Director, Hypertension Fellowship Program
UT Southwestern Medical Center in Dalla

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The new US hypertension guideline places a greater emphasis on out-of-office blood pressure measurement, and maintains that a clinic BP of 130/80 mm Hg is equivalent to the same reading for home BP monitoring or daytime ambulatory BP monitoring. That is based, however, on data from non-US cohorts, primarily from Japanese cohorts and some European populations. None has been studied in the US population until now.

To find out, we analyzed large multi-ethnic studies of primarily young and middle-aged adults in Dallas, Texas, and Durham, N.C., that compared home blood pressure to clinic measurements, using the regression correlation (i.e. regression approach). To confirm the findings, we use another approach called “outcome approach” by determining risks of stroke, MI, and death associated with a clinic systolic blood pressure reading of 130 mmHg from the 3,132 participants in the Dallas study during an 11-year follow up.

Then, we determined the home blood pressure levels that carried the same heart disease risk and stroke risk as the clinic systolic 130 mm Hg reading.

We found that the level of home blood pressure of 130/80 mm Hg actually best correlates with blood pressure taken at the doctor’s office of 130/80 mmHg. This is true for whites, blacks and Hispanic patients in both treated and untreated population.  Continue reading

Low Level Lead Exposure Linked to Resistant Hypertension

MedicalResearch.com Interview with:

Sung Kyun Park Sc.D. M.P.H. Associate professor of epidemiology and environmental health sciences University of Michigan School of Public Health, Ann Arbor, Michiga

Dr. Park

Sung Kyun Park Sc.D. M.P.H.
Associate professor of epidemiology and environmental health sciences
University of Michigan School of Public Health
Ann Arbor, Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is poorly understood that why some patients need more drugs to control high blood pressure than others. Resistant hypertension is that blood pressure is not controlled with 3 medications of different classes including diuretics or is required 4 or more medications of different classes for blood pressure controls. Genes, obesity, physical inactivity, high salt diet, pain medications may do something. Lead is a widespread environmental toxin that can influence high blood pressure. In this study, we examined whether long-term exposure to lead, measured as bone lead, is associated with the risk of resistant hypertension.

Bone lead offers a better method over blood lead measurement to discern long-term lead exposure and accumulation.

The main finding of our study is that low-level lead exposure, measured in the tibia (hard bone), is associated with higher risk of development of resistant hypertension in a cohort of patients diagnosed with hypertension.  Continue reading

Blood Pressure Hard to Control? Maybe its Your Teeth

MedicalResearch.com Interview with:
"Still from "My Dental Hell(th)"" by littledropofpoison is licensed under CC BY 2.0Rita Del Pinto, MD
University of L’Aquila
Department of Life, Health and Environmental Sciences,
L’Aquila – Italy 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a wealth of literature in support of a role for inflammation behind cardiovascular risk factors and diseases. One relatively poorly explored field is that of oral diseases, namely periodontitis, as a potential source of low-grade, chronic inflammation. Previous studies had described a beneficial effect of periodontal treatment on blood pressure; we extended current knowledge with our findings on over 3600 treated hypertensive adults with and without periodontitis, showing a significant benefit over systolic blood pressure behavior and control in the presence of a good periodontal health.  Continue reading

Biomarkers Suggest Intensive Blood Pressure Treatment Does Not Cause True Kidney Damage in CKD Patients

MedicalResearch.com Interview with:

Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu/) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center

Dr. Shlipak

Michael G. Shlipak, MD, MPH
Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu)
Professor of Medicine, Epidemiology & Biostatistics
University of California, San Francisco
Associate Chief of Medicine for Research Development
San Francisco VA Medical Center

MedicalResearch.com: What is the background for this study?

  • Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
  • The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
  • Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
  • In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
  • In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
  • In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group. 

Continue reading

Black-White Hypertension Divide: Is The Southern Diet a Culprit?

MedicalResearch.com Interview with:

Dr. George Howard DPH, for the research team Professor and Chair of Biostatistics University of Alabama at Birmingham

Dr. Howard

Dr. George Howard DPH, for the research team
Professor and Chair of Biostatistics
University of Alabama at Birmingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Perhaps the most important distinction to draw for the readers is that this is not a paper about risk factors for hypertension, but rather a paper that looks for contributors to the black-white difference in the presence of hypertension.  This racial difference in hypertension is the single biggest contributor to the immense disparities in cardiovascular diseases (stroke, MI, etc.) that underpin the approximate 4-year difference in black-white life expectancy.  As such, this work is “going back upstream” to understand the causes that lead to blacks having a higher prevalence of hypertension than whites with hopes that changing this difference will lead to reductions in the black-white disparities in cardiovascular diseases and life expectancy.   This difference in the prevalence of hypertension is immense … in our national study of people over age 45, about 50% of whites have hypertension compared to about 70% of blacks … that is HUGE.   We think that changing this difference is (at least one of) the “holy grail” of disparities research.

This study demonstrates that there are several “targets” where changes could be made to reduce the black-white difference in hypertension, and thereby the black-white difference in cardiovascular diseases and life expectancy; however, the most “potent” of these appears to be diet changes.   Even though we know what foods promote a heart healthy lifestyle, we still have major differences in terms of how that message is being adopted by various groups of Americans.  We can’t know from our data what about the Southern diet is driving these racial differences in hypertension but we can begin to design community based interventions that could possibly help to reduce these racial disparities through diet.  It is interested that diet more than being overweight was the biggest contributor to the racial disparities in hypertension.  This would suggest we might want to consider interventions to increase health foods in the diet while minimizing fried foods and processed meats.

While this is not a clinical trial that “proves” that changes in diet will reduce the disparity in blood pressure, we consider the “message” of the paper to be good news, as the things that we found that contribute to this black-white difference are things that can be changed.   While it is always hard for individual people to change their diet, it can be done.   More importantly, over time we as a society have been changing what we eat … but we need to “double down” and try to change this faster.   Also, policy changes of play a role to gently make changes in these diet, where for example Great Britain has been making policy changes to slowly remove salt from the diet.   These changes are possible … and as such, we may see a day when the black-white differences in hypertension (and thereby CVD and death) may be reduced. 

Continue reading

Low Birth Weight Associated With More Diabetes and Hypertension in Adulthood

MedicalResearch.com Interview with:
“Chinese baby laying on a bed” by simpleinsomnia is licensed under CC BY 2.0Wanghong Xu, MD, PhD

Professor of Epidemiology
School of Public Health
Fudan University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Developmental Origins of Health and Disease (DOHaD) hypothesis proposes that cardiovascular diseases and other chronic conditions in adulthood may be a consequence of an unfavorable intrauterine life, a relationship that is further modified by patterns of postnatal growth, environment, and lifestyle.

Based on the two large-scale cohort studies, the Shanghai Women’s Health Study and the Shanghai Men’s Health Study, we observed nonlinear associations for birth weight with baseline body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), and low birth weight was linked with lower BMI, smaller WC, but larger WHR and WHtR.

An excess risk of T2DM and hypertension was observed for low birth weight (<2500 g) versus birth weight of 2500-3499 g since baseline and since birth. The results support the DoHad hypothesis, and indicate the importance of nutrition in early life on health in Chinese population.  Continue reading

Triple Low Dose Combination Pill May Lower Blood Pressure With Fewer Side Effects

MedicalResearch.com Interview with:

Dr Ruth Webster PhD, BMedSc(hons), MBBS(hons), MIPH(hons) Head, Research Programs, Office of the Chief Scientist Senior Lecturer, Faculty of Medicine UNSW Sydney

Dr. Webster

Dr Ruth Webster PhD, BMedSc(hons), MBBS(hons), MIPH(hons)
Head, Research Programs, Office of the Chief Scientist
Senior Lecturer, Faculty of Medicine
UNSW Sydney
The George Institute for Global Health
Australia

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We know from previous research that 80% of the blood pressure lowering efficacy of any medication occurs in the first half of the dose whilst most side effects occur at higher doses. We also know that most people will require at least 2 blood pressure lowering medications to reach their target blood pressure and that combining multiple pills into one combination medication helps patients take their medication more reliably. There was therefore good evidence to believe that using three half strength doses in one pill would be better than usual care in helping patients to achieve their blood pressure targets.

We showed that, compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of 140/90 or less (with lower targets of 130/80 for patients with diabetes or chronic kidney disease).

It’s estimated more than a billion people globally suffer from high blood pressure with the vast majority having poorly controlled blood pressure. Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke.

Continue reading

Women With History of Preeclampsia or Gestational Hypertension Have Increased Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Jennifer J. Stuart, ScD Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology  Department of Epidemiology Harvard T.H. Chan School of Public Health  Division of Women's Health Brigham and Women's Hospital and Harvard Medical School

Dr. Stuart

Jennifer J. Stuart, ScD
Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Division of Women’s Health
Brigham and Women’s Hospital and Harvard Medical School

 MedicalResearch.com: What is the background for this study?

Response: Preeclampsia and gestational hypertension are common pregnancy complications involving high blood pressure that develops for the first time during pregnancy and returns to normal after delivery. Approximately 10 to 15% of all women who have given birth have a history of either preeclampsia or gestational hypertension. Previous studies have shown that women with a history of high blood pressure in pregnancy are more likely to develop cardiovascular disease events like heart attack and stroke later in life when compared to women with normal blood pressure in pregnancy. However, what is less clear is to what extent these women are more likely to develop chronic hypertension, diabetes, and high cholesterol and when these risk factors begin to emerge after pregnancy.

We examined this question in a cohort of nearly 60,000 American women who we were able to follow for up to 50 years after their first pregnancy. Previous studies have been limited by small numbers, short follow-up, or a lack of information on shared risk factors, such as pre-pregnancy body mass index, smoking, and family history. This research was conducted within the Nurses’ Health Study II, which collected data on these pre-pregnancy factors in tens of thousands of women over several decades.

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Accurate Measurements Suggest High Salt Intake Leads To Higher Death Rate

MedicalResearch.com Interview with:
Salt-Sodium
Dr. Feng J He PhD
Wolfson Institute of Preventive Medicine,
Barts and The London School of Medicine & Dentistry,
Queen Mary University of London,
London

MedicalResearch.com: What is the background for this study?

Response: Studies have shown that there is a strong linear relationship between sodium intake and blood pressure and raised blood pressure is a leading cause of death and disability worldwide.

The current mean population sodium intake among adults in most countries is approximately 4,000 mg/d (10 g/d salt). The World Health Organisation (WHO) has recommended a 30% reduction in sodium intake by 2025 with an eventual target of less than 2,000 mg/d (5 g/d salt) for all countries. Several recent cohort studies have challenged the WHO’s recommendations, as these studies suggested that there was a J or U-shaped relationship between sodium and risk, i.e. lower and higher sodium intake both were associated with an increased risk of cardiovascular events and deaths.

However, these studies have several severe methodological problems, one of which is the use of a biased or unreliable estimate of individual’s usual sodium intake, e.g. a single spot urine with the Kawasaki formula.

Our study, for the first time, has compared the relationship of sodium intake and mortality, based on various methods to assess usual sodium intake, including estimates based on the Kawasaki formula (single and average of multiple days) and a single measured 24-hour urine, with the gold standard method, i.e. the average of multiple non-consecutive measured 24-h urines.

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Midlife Hypertension Increases Risk of Dementia

MedicalResearch.com Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Professor Archana Singh-Manoux, PhD, HDR Epidemiology
Research Director (DR1), INSERM
Honorary Professor, University College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although there have been previous studies that have linked raised blood pressure in midlife to an increased risk of dementia in later life, the term ‘midlife’ has been poorly defined and ranged from 35 to 68 years.

New findings from the long-running Whitehall II study of over 10,000 civil servants has found 50-year-olds who had blood pressure that was higher than normal but still below the threshold commonly used when deciding to treat the condition, were at increased risk of developing dementia in later life.  Continue reading

Under New Lower Blood Pressure Guidelines, More Stroke Victims Would Survive

MedicalResearch.com Interview with:

Dr. Alain Lekoubou Looti, MD Msc Clinical Neurophysiology Department of Neurosciences College of Medicine Medical University of South Carolina

Dr. Lekoubou

Dr. Alain Lekoubou Looti, MD Msc
Clinical Neurophysiology
Department of Neurosciences
College of Medicine
Medical University of South Carolina

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hypertension is strongly associated with stroke. Individuals who suffer a stroke are more likely to have another stroke. They also die at a rate twice as high as those who experience a first event. We have evidence that treating hypertension reduces the risk of recurrence stroke among stroke survivors.

Prior hypertension guidelines defined hypertension for a systolic blood pressure (top number) equal or greater than 140 and a diastolic blood pressure (lower number) equal or greater than 90. The American college of cardiology/American heart association have published a new guideline to help healthcare providers identify and treat blood pressure including among stroke survivors. The threshold to define blood pressure has been lowered to 130 for the top number and 80 for the lower number for everyone. Unlike the general population, pharmacological treatment for stroke survivors is now recommended for systolic blood pressure greater than or equal than 130 and diastolic blood pressure greater than or equal to 80. In the same line achieving a blood pressure of less than 130/80 mmHg in stroke survivors is now recommended. In the stroke community, there has been mounting evidence to suggest that achieving lower blood pressure goal was desirable. When the new guidelines were published, we could not wait any longer to see the impact of the new guidelines on the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target. We were also curious to see how the new guidelines would potentially affect mortality among stroke survivors. 

We have found that the new guidelines would result in a nearly 67% (from 29.9% to 49.8%) to relative increase in the proportion of U.S. stroke survivors diagnosed with hypertension and 54% (from 36.3% to 56%) relative increase in those not within the recommended BP target.  We have also found that if the new guidelines were applied, this would result in a 33% relative drop in mortality.  Continue reading

Hypertension Disorders in Pregnancy Associated With Increase in ASD and ADHD in Offspring

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Ali Khashan, PhD
Senior Lecturer in Epidemiology
School of Public Health & INFANT Centre
University College Cork
Cork, Ireland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is some evidence to suggest an increased likelihood of neurodevelopmental disorders in relation to hypertensive disorders in pregnancy, however consensus is lacking. Considering hypertensive disorders in pregnancy are among the most common prenatal complication, we decided to synthesise the published literature on this topic by conducting a comprehensive systematic review and meta-analysis.

Our main findings suggest that hypertensive disorders in pregnancy are associated with about 30% increase in the likelihood of autism spectrum disorders (ASD) and ADHD in the offspring, compared to offspring not exposed to hypertensive disorders in pregnancy. Continue reading

Benefits of Implementing 2017 Hypertension Guidelines Would Outweigh Side Effects

MedicalResearch.com Interview with:

Dr-Jiang He

Dr. Jiang He

Jiang He, MD, PhD
Joseph S. Copes Chair of Epidemiology, Professor
School of Public Health and Tropical Medicine
Tulane University

MedicalResearch.com: What is the background for this study? What are the main findings?

 

Response: The 2017 American College of Cardiology and American Heart Association hypertension guideline recommended lower blood pressure cut points for initiating antihypertensive medication and treatment goals than the previous hypertension guideline. We estimated the prevalence of hypertension and the proportion of the US adult population recommended for antihypertensive treatment according to the 2017 hypertension guideline. More importantly, we estimated the risk reductions of cardiovascular disease and all-cause mortality, as well as increases in adverse events, assuming the entire US adult population achieved the 2017 guideline-recommended systolic blood pressure treatment goals of less than 130 mmHg.

Our study indicated the prevalence of hypertension was 45.4%, representing 105 million US adults with hypertension, according to the 2017 hypertension guideline. In addition, the proportion of individuals recommended for antihypertensive treatment was 35.9% or 83 million US adults.

Based on data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and US population-based cohort studies, we estimated 610 thousand cardiovascular disease events and 334 thousand total deaths could be prevented annually in the US population if the 2017 hypertension guideline systolic blood pressure treatment goals were achieved in the entire US population.

Compared to full implementation of the previous hypertension guideline, we estimated the 2017 hypertension guideline recommendations would reduce an additional 340 thousand cardiovascular disease events and 156 thousand deaths per year in the US.

Implementing the 2017 hypertension guideline was estimated to increase 62 thousand hypotension, 32 thousand syncope, 31 thousand electrolyte abnormality, and 79 thousand acute kidney injury or kidney failure events.

These analyses indicated implementing the 2017 hypertension guideline would significantly increase the proportion of US adults recommended for antihypertensive treatment and further reduce cardiovascular disease events and all-cause mortality, but might increase the number of adverse events in the US population. Continue reading

White Coat Hypertension Is Not Harmless

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0José R. Banegas, M.D.
Department of Preventive Medicine and Public Health
Universidad Autónoma de Madrid
Madrid, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Population-based studies and a few relatively small clinical investigations have defined the prognostic role of ambulatory blood pressure monitoring (ABPM) in hypertensive patients. However, previous studies were mostly limited by relatively small number of outcomes.

Our study is the largest worldwide and provides unequivocal evidence that ABPM is superior to clinic pressure at predicting total and cardiovascular mortality across a wide range of clinical scenarios – the differences are striking. Also, whether white-coat hypertension is a benign phenotype is still debated.

Our study demonstrates that white-coat hypertension was not benign. Lastly, masked hypertension patients (clinic BP normal but ABPM elevated) experienced the greatest risk of death.   Continue reading

Blood Pressure Med Linked to Increased Risk of Pancreatic Cancer in Postmenopausal Women

MedicalResearch.com Interview with:

Zhensheng Wang, M.P.H., Ph.D. Postdoctoral Associate Duncan Cancer Center-Bondy Baylor College of Medicine Houston, TX, US

Dr. Wang

Zhensheng Wang, M.P.H., Ph.D.
Postdoctoral Associate
Duncan Cancer Center-Bondy
Baylor College of Medicine
Houston, TX

MedicalResearch.com: What is the background for this study?

Response: Our prior research consistently found a significant inverse association between circulating levels of soluble receptor for advanced glycation end products (sRAGE), an anti-inflammatory factor, and risk of pancreatic cancer. It has also been found that sRAGE levels or RAGE signaling are modulated by anti-hypertensive (anti-HT) medications, including angiotensin-converting-enzyme inhibitors (ACEi), β-blockers, and calcium channel blockers (CCBs). These medications have been shown in prior pre-clinical or experimental research to either increase sRAGE concentrations, decrease formation of advanced glycation end-products (AGEs), or dampen pro-inflammatory receptor for AGE (RAGE) signaling pathway. We therefore hypothesized that there would be an inverse association between use of anti-HT medications and risk of developing pancreatic cancer.

Pancreatic cancer is a major public health concern in the United States, as it is the 4th leading cause of cancer-related mortality with an estimated of 43,090 deaths in 2017. Pancreatic cancer typically occurs in elderly individuals who also have chronic comorbid medical conditions, such as hypertension. Anti-HT medication use in individuals ≥ 18 years old has increased from 63.5% in 2001-2002 to 77.3% in 2009-2010, according to the National Health and Nutrition Examination Survey in the U.S. Therefore, it is of great public health significance to address the potential association between anti-HT medication use and risk of pancreatic cancer in the general population.

Continue reading

Should Blood Pressure Measurement Be Repeated During Primary Care Visit?

MedicalResearch.com Interview with:
“Doctors” by Tele Jane is licensed under CC BY 2.0Doug Einstadter, MD, MPH

Center for Health Care Research and Policy
MetroHealth System and Case Western Reserve University 

MedicalResearch.com: What is the background for this study?  

Response: Despite the recognized importance of blood pressure (BP) control for those with hypertension, based on national surveys only 54% of patients with hypertension seen in primary care have their BP controlled to less than 140/90 mm Hg.

Blood pressure measurement error is a major cause of poor BP control. Reducing measurement error has the potential to avoid overtreatment, including side effects from medications which would be intensified or started due to a falsely elevated blood pressure. One way to reduce measurement error is to repeat the BP measurement during an office visit. The American Heart Association recommends repeating a blood pressure at the same clinic visit with at least 1 minute separating BP readings, but due to time constraints or lack of evidence for the value of repeat measurement, busy primary care practices often measure BP only once. Repeating the BP at the same office visit when the initial blood pressure measurement is high has the potential to improve clinical decision-making regarding BP treatment. Several studies have described the effect of a repeat BP measurement in the inpatient setting, but there are little data available to characterize the effect of repeating blood pressure measurement in an outpatient primary care setting.

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With Brain Microbleeds, Can Patients Tolerate Lower Blood Pressure?

MedicalResearch.com Interview with:

Dr. Joshua Goldstein

Dr. Joshua Goldstein

Dr. Joshua Goldstein MD, PhD
J. Philip Kistler Stroke Research Center
Division of Neurocritical Care and Emergency Neurology, Department of Neurology MGH
Harvard Medical School, Boston Department of Emergency Medicine
Massachusetts General Hospital
for the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) and the Neurological Emergencies Treatment Trials (NETT) Network Investigators  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: It’s hard to know how aggressively to lower blood pressure in acute intracerebral hemorrhage (ICH).  Randomized controlled trials have been conflicting. We thought that we could use the presence of severe small vessel disease (SVD) – manifested by microbleeds seen on brain magnetic resonance imaging (MRI) – to guide treatment decisions.  On the one hand, those with severe SVD may be most vulnerable to continued bleeding, and specifically need more intensive blood pressure lowering.  On the other hand, if they have impaired regulation of cerebral blood flow, they might be harmed by rapid drops in blood pressure, and maybe we have to be more careful with them.

To answer this, we performed a subgroup analysis of the multi-centre ATACH-2 clinical trial of intensive blood pressure lowering. This was the first study to assess the effect of randomized acute stroke treatment on patients with more severe SVD, manifested by microbleeds.  We found that no matter what your small vessel disease burden on MRI, you’ll respond the same to early blood pressure management.

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Preliminary Results Show NIAGEN® Has Potential To Lower Blood Pressure For Individuals With Pre-Hypertension

MedicalResearch.com Interview with:

Dr. Charles Brenner, PhD Chief Scientific Advisor ChromaDex

Dr. Charles Brenner

Dr. Charles Brenner, PhD
Chief Scientific Advisor
ChromaDex

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nicotinamide adenine dinucleotide (NAD) is the central regulator of metabolism. NAD is under attack in multiple conditions of metabolic stress and declines in human aging. Thus, using supplements to maintain NAD has emerged as an important strategy to support healthy aging.

There are three vitamin precursors of NAD. However, two of those forms (niacin and nicotinamide) have unwanted side effects and/or inhibit some of the metabolic regulators that can be stimulated by higher NAD. Nicotinamide riboside (NR) is the most recently discovered NAD precursor vitamin. Research has shown that NR boosts NAD more than the other precursors, doesn’t cause flushing, doesn’t inhibit sirtuin enzymes, and that the pathway that converts NR to NAD is turned on in tissues undergoing stress and damage.

Commercialized as NIAGEN®, NR has been clinically proven to significantly increase NAD levels in people as an oral supplement. NIAGEN® is the only NR with published human safety, efficacy and tolerability studies.

The University of Colorado study is the first clinical trial showing that not only does NIAGEN® boost NAD levels, it also may have a beneficial effect on cardiovascular health and function. Continue reading

Hair Growth/Blood Pressure Drug Minoxidil May Improve Vascular Elasticity

MedicalResearch.com Interview with:

Dr. Beth Kozel M.D.-Ph.D The Laboratory of Vascular and Matrix Genetics LASKER CLINICAL RESEARCH SCHOLAR NIH

Dr. Kozel

Dr. Beth Kozel M.D. Ph.D
The Laboratory of Vascular and Matrix Genetics
LASKER CLINICAL RESEARCH SCHOLAR
NIH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Elastin is a protein that allows the blood vessels to stretch and recoil. It is made as a child grows but once the child reaches adolescence, the body stops making elastin. With age, the body slowly begins to lose elastin and blood vessels become less flexible.

In order to study what happens when a vessel has less elastin, we used a mouse that makes half of the normal amount of elastin, the Eln+/- mouse. These mice have higher blood pressure, stiffer blood vessels and decreased blood flow to end organs such as the brain. We then used a blood pressure medication, minoxidil (this same medicine when used in topical form helps hair growth), and treated mice from weaning until 3 months of age. With treatment, Eln+/- blood pressure was lower, the vessels were less stiff and blood flow to the brain increased. That effect remained for weeks after the medication was stopped. Additional studies showed that more elastin was present in the vessel wall after treatment and more than 100 other connective tissue genes were also changed, suggesting vessel remodeling. Minoxidil works by causing cells in the blood vessel to relax, leading to a more open, or dilated artery. When taken chronically, our data suggest that the connective tissue associated with a blood vessel remodels, fixing it in a more open state and allowing better blood flow to the organ on the other side, in this case, the brain.

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Aggressive Systolic Blood Pressure Control In Older Patients With HFpEF Should Be Avoided

“Doctors” by Tele Jane is licensed under CC BY 2.0MedicalResearch.com Interview with:
Dr. Apostolos Tsimploulis, Chief Medical Resident
Dr. Phillip H. Lam, Chief Cardiology Fellow
The Washington, DC Veterans Affairs Medical Center, Georgetown University, and
MedStar Washington Hospital Center, Washington, DC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hypertension is a major risk factor for the development of new heart failure (HF). Findings from multiple randomized controlled trials in hypertension have consistently demonstrated that controlling systolic blood pressure (SBP) to normal levels such as to SBP <120 mm Hg reduces the risk of developing new HF.

However, interestingly, once patients develop heart failure, those with a normal SBP value such as SBP <120 mm Hg tend to have poor outcomes. This paradoxical association – also called reverse epidemiology – although poorly understood – has been described with other HF risk factors such as smoking and obesity. Regarding poor outcomes associated with lower SBP in HF patients with reduced ejection fraction (HFrEF – pronounced Hef-ref), it has been suggested that it may be a marker of weak heart muscle that is unable to pump enough blood. However, less is known about this association in patients with HF and preserved ejection fraction (HFpEF – pronounced Hef-pef) –– the heart muscle is not weak in the traditional sense.

This is an important question for a number of reasons: nearly half of all heart failure patients have HFpEF which accounts for about 2.5 to 3 million Americans. These patients have a high mortality similar to those with HFrEF – but unlike in HFrEF few drugs have been shown to improve their outcomes. Thus, there is a great deal of interest in improving their outcomes. One of those approaches is to control . systolic blood pressure and the 2017 ACC/AHA/HFSA Focused Update of the HF guidelines recommend that SBP “should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity.”

Thus, our study was designed to answer that simple question: do patients with HFpEF and SBP <120 mmHg, which is considered to be normal SBP, have better outcomes than those with SBP ≥120 mmHg.

Using a sophisticated approach called propensity score matching we assembled two groups of patients with HFpEF – one group with SBP <120 mmHg and the other groups had SBP ≥120 mmHg – and patients in both groups were similar in terms of 58 key baseline characteristics. In this population of balanced patients with HFpEF, those with a normal systolic blood pressure had a higher risk of mortality – starting 30 days post-discharge up to about 6 years. Finding from our restricted cubic spline plots suggest that compared with SBP <120 mm Hg, SBP values ≥120 mm Hg (up to 200 mm Hg) was not associated with a higher risk of death.

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How Much DASH Diet is Required To Reduce Uric Acid?

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Stephen P. Juraschek, MD, PhD

Instructor of Medicine
Beth Israel Deaconess Medical Center/Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent evidence suggests that the DASH diet is associated with lower uric acid levels and lower risk of gout. Furthermore, a secondary analysis of the DASH trial showed that complete replacement of a typical American diet with the DASH diet lowered uric acid levels. However, it is unknown if partial replacement of a typical American diet with DASH foods might lower uric acid.

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