Some Cancer Drugs May Also Treat Hypertension

MedicalResearch.com Interview with:

Anton Wellstein, MD PhD Professor Oncology & Pharmacology Georgetown University Medical School Associate Director for Basic and Translational Science Lombardi Comprehensive Cancer Center Washington DC

Dr. Wellstein

Anton Wellstein, MD PhD
Professor Oncology & Pharmacology
Georgetown University Medical School
Associate Director for Basic and Translational Science
Lombardi Comprehensive Cancer Center
Washington DC

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

Response: Tumor angiogenesis and signaling by growth factors such as Fibroblast growth factors (FGFs) are targets for the treatment of cancer. Targeting some of these factors will alter blood pressure. We show that FGF activation in an animal model can cause hypertension. We show that the hypertension is driven by sensitization of resistance vessels to the vasoconstrictor angiotensin II. We propose that drugs used to target FGF pathway signaling in cancer could be useful to treat hypertension.

Continue reading

Benefits of Hypertension Treatment Depends Somewhat on Starting Blood Pressure Level

MedicalResearch.com Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Dr. Mattias Brunström
Department of Public Health and Clinical Medicine
Umeå University,Sweden

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

Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering.

We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD.

While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg.

Continue reading

DASH Diet and Sodium Reduction Can Have Big Impact in Improving Blood Pressure

MedicalResearch.com Interview with:

Stephen P. Juraschek, MD, PhD Instructor of Medicine Beth Israel Deaconess Medical Center/Harvard Medical School

Dr. Juraschek

Stephen 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: The DASH-Sodium trial demonstrated that both the DASH diet and sodium restriction, individually and combined, lowered blood pressure in adults with pre-hypertension or stage 1 hypertension. Whether these effects varied by level of blood pressure prior to starting these interventions was unknown. In a secondary analysis of the original DASH diet it had been observed that the effects from DASH were greater among adults with higher blood pressure (systolic greater than or equal to 140 mm Hg) at baseline with the appearance of even greater effects among people with baseline systolic blood pressures above 150 mm Hg. However, this has never been shown. Furthermore, it was unknown whether sodium reduction followed a similar linear trend of greater effects among adults with more severely uncontrolled systolic blood pressure.

In our study, we found that effects were indeed greater in adults with a baseline systolic blood pressure of 150 mm Hg or greater. Furthermore, the combined systolic blood pressure-lowering effect from both interventions was as high was 20 mm Hg. This is a magnitude comparable if not greater than medications for lowering blood pressure.

Continue reading

SPRINT Trial: Greater Mean Blood Pressure Reductions Linked To Increased Risk of Kidney Function Decline

MedicalResearch.com Interview with:
Rita Magriço MD

Hospital Garcia de Orta
Almada, Portugal 
 

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

Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality. However, intensive treatment was unexpectedly associated with increased kidney function decline.

We thought that lowering blood pressure could compromise kidney perfusion, evaluated by mean arterial pressure (MAP). If so, the magnitude of MAP reduction was expected to be associated with kidney function decline. We hypothesized that a greater difference between the baseline MAP and the lowest achieved MAP may be associated with a higher risk of kidney function decline.

Our analysis supports this hypothesis. We discovered that MAP reduction >20 mmHg in patients with a target systolic BP <120 mmHg was associated with higher incidence of kidney function decline. The benefit-risk balance of intensive treatment seemed to be less favourable with greater MAP reduction. Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted.

Continue reading

High Blood Pressure Is a Risk Factor For Mitral Regurgitation

MedicalResearch.com Interview with:

Professor Kazem Rahimi, FRCP MD DM MSc FES Deputy Director, The George Institute for Global Health UK Associate Professor of Cardiovascular Medicine, University of Oxford Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust

Dr. Rahimi

Professor Kazem Rahimi, FRCP MD DM MSc FES
Deputy Director, The George Institute for Global Health UK
Associate Professor of Cardiovascular Medicine, University of Oxford
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust 

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

Response: Mitral regurgitation, the most common heart valve disorder in high-income countries, has until now been considered a degenerative disorder, which results from damage over time due to ‘wear and tear’. As a result, the focus of medical practitioners has been on treating the disorder – by repairing or replacing the valve – rather than preventing it. This is partly because there has been a lack of large-scale, longitudinal studies investigating the effect of risk factors on the condition.

We set out to analyse data on 5.5 million patients in the UK over 10 years. Our findings show, for the first time, that elevated blood pressure is an important risk factor for mitral regurgitation. Consistent with prior evidence on blood pressure associations with other cardiovascular disease – such as stroke and heart attacks – we found an association with mitral regurgitation that is continuous across the whole spectrum of blood pressure. More specifically, every 20 mmHg higher baseline systolic blood pressure is associated with a 26% increased risk of mitral regurgitation, with no threshold below or above which this relationship is not true.

The association we found was only partially mediated by conditions that are established causes of secondary mitral regurgitation, which suggests that high blood pressure has a direct and independent effect on valve degeneration.

Continue reading

Maternal Blood Pressure Rise During Pregnancy Linked To Increased Risk Of Childhood Obesity

MedicalResearch.com Interview with:

Duo Li, PhD Chief professor of Nutrition Institute of Nutrition and Health Qingdao University, China. 

Dr. Duo Li

Duo Li, PhD
Chief professor of Nutrition
Institute of Nutrition and Health
Qingdao University, China. 

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

Response: Childhood obesity is becoming an emerging public health issue worldwide, owing to its association with a variety of health problems at younger ages in adulthood, including obesity, type 2 diabetes and cardiovascular diseases. Identification of prenatal and early life risk factors is key for curbing the epidemic of the childhood obesity.

Main finding of the present study is that among pregnant women, elevated blood pressure is associated with a greater risk of overweight and obesity for their children.

Continue reading

Targeting a Lower Systolic Blood Pressure Likely To Be Well Tolerated, Even In Elderly

MedicalResearch.com Interview with:
Dan Berlowitz, MD, MPH

Investigator, CHOIR
Chief of Staff, Edith Nourse Rogers Memorial VA Hospital
Professor, Boston University Schools of Public Health and Medicine

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

Response: The main results from the SPRINT study, published in 2015, demonstrated that intensive hypertension therapy targeting a systolic blood pressure (SBP) of 120 mm Hg results in reduced cardiovascular morbidity and mortality when compared to standard therapy targeting a SBP of 140. Yet many have expressed concerns that lowering SBP to 120 may be associated with a variety of symptoms, including dizziness, fatigue, and depression, especially in older and frailer patients.

This study using SPRINT data examined patient-reported outcomes including health-related quality of life, depressive symptoms, and satisfaction.

The main findings are that there were no differences in patient-reported outcomes among patients receiving intensive therapy compared to standard therapy, even among older SPRINT participants with multiple comorbidities.

Continue reading

CALM Study Launches Trial of MobiusHD Carotid Implant For Resistant Hypertension

MedicalResearch.com Interview with:

Gregg W. Stone MD Professor of Medicine Columbia University Director of Cardiovascular Research and Education Center for Interventional Vascular Therapy New York Presbyterian Hospital/ Columbia University Medical Center Co-Director of Medical Research and Education The Cardiovascular Research Foundation New York, NY

Dr. Stone

Gregg W. Stone MD
Professor of Medicine
Columbia University
Director of Cardiovascular Research and Education
Center for Interventional Vascular Therapy
New York Presbyterian Hospital/ Columbia University Medical Center
Co-Director of Medical Research and Education
The Cardiovascular Research Foundation
New York, NY


MedicalResearch.com:
How does the MobiusHD system work?

Response: The MobiusHD System is a thin stent-like device which is implanted during a minimally invasive procedure into the carotid artery. The MobiusHD modifies the activity of baroreceptors located in the carotid artery, increasing arterial vasodilation to reduce blood pressure.

Continue reading

Best To Measure Orthostatic Hypotension Within A Minute of Standing

MedicalResearch.com Interview with:

Stephen P. Juraschek, MD, PhD Instructor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School

Dr. Juraschek

Stephen P. Juraschek, MD, PhD
Instructor of Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School

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

Response: Many adults experience dizziness and light-headedness when they stand up. This is more common in older adults and is related to risk of falling, fractures, fainting, car crashes, and early death. These symptoms are thought to be caused by a drop in blood pressure after standing also called orthostatic hypotension. However, if measured at the wrong time it is possible to miss this important clinical sign.

For over 2 decades (since 1996), it has been recommended that orthostatic hypotension be identified by measuring blood pressure within 3 minutes of standing. Furthermore, it was also thought that measurements immediately after standing be avoided because they might be inaccurate (based on fluctuation in blood pressure immediately after standing). As a result, a lot of clinical protocols instructing healthcare staff on measuring orthostatic blood pressure encourage measurement at 3 minutes, but this has not been scientifically evaluated.

Continue reading

Elderly At Greater Risk of Falls With Intensive Blood Pressure Control

MedicalResearch.com Interview with:
Donal J. Sexton, BSc, MD
The Irish Longitudinal Study on Ageing
Trinity College Dublin
Health Research Board Clinical Research Facility Galway
National University of Ireland Galway, Galway, Ireland
Trinity Health Kidney Centre, Tallaght Hospital
Department of Nephrology, Beaumont Hospital, Royal College of Surgeons of Ireland
Dublin, Ireland

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

Response: In this study we used the inclusion criteria for SPRINT to identify those community dwelling elders who would meet criteria for the trial in clinical practice.

Our data are based on a prospective cohort study composed of participants chosen by a national stratified random sampling mechanism. If SPRINT participants were truly representative of the population, then the participants in the standard care arm of the trial should resemble the population to some extent. If this were true then the injurious falls rate might be similar between the two samples also.

Continue reading

Intensive Blood Pressure Reduction and Spot Sign in Intracerebral Hemorrhage

MedicalResearch.com Interview with:
Andrea Morotti, M.D.
Research Fellow in Neurology
Massachusetts General Hospital
Harvard Medical School

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

Response: The CT angiography (CTA) spot sign is a validated marker of Intracerebral Hemorrhage (ICH) expansion and may identify those subjects more likely to benefit from intensive blood pressure reduction.

We observed that less than 20% of ICH patients received a CTA as part of their diagnostic workup in a large, international randomized clinical trial. The performance of the spot sign in predicting ICH growth was suboptimal compared with what was reported in previous studies. Intensive blood pressure reduction did not improve functional outcome in spot sign positive patients.

Continue reading

Fixed-Dose Blood Pressure Medications Save Money In The Long Run

MedicalResearch.com Interview with:

Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610

Dr. Sonawane

Kalyani B. Sonawane, PhD
Assistant Professor/ PhD Program Director
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville, FL 32610

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

Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies.

Continue reading

Most Strokes In Women With Preeclampsia During Pregnancy Occur After Delivery

MedicalResearch.com Interview with:

Eliza Miller, M.D. Vascular neurology fellow New York-Presbyterian Hospital/Columbia University Medical Center New York City

Dr. Eliza Miller

Eliza Miller, M.D.
Vascular neurology fellow
New York-Presbyterian Hospital/Columbia University Medical Center
New York City 

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

Response: Preeclampsia is a common disorder that causes high blood pressure during pregnancy. It affects about 1 in 20 pregnant women. Women with preeclampsia are at higher risk for stroke during pregnancy and post-partum, but it’s very difficult to predict who is going to have a stroke. Our study looked at a large dataset of billing data from New York State, and compared women who had preeclampsia and strokes to women who had preeclampsia but did not have a stroke.

We found that preeclamptic women with urinary tract infections, bleeding or clotting disorders, or preexisting high blood pressure were at higher risk of having strokes during pregnancy or postpartum.

Continue reading

Synthetic Human Angiotensin II for the Treatment of Vasodilatory Shock

MedicalResearch.com Interview with:

Ashish Khanna, MD, FCCP Assistant Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine Staff Intensivist Center for Critical Care and Department of Outcomes Research Cleveland Clinic, Cleveland

Dr. Khanna

Ashish Khanna, MD, FCCP
Assistant Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine
Staff Intensivist
Center for Critical Care and Department of Outcomes Research
Cleveland Clinic, Cleveland

MedicalResearch.com: How did you become interested in this topic?

Response: Anesthesia forms the basis of my training but I also completed a fellowship in critical care and, at the present time, I do more work in critical care than anesthesia. About 75% of my time is spent in the Cleveland Clinic critical care units, including the Medical and surgical ICUs (Intensive Care Units).

Continue reading

Study Suggests Isolated Systolic Hypertension In Young Adults Should Be Treated To Prevent Damage To Aorta

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D.</strong> 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. Vongpatanasin

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

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

Response: It is well know that treatment of isolated systolic hypertension (ISH), a subtype of hypertension with elevated systolic BP 140 or above but normal diastolic BP of < 90 mmHg, improves cardiovascular outcomes in older adults after the sixth decade of life. However, it is controversial if ISH in young adults requires treatment because it was suggested that elevated systolic BP in these individuals are related to high stroke volume, rather than increased aortic stiffness. In earlier case series, ISH in young adults were particularly common in athletes with long arms and legs, suggesting that pulse wave amplification coupled with high stroke volume were responsible for elevated brachial systolic blood pressure but the true central BP was normal. Thus,  isolated systolic hypertension was proposed to be a spurious condition in young adults that can be ignored.

However, previous studies used only indirect technique in assessing aortic structure and function. Furthermore, none of these studies were conducted in the U.S. Population.

Continue reading

Risk Factors for Nonadherence to Antihypertensive Treatment

MedicalResearch.com Interview with:

Dr. Gupta Pankaj

Dr.Gupta

Dr. Gupta Pankaj
Consultant Metabolic Physician/Chemical Pathologist

Dr. Patel Prashanth - Consultant Metabolic Physician/Chemical Pathologis

Dr. Patel

Dr. Patel Prashanth – Consultant Metabolic Physician/Chemical Pathologist

Department of Metabolic Medicine and Chemical Pathology
University Hospitals of Leicester NHS Trust, UK

 

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

Response: Non-adherence or patients not taking their medications as prescribed is known since the time of Hippocrates. It is the key reason why blood pressure is well controlled in only around 50% of patients with hypertension, despite the availability of good medicines. Non-adherence leads to poorer cardiovascular outcomes and is thought to cost $100 billion to the US health economy. A crucial reason for the lack of progress in improving adherence has been the previous lack of a clinically useful objective measure.

We and others have developed a robust and reliable biochemical screening method to assess for non- adherence to antihypertensive medications in urine or blood using a technique called liquid chromatography-tandem mass spectrometry.  We have previously reported a single centre study that demonstrated high rates of non-adherence in patients attending a hypertension clinic.

Since, then we have set up a National Centre for Adherence Testing (NCAT, ncat@uhl-tr.nhs.uk) in the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust (UHL) and receive samples from around 25 hypertension clinics across UK. This study analysed data from~1400 patients consisting of samples received in UHL and also from a cohort of patients in the Czech Republic.

Continue reading

Chronic Kidney Disease Still Highly Prevalent in Hypertensive Patients

MedicalResearch.com Interview with:
Tanushree Banerjee, M.S., M.Phil., Ph.D.
Research Specialist,
Department of General Internal Medicine,
San Francisco General Hospital,
University of California, San Francisco,

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

Response: Prevalence of chronic kidney disease (CKD) has increased among adults with diagnosed hypertension (HTN), undiagnosed HTN and pre-hypertension as compared to normotension. However, whether CKD prevalence has changed across each of these groups is unknown.

The prevalence of CKD decreased over time among persons with diagnosed, undiagnosed, and pre-hypertension while there was not any change in normotensives.

Continue reading

Rotational Shift Work Linked To Increased Risk of Hypertension, Especially in Men

MedicalResearch.com Interview with:

Sandhya Manohar, MBBS, Nephrology Fellow Project mentor: Sandra M. Herrmann, MD Department of Nephrology and Hypertension Mayo Clinic, Rochester, MN

Dr. Sandhya Manohar

Sandhya Manohar, MBBS, Nephrology Fellow
Project mentor: Sandra M. Herrmann, MD
Department of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

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

Response: In the last few decades advances in the field of industrialization and technology has turned our world into a 24-7 work zone. Many organizations have turned to a shift system to keep up with the demands of the new world. The consequent changes to our circadian rhythm have resulted in dramatic effects to our body’s physiology. Reports have been surfacing of higher rates of diabetes, obesity, and even cancer in this shift work population.

The risk of hypertension though was controversial and so we set out to review this in our meta-analysis.

Continue reading

Blood Pressure Medications In Elderly Require Personalized Approach

MedicalResearch.com Interview with:

Dr. Rathi Ravindrarajah PhD Division of Health and Social Care Research Faculty of Life Sciences & Medicine  Guy’s Campus King’s College London

Dr. Ravindrarajah

Dr. Rathi Ravindrarajah PhD
Division of Health and Social Care Research
Faculty of Life Sciences & Medicine
Guy’s Campus
King’s College London

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

Response: Clinical trials show that it is beneficial to lower systolic blood pressure (SBP) in adults aged 80 and over, but non-randomized epidemiological studies suggest that lower systolic blood pressure may be associated with a higher risk of mortality.

Our main findings were that there was a terminal decline in systolic blood pressure in the final 2 years of life suggesting that the higher mortality in those with a low SBP shown in non-randomized epidemiological studies might be due to reverse causation.

Continue reading

Pregnant Women Should Have Blood Pressure Screening for Preeclampsia Throughout Pregnancy

MedicalResearch.com Interview with:

Dr. Maureen Phipps, USPTS Task Force member Department chair and Chace-Joukowsky professor of obstetrics and gynecology Assistant dean for teaching and research on women's health Warren Alpert Medical School of Brown University

Dr. Phipps

Dr. Maureen Phipps, USPTS Task Force member
Department chair and Chace-Joukowsky professor of obstetrics and gynecology
Assistant dean for teaching and research on women’s health
Warren Alpert Medical School of Brown University

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

Response: Preeclampsia, which includes high blood pressure after 20 weeks of pregnancy, is one of the most serious health problems affecting pregnant women. After reviewing the evidence, the Task Force found the benefits of screening for preeclampsia outweighed the harms and recommended screening pregnant women for preeclampsia with blood pressure measurements throughout pregnancy. The evidence showed mothers and their babies are likely to benefit from screening, as screening leads to treatment that reduces their risk of severe complications, including death.

Continue reading

Blood Pressure Variability May Trigger Stroke, Especially During Sleep

MedicalResearch.com Interview with:

Shyam Prabhakaran, MD, MS</strong> Department of Neurology Feinberg School of Medicine Northwestern University Chicago, IL

Dr. Prabhakaran

Shyam Prabhakaran, MD, MS
Department of Neurology
Feinberg School of Medicine
Northwestern University
Chicago, IL

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

Response: Wake-up stroke, or stroke onset during sleep, accounts for one-quarter of stroke presentations. Yet, there are few studies exploring mechanisms or triggers of onset during sleep. We explored whether blood pressure variability which is known to have circadian patterns could trigger wake-up stroke. We found that in the first 24 hours after stroke, those with wake-up stroke had greater blood pressure variability than non-wake up stroke patients.

Continue reading

Men and African Americans More Likely To Transition to Hypertension At Younger Age

MedicalResearch.com Interview with:

Shakia Hardy, MPH, CPH. PhD

Dr. Hardy

Shakia Hardy, MPH, CPH. PhD
Department of Epidemiology
The University of North Carolina at Chapel Hill

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

Response: Previous studies characterizing blood pressure levels across the life course have relied on prevalence estimates at a given age.

Our study was interested in identifying critical ages at which net transitions between levels of blood pressure occurred. We used data from the National Health and Nutrition Examination Survey (2007-2012) to estimate age-, race-, and sex-specific annual net transition probabilities between ideal blood pressure, prehypertension and hypertension.

We found that African Americans and men were more likely to transition from ideal levels of blood pressure in childhood or early adulthood compared to white Americans and women, which puts them at increased risk of developing prehypertension and hypertension earlier in life.

Continue reading

Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With CKD

MedicalResearch.com Interview with:
Hon-Yen Wu, MD, PhD, on behalf of all authors

Attending Physician and Assistant Professor, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Assistant Professor, National Taiwan University Hospital and College of Medicine,
National Taiwan University, Taipei, Taiwan.
Assistant Professor, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 

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

Response: The effect of intensive blood pressure (BP) control in nondiabetic patients with chronic kidney disease (CKD) has long been a topic of debate. We summarized the published information comparing intensive BP control (< 130/80 mmHg) with standard BP control (< 140/90 mmHg) on major renal outcomes in CKD patients without diabetes. We pooled data from 9 randomized clinical trials with more than 8000 patients and over 800 events of kidney disease progression. We found that targeting blood pressure below the current standard did not provide additional benefit for renal outcomes compared with standard BP control, but may benefit nonblack patients or those with heavy proteinuria.

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

Response: For the optimal blood pressure target in CKD patients without diabetes, an individually tailored treatment rather than a general rule to control hypertension is suggested.

Continue reading

Genetic Variants Tied To Kidney Disease in African Americans

MedicalResearch.com Interview with:

Katalin Susztak MD, PhD Associate Professor of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104

Dr. Susztak

Katalin Susztak MD, PhD
Associate Professor of Medicine
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104

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

Response: Previous studies showed an association between genetic variants in the APOL1 gene and kidney disease development, but it has not been confidently shown that this genetic variant is actually causal for kidney disease. For this reason we developed a mouse model that recapitulates the human phenotype.

Continue reading

Intensive Systolic Blood Pressure Control Would Risk Side Effects But Save Lives

MedicalResearch.com Interview with:

Dr. Adam Bress, PharmD, MS. Assistant Professor, Population Health Sciences Division of Health System Innovation and Research University of Utah

Dr. Adam Bress

Dr. Adam Bress, PharmD, MS.
Assistant Professor, Population Health Sciences
Division of Health System Innovation and Research
University of Utah

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

  • Observational studies show a strong and graded association between higher blood pressure, beginning at 115 mm Hg systolic, and increased cardiovascular disease events.
  • Despite this, hypertension is diagnosed and treated among people with a blood pressure threshold, typically 140/90 mm Hg SBP/DBP.
  •  Until recently, randomized trials did not provide definitive evidence supporting lower SBP goals in high-risk sub-populations.
  • The Systolic Blood Pressure Intervention Trial showed that among U.S. adults at high cardiovascular disease risk but without diabetes, stroke, or heart failure, treating to a systolic blood pressure goal of 120 mm Hg compared to the standard goal of 120 mm Hg compared to the standard goal of <140 mm Hg, resulted in a 27 % reduction in all-cause mortality.
  • However, intensive treatment cause a higher rate of treatment-related serious adverse events (SAEs).

MedicalResearch.com: What are the main findings?

  • To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess SAEs incurred if the SPRINT intensive SBP goal (i.e., – Based on population estimates of U.S adults that would have been eligible for the SPRINT trial and their observed 5-year mortality rate and the treatment effects observed in SPRINT, we found that if intensive treatment is widely adopted and achieved in all of these people, about 100,000 deaths per year could be prevented.
  • It could also give rise to about 56,100 episodes of hypotension, 34,400 episodes of syncope, 43,400 serious electrolyte disorders, and 88,700 cases of acute kidney injury per year compared to standard blood pressure treatment.

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

  • The public health impact of wide-spread implementation of intensive blood pressure treatment in the right patients is large.
  • However, careful patient selection and implementation are important because intensive treatment is associated with increased risk of hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

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

  • More research is needed to determine which patients derive the largest absolute benefit from intensive blood pressure treatment in order to maximize health benefits and minimize harms.
  • Research and development of tools to enhance shared decision making between providers and patients is also needed to maximize the positive public health impact of intensive blood pressure treatment.

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

Response: I am a member of the SPRINT Research Group

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Circulation. 2017 Feb 13. pii: CIRCULATIONAHA.116.025322. doi: 10.1161/CIRCULATIONAHA.116.025322. [Epub ahead of print]
Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES.
Bress AP1, Kramer H2, Khatib R3, Beddhu S4, Cheung AK4, Hess R5, Bansal VK6, Cao G3, Yee J7, Moran AE8, Durazo-Arvizu RA3, Muntner P9, Cooper RS3

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Over 100 Genetic Signals Influence Blood Pressure

MedicalResearch.com Interview with:

Helen R Warren PhD</strong> Analysis, Statistics, Genetic Epidemiology Queen Mary, University of London

Dr. Helen Warren

Helen R Warren PhD
Analysis, Statistics, Genetic Epidemiology
Queen Mary, University of London

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

Response: This study analysed data from UK Biobank, which is a large cohort including over 500,000 male and female participants from across the UK, aged 40-69 years. We performed a genetic association study for blood pressure, which analysed ~140,000 individuals of European ancestry (as currently interim genetic data is only available for ~150,000 participants).

Our study identified 107 genetic regions associated with blood pressure, which had not been previously reported at the time of our analysis. All our new findings were robustly validated within independent replication data resources, comprising a large, total sample size of up to 420,000 individuals.

Continue reading

Hypertension in Pregnancy Linked To Early Mortality

MedicalResearch.com Interview with:
Dr. Lauren Theilen, MD

Obstetrics/Gynecology specialist
Salt Lake City, Utah.

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

Response: Women with a history of hypertensive disease of pregnancy are known to have increased risk of mortality from cardiovascular and other causes.

Our study shows that hypertensive disease of pregnancy is strongly associated with deaths due to diabetes, heart disease, and stroke. The association is strongest for early mortality – deaths occurring before age 50 – and life expectancy decreases with increasing number of affected pregnancies.

Continue reading

Hypertension Is Global Risk For Disability and Premature Death

MedicalResearch.com Interview with:

Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington

Dr. Gregory Roth

Dr. Gregory Roth MD
Assistant Professor of Medicine
Institute for Health Metrics and Evaluation and
Division of Cardiology at the University of Washington

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

Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time.

In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased.

Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).

Continue reading

Genetics Magnifies Health Effects of Discrimination

MedicalResearch.com Interview with:

Connie J. Mulligan, PhD Professor, Department of Anthropology University of Florida Gainesville, FL

Dr. Connie J. Mulligan

Connie J. Mulligan, PhD
Professor, Department of Anthropology
University of Florida
Gainesville, FL

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

Response: Lance Gravlee (UF Dept of Anthropology, UF Genetics Institute) started this research over 10 years ago. As a cultural anthropologist, Lance uses ethnographic (open-ended questions) interviews and discovered that over half of the participants in our study talked about experiences of discrimination that happened to people close to them.

As a geneticist (UF Dept of Anthropology, UF Genetics Institute), I came into the project because I was interested in seeing how genetics and sociocultural stressors, like discrimination, interact. In our project, we look at blood pressure because hypertension is a disease that shows racial disparities and also because it is a complex disease that is caused by both genetic and environmental factors (like discrimination).

Continue reading

Low-Dose Blood Pressure Medication Effectively Treated PreHypertension

MedicalResearch.com Interview with:

Sandra Costa Fuchs, MD, PhD

Dr. Sandra Costa Fuchs

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

Response: High blood pressure is the worldwide leading cause of cardiovascular disease. It has been estimated that more than 50%, maybe as much as 70%, of cardiovascular diseases are due to hypertension. Approximately 30% among the Brazilian adult population has hypertension and can reach 70% of individuals over 60 years of age.

Prehypertension (systolic BP 120–139 or diastolic BP 80–89 mm Hg) conveys three potentially deleterious consequences.

  • First, it substantially increases the risk of developing hypertension.
  • Second, patients with prehypertension have evidence of end-organ damage, such as left ventricular geometric and functional abnormalities.
  • Third, there are evidence that adults with prehypertension are at a substantially higher risk of cardiovascular mortality.

The PREVER-Prevention study aimed to assess the efficacy and safety of a low-dose diuretic versus placebo for the prevention of hypertension and end-organ damage.

Continue reading

Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect

MedicalResearch.com Interview with:

Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096

Dr. Joshua I. Barzilay

Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096

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

Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.

Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.

After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.

Continue reading

Increased Aortic Stiffness May Explain Elevated Hypertension Risk in African Americans

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

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

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

Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors.

Continue reading

Ambulatory vs. Office Blood Pressure as Inclusion Criteria for the SPRINT Trial

MedicalResearch.com Interview with:
Alejandro de la Sierra, MD, PhD, FESC, FAHA
Professor of Medicine
Head, Internal Medicine Department
Hospital Mutua Terrassa
University of Barcelona, Spain

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

Response: The Systolic Blood Pressure Intervention (SPRINT) trial has demonstrated that a strategy of systolic blood pressure (BP) reduction to a goal of 120 mmHg in selected hypertensive patients prevents the development of cardiovascular complications and mortality. The trial used automated office BP measurements. However, ambulatory BP monitoring (ABPM) has demonstrated to be superior to office BP in predicting cardiovascular events and mortality. We aimed to evaluate ambulatory BP values in hypertensive patients from the Spanish ABPM Registry who meet eligibility criteria for the SPRINT trial.

The results indicated that one third of our hypertensive population met such eligibility criteria and that ABPM values were considerably lower than office BP, with 42% of subjects having daytime BP below 130 mmHg and 21% with 24-hour BP below 120 mmHg.

Continue reading

Lower Salt Intake Linked To Decreased Blood Pressure, Heart Disease and Mortality

MedicalResearch.com Interview with:

Nancy Cook ScD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School Public Health Brigham & Women’s Hospital Division of Preventive Medicine Boston, MA 0221

Dr. Nancy Cook

Nancy Cook ScD
Professor of Medicine, Harvard Medical School
Professor in the Department of Epidemiology
Harvard T.H. Chan School Public Health
Brigham & Women’s Hospital Division of Preventive Medicine
Boston, MA 02215

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

Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure.

In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate.

Continue reading

Some US Regions and Ethnicities At Greater Risk of Non-Adherence to Blood Pressure Medications

MedicalResearch.com Interview with:

Matthew Ritchey, DPT, PT, OCS, MPH Epidemiologist Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion

Dr. Matthew Ritchey

Matthew Ritchey, DPT, PT, OCS, MPH
Epidemiologist
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion

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

Response: High blood pressure is a leading cause of heart disease, stroke, kidney disease and death. Unfortunately, almost one in three U.S. adults (around 75 million) has high blood pressure, and nearly half of that group (about 34 million) doesn’t have it under control.

As part of CDC’s ongoing efforts to monitor trends and risk factors contributing to cardiovascular disease, we collaborated with colleagues at the Centers for Medicare and Medicaid Services to look at blood pressure medicine nonadherence among Medicare Part D enrollees ages 65 and over. Being nonadherent means that patients skip doses of their medicine or stop taking it altogether.

Continue reading

Large fluctuations in blood pressure associated with higher risk of heart disease and kidney failure

MedicalResearch.com Interview with:

Elvira Gosmanova MD Department of Nephrology University of Tennessee Health Science Center Memphis TN, 38163

Dr. Elvira Gosmanova

Elvira Gosmanova MD
Department of Nephrology
University of Tennessee Health Science Center
Memphis TN, 38163

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

Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range.

In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease.

We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure.

Continue reading

Systolic blood pressure target 130-140 may be associated with the lowest risk of all-cause mortality

MedicalResearch.com Interview with:
Islam Elgendy, MD

Cardiology Fellow
University of Florida

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

Response: The optimal systolic blood pressure target in adults with coronary artery disease is not well known. The Eighth Joint National Committee Panel recommended a target therapeutic goal <150 mm Hg for adults aged ≥60 years and <140 mm Hg in those aged <60 years. These recommendations are inconsistent with the different society guidelines (such as American Heart Association/American College of Cardiology, European Society of Cardiology, and American Society of Hypertension) which recommended a therapeutic target < 140 mm Hg. Given that the dyad of hypertension and coronary artery disease is the most prevalent chronic disease dyad among adults, we aimed to assess the long term risk of all-cause mortality with the different systolic blood pressure targets.

Using the extended follow-up data from the US cohort of the INVEST trial, we demonstrated that achieving a systolic blood pressure of 130 to <140 mm Hg in the initial 2-3 years of treatment is associated with reduced all-cause mortality after ≈11.6 years of follow-up in hypertensive patients with coronary artery disease.

Continue reading

Intensive Blood Pressure Control of More Americans Could Further Reduce Annual Mortality Rate

MedicalResearch.com Interview with:

Holly Mattix-Kramer, MD, MPH</strong> Public Health Sciences Medicine, Nephrology Associate Professor Loyola Medicine, Illinois

Dr. Holly Mattix-Kramer

Holly Mattix-Kramer, MD, MPH
Public Health Sciences
Medicine, Nephrology
Associate Professor
Loyola Medicine, Illinois

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

Response: The background is that the Systolic Blood Pressure Lowering Intervention Trial (SPRINT) showed that intensive systolic blood pressure lowering reduces all-cause mortality by 27% compared to standard blood pressure lowering among adults age 50 years and older without diabetes or stroke but with high cardiovascular disease risk. We applied these findings to the U.S. population and asked “What if intensive systolic blood pressure lowering were applied to the U.S. population who meet SPRINT eligibility criteria?

We found that approximately 18.1 million U.S. adults meet SPRINT criteria and that their annual mortality rate is 2.2%. If intensive systolic blood pressure lowering reduces all-cause mortality by 27%, then the annual mortality rate would be reduced to 1.6% and approximately 107,500 deaths would be prevented each year.

Continue reading

Intensive Blood Pressure Management Found To Be Cost Effective

MedicalResearch.com Interview with:

Ilana B. Richman, MD Palo Alto VA Health Care System, Palo Alto, California Center for Primary Care and Outcomes Research/Center for Health Policy Department of Medicine Stanford University School of Medicine Stanford, California

Dr. Ilana B. Richman

Ilana B. Richman, MD
Palo Alto VA Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research/Center for Health Policy
Department of Medicine
Stanford University School of Medicine
Stanford, California

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

Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently.

Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value.

Continue reading

Targeted Case Finding Through EHR Starts More High Risk Patients On Treatment

MedicalResearch.com Interview with:

Tom Marshall, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Edgbaston, Birmingham

Prof. Tom Marshall

Tom Marshall, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham
Edgbaston, Birmingham

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

Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action.

This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins.

Continue reading

DASH Diet For Hypertension May Also Lower Uric Acid in Gout Patients

MedicalResearch.com Interview with:

Stephen P. Juraschek, MD, PhD Fellow, Division of General Internal Medicine Johns Hopkins Hospital

Dr. Stephen Juraschek

Stephen P. Juraschek, MD, PhD
Fellow, Division of General Internal Medicine
Johns Hopkins Hospital

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

Response: Diet has long been viewed as an important way to lower uric acid levels to prevent gout attacks; however, there is little evidence about whether a particular dietary pattern might be effective for lowering uric acid. For the first time we show that the DASH diet, an effective diet for lowering blood pressure, it lowers uric acid levels substantially in people with abnormally high uric acid levels.

Continue reading

Low Vitamin D Linked To Increase Risk of Orthostatic Hypotension

MedicalResearch.com Interview with:
Dr. Nicola Veronese
University of Padova
Department of Medicine – DIMED, Geriatrics Division
Padova, Italy

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

Response: In the last 5 years, some studies investigated the possible association between hypovitaminosis D and orthostatic hypotension. However, all these studies were cross-sectional,  not disentangling if hypovitaminosis D precedes or follows orthostatic hypotension. In our work, we reported that low vitamin D at baseline predict the onset of orthostatic hypotension at follow-up in older people. This association was stronger in women than in men.

Continue reading

High Phosphates in Processed Foods May Contribute To Increased Blood Pressure

MedicalResearch.com Interview with:

Dr-Wanpen-Vongpatanasin.jpg

Dr. Vongpatanasin

Wanpen Vongpatanasin, MD
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension Research
Director, Hypertension Section
Cardiology Division
UT Southwestern Medical Center

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

Response: Inorganic phosphate has been added to our processed food at an enormous amount as food preservatives and flavor enhancer such that typical American diet contains twice as much as the recommended daily allowance. A high phosphate (Pi) diet was recently shown to trigger blood pressure (BP) elevation in otherwise normal rats but the mechanisms are still unknown.We found that rats treated with high phosphate diet that mimics the excess Pi consumed by the general American population developed high BP related to increased sympathetic nerve activity (SNA), resulting in excessive peripheral vasoconstriction. This exaggerated increase in SNA and BP is evident particularly during exercise. This study is conducted in collaboration with Drs. Masaki Mizuno and Scott Smith, the two leading experts in neural control of circulation at UT Southwestern in the Department of Health Care Sciences.

Continue reading

Potassium Compound In Fruits/Vegetables May Reduce Oxidative Stress

MedicalResearch.com Interview with:

Dr-Wanpen-Vongpatanasin.jpg

Dr. Vongpatanasin

Dr. Wanpen Vongpatanasin MD
The Norman and Audrey Kaplan Chair in Hypertension
UT Southwestern Medical Center

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

Response: Diet rich in fruits, vegetables, and dairy products, known as the DASH diet, is known to reduce blood pressure in hypertensive patients. More recently, the DASH diet was shown to reduce oxidative stress in people with and without high blood pressure . However, the main nutritional ingredient responsible for these beneficial effects of the DASH diet remain unknown. Because the DASH diet is rich in potassium (K), magnesium (Mg), and alkali, we performed a randomized, double-blinded, placebo-controlled study to compare effects of KMg Citrate (KMgCit), K Chloride (KCl), and K Citrate (KCit) to allow dissociation of the three in hypertensive and prehypertensive individuals. This study was conducted in collaboration with Drs. Charles Pak and Orson Moe at UT Southwestern, the two leading experts in the field of Mineral Metabolism. We found that oxidative stress was markedly reduced by KMgCit powder compared to placebo, K Chloride, and K Citrate. On the hand, KMgCit has no significant effects on blood pressure .

MedicalResearch.com Editor’s note:  DO NOT Take Potassium supplements unless under the direction of your health care provider.

Continue reading

Prehypertension in Pregnancy Linked to Postpartum Metabolic Syndrome

MedicalResearch.com Interview with:

Jian-Min Niu Department of Obstetrics Guangdong Women and Children Hospita Guangzhou , China

Dr. Jian Min Niu

Dr. Jian-Min Niu
Department of Obstetrics
Guangdong Women and Children Hospita
Guangzhou , China

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

Response: Physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the non-pregnant population. The optimal blood pressure levels in pregnant women remain an open question. Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed.

Continue reading

Study Addresses Appropriate Treatment Setting for Hypertensive Urgency

MedicalResearch.com Interview with:
Krishna Patel, MD, PG Y3 Resident
Internal Medicine Residency Program
Cleveland Clinic
Cleveland, OH 44195

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

Dr. Patel: In our outpatient resident clinic practice, we found that patients with poorly controlled hypertension presenting with blood pressures in the hypertensive urgency range (SBP>=180mmHg or DBP >=110 mmHg) but with no symptoms of end-organ damage were common, however there was no clear cut manner in which these patient’s blood pressures were treated. According to the comfort level of the physician, these patients were managed in the office and on serial outpatient visits and some of the patients would be referred to the emergency department for management of these elevated blood pressures. Given there was not much prior literature on this topic, we decided to study the prevalence and short term cardiovascular outcomes for this population of patients.

We found that hypertensive urgency is quite common in the office setting (4.6% in our study). In absence of symptoms of end organ damage, the short term risk of major cardiovascular events was very low around 1%, and patients who were referred to the ED for management of blood pressures had a lot of unnecessary testing and more hospital admissions than those who were managed as an outpatient.

Continue reading

Observational Study Confirms SPRINT Trials’ Link Between Lower BP Target and Fewer CV Events

MedicalResearch.com Interview with:
Duk-Woo Park, MD, PhD

Duk-Woo Park, MD, PhD Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine and National Evidence-based Healthcare Collaborating Agency Seoul, Republic of Korea

Dr. Duk Woo Park

Division of Cardiology, Asan Medical Center
University of Ulsan College of Medicine and National Evidence-based Healthcare Collaborating Agency
Seoul, Republic of Korea

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

Response: Currently, less restrictive blood pressure (BP) target by the 2014 hypertension guidelines (JNC-8) and more intensive BP target of the SPRINT is now conflicting, which causes uncertainty and confusion among clinicians. In our study, the proportion of persons who would meet the SPRINT BP goals is substantially less than those who would meet the 2014 guideline blood pressure goals. There is a positive association between the risk of major cardiovascular events and increasing levels of BP control status under different 2014 guideline and SPRINT criteria. Our study reconfirmed the findings of the SPRINT trials in real-world population.

Continue reading

No Clinical Benefit With Intensive Blood-Pressure Lowering in Acute Cerebral Hemorrhage

MedicalResearch.com Interview with:
Adnan I. Qureshi, M.D
Zeenat Qureshi Stroke Research Center
University of Minnesota
Minneapolis, MN

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

Dr. Qureshi: An acute hypertensive response in patients with intracerebral hemorrhage is common and may be associated with hematoma expansion and increased mortality. The Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial was designed to determine the efficacy of rapidly lowering systolic blood pressure in patients in an earlier time window after symptom onset than evaluated in previous trials. The trial was based on evidence that hematoma expansion and subsequent death or disability might be reduced with very early and more aggressive reduction in systolic blood pressure in those at higher risk due to presence of high systolic blood pressure at presentation. The trial randomized eligible subjects with intracerebral hemorrhage to test the superiority of intensive (goal 110-140 mmHg) over standard (goal 140-180 mmHg) systolic blood pressure reduction using intravenous nicardipine within 4.5 hours of symptom onset. Of a total of 1000 subjects that were recruited with a mean (standard deviation) baseline systolic blood pressure of 200.6 (27.0) mmHg, 500 were assigned to intensive-treatment and 500 to standard-treatment. Enrollment was stopped following a pre-specified interim analysis because of futility.

The primary endpoint of death or disability at 3 months post-randomization was observed in 38.7% (186/481) of subjects receiving intensive treatment and 37.7% (181/480) subjects receiving standard treatment (relative risk: 1.03; 95% confidence interval: 0.85 to 1.27), adjusted for age, initial Glasgow Coma scale, and presence or absence of intraventricular hemorrhage. The rate of renal adverse events within 7 days of randomization was significantly higher among subjects randomized to intensive treatment. Compared to a target systolic blood pressure of 140-180 mmHg, treating subjects with intracerebral hemorrhage to a target systolic blood pressure of 110-140 mmHg did not lower the rate of death or disability.

Continue reading

Hypertension: Screening For Medication Non-Adherence Critical Before Renal Denervation

MedicalResearch.com Interview with:

Dr Prashanth Patel MSc, FRCP, FRCPath Consultant Metabolic Physician/ Chemical Pathologist and Head of Service Department of Chemical Pathology and Metabolic Diseases Honorary Senior Lecturer, Dept of Cardiovascular Sciences University of Leicester

Dr. Patel Prashanth

Dr Prashanth Patel MSc, FRCP, FRCPath
Consultant Metabolic Physician/ Chemical Pathologist and Head of Service
Department of Chemical Pathology and Metabolic Diseases
Honorary Senior Lecturer
Dept of Cardiovascular Sciences
University of Leicester

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

Dr. Patel: Hypertension (HTN) is one of the most important and common chronic treatable condition. It affects nearly one third of the adult population. Nearly one fifth of patients treated for hypertension are thought to be resistant to treatment and these patients have a high mortality from cardiovascular diseases. Percutaneous radiofrequency catheter-based renal sympathetic denervation (renal denervation, RD) may be a potential treatment for resistant hypertension. Although RD is a safe procedure, it is irreversible and expensive. It is important that patients’ suitability for renal denervation is carefully assessed to maximise the potential benefits of the procedure. Therefore causes of pseudo-resistant hypertension namely white-coat hypertension, suboptimal pharmacological antihypertensive treatment and non-adherence to antihypertensive medications and secondary hypertension are needed to be robustly ruled out before considering a patient as suitable for renal denervation.

Continue reading

Air Pollution Linked to Increase in Hypertension Risk

MedicalResearch.com Interview with:
Tao Liu Ph.D
Guangdong Provincial Institute of Public Health
Guangdong Provincial Center for Disease Control and Prevention

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

Response: Hypertension is the most important cause of disability and the leading risk factor for death globally and causes approximately 16.5% of all deaths. Since the 1990s, many epidemiological studies have investigated the associations between air pollution exposure and hypertension, the two most common public health concerns. However, their results remain controversial. Some studies found an association between them, while other studies sowed either no association or an association only for selected pollutants. In order to quantitatively synthesize and interpret these inconsistent and controversial results, here we used a new analysis method (Meta-analysis) to combine results from different previous studies to estimate the overall effect of every air pollutant on hypertension. This is the first study to simultaneously estimate the effects of short-term and long-term exposure to air pollutants on hypertension by meta-analysis. These results could provide more explicit information for policy decisions and clinical use.

Continue reading