Elevated Blood Pressure Is Risk Factor For Vascular Dementia

MedicalResearch.com Interview with:

Kazem Rahimi, DM, MSc Oxford Martin School University of Oxford United Kingdom

Dr. Kazem Rahimi

Kazem Rahimi, DM, MSc
Oxford Martin School
University of Oxford
United Kingdom

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

Dr. Rahimi: Vascular dementia is the second most common cause of dementia and is increasing in prevalence worldwide. Vascular dementia often occurs after stroke and can cause apathy, depression, and a decline in cognitive function, and can eventually result in death. High blood pressure (BP) has been identified as a potential risk factor for the development of vascular dementia. However, previous studies, which have been small in size, have reported conflicting results on the relationship between blood pressure and vascular dementia.

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Controversy Over Salt Content Continues

Salt-SodiumMedicalResearch.com Interview with:
Prof Andrew Mente PhD
Clinical Epidemiology and Biostatistics, McMaster University
Hamilton, Canada

MedicalResearch.com Editor’s Note:  Dr. Mente discusses his Lancet publication regarding salt intake below.  Dr. Mente’s findings are disputed by the American Heart Association (AHA).  A statement from the AHA follows Dr. Mente’s comments.

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

Prof. Mente: Several prospective cohort studies have recently reported that both too little and too much sodium intake is associated with cardiovascular disease or mortality. Whether these associations vary between those individuals with and without high blood pressure (hypertension) is unknown.

We found that low sodium intake (below 3 g/day), compared to average intake (3 to 6 g/day), is associated with more cardiovascular events and mortality, both in those with high blood pressure and in those without high blood pressure. So following the guidelines would put you at increased risk, compared to consuming an sodium at the population average level, regardless of whether you have high blood pressure or normal blood pressure.

High sodium intake (above 6 g/day) compared to average intake, was associated with harm, but only in people with high blood pressure (no association in people without high blood pressure).

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Intensive Blood Pressure Control Benefited Elderly, Did Not Increase Falls

MedicalResearch.com Interview with:

Jeff D. Williamson, MD, MHS Section on Gerontology and Geriatric Medicine Interim Chair, Internal Medicine Program Director, Sticht Center on Aging Professor, Gerontology and Geriatric Medicine Sticht Center on Aging, Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NC 27157

Dr. Jeff Williamson

Jeff D. Williamson, MD, MHS
Section on Gerontology and Geriatric Medicine
Interim Chair, Internal Medicine
Program Director, Sticht Center on Aging
Professor, Gerontology and Geriatric Medicine
Sticht Center on Aging, Department of Internal Medicine
Wake Forest School of Medicine
Winston-Salem, NC 27157

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

Dr. Williamson: This is a deeper look into the SPRINT results published last November in the New England Journal of Medicine.

SPRINT was funded to add a larger number of adults over age 75 who live independently, including frail elders who can travel to their doctor’s office (not in a nursing home). These funds also added measures that would assess and categorize each person’s degree of frailty and also their walking speed which is a marker for frail health.

This support was provided via ARRA funds to the NIH.

SPRINT tested whether treating high blood pressure to a systolic blood pressure (SBP) target of <120 mmHg prevents more CVD (stroke, MI, CHF) morbidity and mortality than treating to a goal of >< 140mmHg. Epidemiological evidence for many years has indicated that the 120 mm Hg target would reduce CVD complications and death from Hypertension. However epidemiological data has also indicated that this lower target might be dangerous for the elderly, causing more falls in particular. 90% of medications used in SPRINT are generic.

These new results show that people over age 75 with high blood pressure (HBP) benefit just as much as younger people with high blood pressure, even if frail. The patients on intensive high blood pressure therapy did not fall more. Neither did they, overall, have more serious adverse events. Intensive systolic blood pressure therapy to a goal of ><120 mmHg prevented many of the high blood pressure related CVD complications that are associated with greater disability and nursing home placement.

These results do not apply for persons with Heart failure or type 2 diabetes.

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

Dr. Williamson: People over age 75 who are still living at home can safely lower blood pressure and reduce their risk for stroke, heart attack and heart failure as well as death.

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

Dr. Williamson: More studies testing treatments for common conditions in elderly people need to include large numbers of older people and also measures of frailty.

SPRINT Is also continuing to follow these individuals to see if better blood pressure control could be a strategy for preventing Alzheimer’s disease.

Further follow up is also needed to understand any long term effects on the kidney as more people in the intensive group at all ages had episodes of transient declines in kidney function or mild decreases in kidney function over time.

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

Citation:

Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years

Jeff D. Williamson MD, MHS, Mark A. Supiano MD, William B. Applegate MD, MPH, Dan R. Berlowitz MD, Ruth C. Campbell MD, MSPH, Glenn M. Chertow MD, Larry J. Fine MD, William E. Haley MD, Amret T. Hawfield MD, Joachim H. Ix MD, MAS, Dalane W. Kitzman MD, John B. Kostis

MD, Marie A. Krousel-Wood MD, Lenore J. Launer PhD, Suzanne Oparil MD, Carlos J. Rodriguez MD, MPH, Christianne L. Roumie MD, MPH, Ronald I. Shorr MD, MS, Kaycee M. Sink MD, MAS, Virginia G. Wadley PhD, Paul K. Whelton MD, Jeffrey Whittle MD, Nancy F. Woolard , Jackson T. Wright MD, PhD, Nicholas M. Pajewski PhD

JAMA. doi:10.1001/jama.2016.7050 Published online May 19, 2016

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

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Lower Blood Pressure Goals Would Save Lives and Money

MedicalResearch.com Interview with:

Nathalie Moise, MD, MS Assistant Professor   Center for Behavioral Cardiovascular Health Department of Medicine  Columbia University Medical Center New York, NY 10032

Dr. Nathalie Moise

Nathalie Moise, MD, MS
Assistant Professor
Center for Behavioral Cardiovascular Health
Department of Medicine
Columbia University Medical Center
New York, NY 10032

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

Dr. Moise:  Our research aimed to compare the number of lives saved and changes in medical costs expected if intensive blood pressure goals of less than 120 mmHg were implemented in high cardiovascular disease risk patients.

In 2014, the 8th Joint National Committee (JNC8) on Detection, Evaluation, and Treatment of High Blood Pressure issued new guidelines recommending that physicians aim for a systolic blood pressure (SBP) of 140 mmHg in adults with diabetes and/or chronic kidney disease and 150 mmHg in healthy adults over age 60. The new guidelines represented a major departure from previous JNC7 guidelines recommending SBPs of 130 mmHg and 140, mmHg for these groups, respectively. Under the 2014 guidelines, over 5 million fewer individuals annually would receive drug treatment to lower their blood pressure, compared with the prior 2003 guidelines.

Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) found that having a more intensive systolic blood pressure (SBP) goal of 120 mmHg in patients at high risk for cardiovascular disease reduced both cardiovascular events and mortality by about one quarter, compared with the current goal of 140 mmHg.

These recent studies and guidelines have created uncertainty about the safest, most effective and high-value blood pressure goals for U.S. adults with hypertension, but no prior study has compared the cost-effectiveness of adding more intensive blood pressure goals in high cardiovascular disease risk groups to standard national primary prevention hypertension guidelines like JNC8 and JNC7.

Our team at Columbia University Medical Center conducted a computer simulation study to determine the value of adding the lower, life-saving  systolic blood pressure goal identified in SPRINT to the JNC7 and JNC8 guidelines for high-risk patients between the ages of 35 and 74 years. (High risk was defined as existing cardiovascular disease, chronic kidney disease, or a 10-year cardiovascular disease risk greater than 15 percent in patients older than 50 years and with a pre-treatment SBP greater than 130 mmHg)

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Melatonin May Improve Blood Pressure Control Through Circadian Rhythm Regulation

MedicalResearch.com Interview with:
Dr. Denis Gubin
The Tyumen Medical University
Tyumen, Russia

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

Dr. Gubin: The older we get, the more likely our circadian rhythms are disrupted. For example, blood pressure, BP, not only tends to increase but as well become more irregular.

One of the possible causes is an age-dependent deficit of endogenous melatonin production. We have shown that exogenous melatonin helps to ameliorate both trends – lowers  blood pressure and also stabilizes and synchronizes blood pressure and heart rate variability.
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Ideal Blood Pressure After Stroke Differs For Blacks, Whites

MedicalResearch.com Interview with:

Azizi Seixas, Ph.D. Fellow NYU Langone School of Medicine  Department of Population Health Center for Healthful Behavior Change

Dr. Azizi Seixas

Azizi Seixas, Ph.D.
Fellow
NYU Langone School of Medicine
Department of Population Health
Center for Healthful Behavior Change
 

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

Dr. Seixas: Twenty-five percent of strokes in the US are attributed to high blood pressure. Studies indicate that lowering blood pressure after a stroke significantly reduces risk of recurrent stroke by almost 50%. However, recent evidence suggests that lowering blood pressure did not lower risk of recurrent stroke or mortality. In fact, epidemiological evidence indicates that low to normal blood pressure (120-140mmHg) had the highest cumulative all-cause mortality compared to high (140-149mmHg) and very high (>=150 mmHg) blood pressure. However, these studies did not look at this relationship among blacks/African Americans, non-White Hispanics and non-Hispanic Whites.

Please see link for more background information as reported recently by the AHA.

http://news.heart.org/high-blood-pressure-causing-deaths-despite-drop-heart-disease-stroke-deaths/

MedicalResearch.com: What are the main findings?

Dr. Seixas: We found that black stroke survivors who have a post-stoke blood pressure in the low-normal range <140 mmHg were 46% more likely to die compared to those who had a blood pressure in the range of 140-149mmHg, over a five year period. Non-Hispanic Whites stroke survivors with a very high post-stroke blood pressure (>= 150mmHg) had a 79% greater odds of dying over a five year period.

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

Dr. Seixas: Black stroke survivors with low-normal blood pressure and white stroke survivors with very high blood pressure are at increased all-cause mortality risk. Our findings with blacks suggest there may be another factor[s] responsible for mortality.

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

Dr. Seixas: Future research should investigate which factors might be interacting with low-average blood pressure to increase mortality risk.

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

Dr. Seixas: Our findings do not suggest that blood pressure is the cause of mortality but instead indicates that it plays a very important role in mortality in stroke survivors.

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

Citation: Abstract presented at the 2016 American Society of Hypertension

Racial/ethnic differences in post-stroke blood pressure trajectory and mortality risk

Seixas, Azizi et al.
Journal of the American Society of Hypertension , Volume 10 , Issue 4 , e51

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

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Boiled, Baked, Mashed or Fried – Potatoes Increase Hypertension Risk

MedicalResearch.com Interview with:
Lea Borgi, MD, MMSc

Renal Division, Brigham and Women’s Hospital 

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

Dr. Borgi:   The association of potatoes intake with the risk of developing hypertension has not been studied. In our analyses of more than 187,000 participants without a diagnosis of high blood pressure at baseline, we observed that higher intakes of boiled, baked or mashed potatoes and French fries were associated with an increased risk of developing hypertension.

Indeed, when participants consumed 4 or more than 4 servings per week of boiled, baked or mashed potatoes as compared to 1 or less than one serving per month, the risk of hypertension increased by 11% (and 17% when French fries were consumed 4 or more than 4 times a week as compared to 1 or less than 1 serving per month). We also found that replacing one serving of boiled, baked or mashed potatoes per day with one serving of a non-starchy vegetable was associated with a lower risk of developing hypertension.

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Daytime Naps May Raise Your Blood Pressure

MedicalResearch.com Interview with:

Wisit Cheungpasitporn, MD, Nephrology Fellow Project mentor: Stephen B. Erickson, MD Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN

Dr. Wisit Cheungpasitporn

Wisit Cheungpasitporn, MD, Nephrology Fellow
Project mentor: Stephen B. Erickson, MD
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

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

Dr. Cheungpasitporn: The prevention and management of hypertension continue to be major public health challenges. Studies have shown the benefits of napping, including reduction of fatigue and improvement of alertness, mood and work performance. However, there have also been increasing reported associations between napping and cardiovascular disease, diabetes mellitus, strokes, and higher mortality from all causes. The risk of hypertension in adults who regularly take a nap is controversial.

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Treating Insomnia May Improve Blood Pressure Control

MedicalResearch.com Interview with:

Haicong Li Director and Professor, Department of Geriatrics China-Japan Friendship Hospital Beijing, China.

Dr. Haicong Li

Haicong Li
Director and Professor, Department of Geriatrics
China-Japan Friendship Hospital
Beijing, China. 

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

Response: Based on our clinical observations over the years, we noticed two common
phenomena:

  • One is that the occurrence of hypertension in patients with
    chronic sleep disorders tend to be higher than those with normal sleep
    conditions;
  • The other is that the blood pressure of some hypertensive
    patients cannot be lowered to normal level even with anti-hypertensive
    treatments, of which group many have sleep disorders.

So we hypothesized that the improvement of insomnia can effectively help lower the of
hypertensive patients and the combination of anti-hypertensive medication
and sedative-hypnotic drugs can achieve better therapeutic effects.
In our experiment, a total of 402 patients with a diagnosis of insomnia and
hypertension were selected and randomly divided into two groups. The
treatment group (202 cases) received standard antihypertensive treatment
with Estazolam and the control group (200 cases) received standard
antihypertensive treatment with placebo. We measured the sedentary
diastolic (SiSBP) and systolic blood pressure (SiDBP) before the treatment
and every 7 days during the experiment. To assess the sleep quality and
anxiety and depression levels of patients, we reported the scores of the
Pittsburgh Sleep Quality Index (PSQI), the Hamilton Anxiety Rating Scale
(HAMA) and the Hamilton Depression Scale-17 (HAMD 17) at the same time
points.

At the conclusion of the experiment, PSQI, HAMA, and HAMD17
scores were significantly lower than those of the control group (P&lt;0.001).
The insomnia treatment efficacy of Estazolam in the treatment group was
67.3%, significantly higher than that (14.0%) of the control group (P &lt;
0.001). The blood pressure of the treatment group showed significant improvement
throughout the experiment. By Day 28, the decrease of SiSBP and SiDBP in
the treatment group was significantly greater than that of the control group
(SiSBP: 10.5±3.9 vs. 3.4±2.5; DiSBP: 8.1±3.6 vs. 2.7±2.1, mmHg, P&lt;0.001)
and the compliance rate of goal BP (&lt;140/90 mmHg) was 74.8% with
Estazolam, compared to 50.5% with placebo (P&lt;0.001).

Thus, our findings indicated that the improvement of insomnia can significantly help lower the blood pressure in hypertensive patients.

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Elderly CKD Patients Need More Cautious Blood Pressure Management Strategies

MedicalResearch.com Interview with:

Csaba P Kovesdy MD Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163

Dr. Csaba P. Kovesdy

Csaba P Kovesdy MD
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163

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

Dr. Kovesdy: Older patients experience several physiologic changes which could modify their response to blood-pressure lowering. In fact, hypertension treatment guidelines such as JNC8 recommend slightly higher blood pressure targets when treating elderly patients. Patients with chronic kidney disease (CKD) have been excluded from most hypertension treatment trials, hence the blood pressure treatment goals in this group are mainly derived based on extrapolations. Even less is known about the effects of age on the association of blood pressure with mortality and various other clinical outcomes in patients with CKD.

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Anti-Hypertension Drug Prazosin May Inhibit Glioblastoma Brain Tumor Cells

MedicalResearch.com Interview with:

Hervé Chneiweiss MD PhD Bâtiment A3 pièce 336 Case courrier 2 Plasticité Gliale et Tumeurs cérébrales Neuroscience Paris Seine (directeur) Inserm/Université Pierre et Marie Curie

Dr. Herve Chneiweiss

Hervé Chneiweiss MD PhD
Bâtiment A3 pièce 336 Case courrier 2 Plasticité Gliale et Tumeurs cérébrales Neuroscience Paris Seine (directeur) Inserm/Université Pierre et Marie Curie

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

Dr. Chneiweiss: Treatments available for glioblastoma — malignant brain tumors — have little effect. An international collaboration[1] led by the Laboratoire Neurosciences Paris-Seine (CNRS/ INSERM/UPMC)[2] tested active ingredients from existing medications and eventually identified one compound of interest, prazosin, on these tumors.

We chose to study the most common malignant tumors that develop from brain cells, glioblastomas, which represent the fourth most frequent cause of cancer deaths among adults and the second in children. This is due to the inefficacy of current treatments. Indeed, a glioblastoma can resist treatment and reawaken from a very small number of tumor cells called glioblastoma-initiating cells (GIC). It is these cells — whose characteristics and properties resemble those of stem cells — that were targeted in the study.

Rather than trying to discover new compounds, the team opted for repositioning existing drugs. In other words, we tested a collection of substances used for so long to treat other conditions that their patents have now fallen into the public domain[3]. This method makes it possible to develop new active ingredients cheaply and very rapidly. Twelve hundred compounds were thus tested on normal human neural stem cells and on glioblastoma-initiating cells from different aggressive tumors. Twelve of these compounds showed a toxic effect on GIC — and none on the normal neural stem cells. The most effective was prazosin. Tested in mice carrying glioblastoma-initiating cells, prazosin significantly reduced the size of tumors and prolonged survival of the mice by more than 50%.

[1] Including scientists from the Laboratoire d’Innovation Thérapeutique (CNRS/Université de Strasbourg), the Stanford University Institute for Stem Cell Biology and Regenerative Medicine (USA) and the Instituto Estadual do Cérebro Paulo Niemeyer in Rio de Janeiro (Brazil).

[2] This laboratory forms part of the Institut de Biologie Paris-Seine.

[3] Pharmaceutical compounds are protected by a patent for 20 years after their discovery. Because of the length of the clinical trials that are necessary before a drug can be put on the market, the duration of their patent protection does not normally exceed 10-15 years after a Marketing Authorization (MA) is granted.

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Healthy Diet After Gestational Diabetes Lowers Long-Term Hypertension Risk

MedicalResearch.com Interview with:

Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852

Dr. Cuilin Zhang

Cuilin Zhang MD, PhD
Senior Investigator, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Rockville, MD 20852

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

Dr. Zhang: Hypertension is one of the most prevalent and preventable risk factors for cardiovascular and kidney diseases, and is one of the leading causes of death in the United States.

We have previously reported that the cumulative incidence of hypertension for women with a history of gestational diabetes mellitus (GDM) was 26% higher than those who did not have GDM even 16 years after the index pregnancy. Thus, women with a history of GDM represent a high-risk population for hypertension that could benefit from early prevention. While there is extensive literature on how lifestyle factors may influence blood pressure in the general population, no information is currently available on the role of diet and lifestyle in the development of hypertension specifically in this susceptible population. To address these gaps, we prospectively examined the associations between long-term adherence to three healthy diets with subsequent risk of hypertension among women with a history of gestational diabetes mellitus, specifically the DASH diet, the alternative Mediterranean diet (aMED), and the Alternative Healthy Eating Index (AHEI).

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Morning Home Blood Pressure Readings Linked To CAD and Stroke Risk

MedicalResearch.com Interview with:

Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK

Dr. Kazuomi Kario

Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC
Professor, Chairman
Division of Cardiovascular Medicine, Department of Medicine
Jichi Medical University School of Medicine (JMU)
JMU Center of Excellence, Cardiovascular Research and Development (JCARD)
Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
Staff Visiting Professor of Medicine,
UCL Institute of Cardiovascular Science
University College London, London UK

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

Dr. Kario: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly.

The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent.

The present analysis shows that home BP measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home BP and CAD or stroke events.

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Only a Few Neurons in Brain Responsible For Salt Hunger

MedicalResearch.com Interview with:

Matthew Bailey PhD Faculty Principal Investigator British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh, Edinburgh, United Kingdom.

Dr. Mathew Bailey

Matthew Bailey PhD
Faculty Principal Investigator
British Heart Foundation Centre for Cardiovascular Science
The University of Edinburgh, Edinburgh, United Kingdom.

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

Dr. Bailey: This study started with our interest in salt homeostasis and long term blood pressure, so it’s firmly rooted in the cardiovascular/renal disease risk factor arena. We were interested in salt-sensitivity- why does blood pressure go up in some people when they eat salt but not in others. I’m a renal physiologist, so we had a number of papers looking at renal salt excretion and blood pressure. We initially used a gene targeting approach to remove a gene (Hsd11b2) which acts as a suppressor of the mineralocorticoid pathway. It’s mainly expressed in the kidney and when we deleted the gene  throughout the body we saw a number of renal abnormalities all associated with high mineralocorticoid activity. This was consistent with the “hypertension follows the kidney” theory of blood pressure control. There is a human disease called “Apparent Mineralocorticoid Excess”- there are people do not have the gene and are thought to have renal hypertension. Our study threw up some anomalies which we couldn’t easily interpret but suggested that the brain was involved. We moved to a more refined technology that allowed us to knockout a gene in one organ system but not another. We knew the gene was in the brain and localized to a very restricted subset of neurons linked to salt-appetite and blood pressure control. Previous studies had shown that these neurons were activated in salt-depleted rats (ie rats that needed to eat salt). We started there but didn’t anticipate that the effect on salt hunger and on blood pressure would be so large because renal function is -as far as we can tell- normal.

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Morning Home Blood Pressure Is Stronger Predictor of CAD and Stroke

MedicalResearch.com Interview with:

Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK

Dr. Kazuomi Kario

Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC
Professor, Chairman
Division of Cardiovascular Medicine, Department of Medicine,
Jichi Medical University School of Medicine (JMU)
JMU Center of Excellence, Cardiovascular Research and Development (JCARD)
Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science
University College London, London UK

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

Response: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly.

The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent.

The present analysis shows that home blood pressure measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home  blood pressure and CAD or stroke events.

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Maternal Weight, Blood Glucose and Blood Pressure Affect Baby’s Birth Weight

MedicalResearch.com Interview with:
Debbie Lawlor PhD
School of Social and Community Medicine
University of Bristol, Oakfield House, Oakfield Grove
Medical Research Council Integrative Epidemiology Unit
University of Bristol, UK and
Rachel Freathy PhD,
University of Exeter, Institute of Biomedical and Clinical Science,
Royal Devon and Exeter Hospital,  Exeter  UK

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

Response: A healthy birth weight is important for babies’ health and wellbeing in the first year of their life. It reflects how well the baby has grown and developed in the womb. The experience of fetuses in the womb and how well they grow and develop might also determine their future health, even into adulthood. Both being too light or too heavy at birth is not good for the baby. Lots of studies have shown that mothers who are fatter at the start of their pregnancy have babies who are more likely to be heavier. But is it not clear whether the mother being fatter causes their baby to be bigger at birth. If mothers’ fatness does cause their baby to be heavier at birth, why this happens is not clear.

We used genes to find out whether being fatter in pregnancy causes babies to be born heavier. We also tested whether risk factors in the mother that are affected by her fatness, such as her blood pressure, and the level of glucose (sugar) and lipids (fats) in her blood stream affect how heavy her baby is.

Our results showed that being fatter during pregnancy did cause a mothers’ baby to be born heavier. We also showed that having higher blood levels of glucose in pregnancy also caused a mothers’ baby to be heavier. But we did not find any effect of mothers’ blood levels of lipids in pregnancy on their baby’s weight. Whilst mothers who are heavier in pregnancy will tend to have higher blood pressure in pregnancy we found that higher blood pressure caused the women’s babies to be lighter.

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Hypertensive Disorders in Pregnancy Linked To Later Risk of Cardiomyopathy

MedicalResearch.com Interview with:
Ida Behrens, MD
and Heather Boyd PhD
Department of Epidemiology Research
Statens Serum Institut
Copenhagen, Denmark

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

Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life.

MedicalResearch.com: What are the main findings?

Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy).  Continue reading

Diabetics Need To Find ‘Sweet Spot’ For Blood Pressure Control

MedicalResearch.com Interview with:

Dr-Mattias-Brunström

Dr-Mattias-Brunström

Mattias Brunström, MD PhD student
Department of Public Health and Clinical Medicine
Umeå University Hospital
Umeå, SE  Sweden

Medical Research: What is the background for this study? What are the main findings?

Dr. Brunström: Current guidelines differ in their recommendations on blood pressure treatment targets for people with diabetes. We did a systematic review and meta-analysis of 49 studies, including almost 74 000 patients, to investigate the effect of treatment at different blood pressure levels. We found that treatment reduced the risk of death, stroke, myocardial infarction and heart failure if systolic blood pressure before treatment was above 140 mm Hg. However, if systolic blood pressure was below 140 mm Hg, treatment increased the risk of cardiovascular death.

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Post Menopausal Stroke Risk Raised In Women With Later Life Pregnancy

MedicalResearch.com Interview with:

Dr. Adnan Quershi MD Professor of Neurology, Neurosurgery and Radiology University of Minnesota

Dr. Adnan Qureshi

Dr. Adnan Qureshi MD
Professor of Neurology, Neurosurgery and Radiology
University of Minnesota 

Medical Research: What is the background for this study?

Dr. Quershi: Women who have the last pregnancy at advanced age (usually defined as pregnancy at age of 40 years or greater) have higher risk of developing hypertension, hypertension related disorders, and diabetes mellitus during pregnancy. There is some evidence that disproportionately higher rates of cardiovascular risk factors continue years after the pregnancy. Perhaps there are unknown medical conditions triggered during pregnancy at advanced age. These changes continue to progress without being clinically evident until years later manifesting as a cardiovascular event.

Medical Research: What are the main findings?

Dr. Quershi: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women’s Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period  of 12 years. A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p<0.0001), hemorrhagic stroke (0.5% versus 1.0%, p<0.0001), myocardial infarction (2.5% versus 3.0%, p<0.0001), and cardiovascular death (2.3% versus 3.9%, p<0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke even after adjusting for differences in age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking were adjusted.

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Which Fruits and Vegetables Are Better For Lowering Blood Pressure?

MedicalResearch.com Interview with:
Lea Borgi, MD
Joint Fellowship
Program in Nephrology
Brigham and Women’s/ Massachusetts General

Medical Research: What is the background for this study? What are the main findings?

Dr. Borgi: Hypertension is one of the most common diseases in the United States and in the world. It is a known risk factor for cardiovascular disease. Even when hypertension is well-controlled with anti-hypertensives, these individuals are at an increased cardiovascular risk. Therefore, a healthy lifestyle is critical for normotensive individuals. This usually includes dietary patterns. However, if we could restrict dietary patterns to specific foods, then we would be able to provide better advice to our patients.

In this study, we analyzed the association of fruits and vegetables with the incidence of hypertension. We were also interested in studying the change in consumption of fruits and vegetables over time and the incidence of hypertension. We used data from 3 large prospective cohort studies: the Nurses’ Health Study, the Nurses’ Health Study II and the Health Professional Follow-up study (total of 187,453 participants). Information about health and food intake was updated every 2 and 4 years, respectively.

We found that participants who consumed ≥4 servings/day of fruits (not including fruit juice) had a lower risk of developing hypertension (follow-up was more than 20 years), when compared to participants whose consumption was ≤4 servings/weeks (Hazard ratio=0.92; 95%CI= 0.87-0.97). However, the association of vegetable intake with hypertension was different; indeed, we found no significant association with a HR of 0.95(0.86-1.04).

To better understand these associations, we further analyzed individual fruits and vegetables with the incidence of hypertension. We found lower risks of developing hypertension when these individual fruits and vegetables were consumed ≥4 servings/week as compared to <1 serving/month: broccoli, carrots, tofu or soybeans, raisins and apples. In contrast, we found that eating more string beans or brussel sprouts was associated with an increased risk of hypertension with HRs of 1.11(1.05-1.17) and 1.23(1.04-1.46), respectively. In all of our analyses, we adjusted for potential cofounders (such as age, gender, body mass index and more).

Finally, we also found that increasing total fruit (but not total vegetable) consumption by ≥7servings/week in the preceding 8 years was associated with a lower risk of hypertension with a pooled HR 0.94(0.90-0.97).

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Some Blood Pressure Medications May Be Protective Against Alzheimer’s Disease

MedicalResearch.com Interview with:
Dr. Juan M. Saavedra, MD and
Dr. Abdel Elkahloun PhD
Comparative genomics and Cancer Genetics Branch
National Human Genome Research Institute,
National Institutes of Health, Bethesda, MD

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

Response: Alzheimer’s disease is the most frequent age-related dementia, a progressing, devastating illness without effective treatment. By the time it is diagnosed, major and irreversible cell injury has already occurred. It is therefore imperative to identify therapeutic agents effective against early, pre-symptomatic injury mechanisms and risk factors increasing vulnerability the disease.

We focused on a class of compounds blocking receptors for Angiotensin II, the Angiotensin Receptor Blockers (ARBs). These compounds are commonly used for the treatment of hypertension, a major risk factor for Alzheimer’s disease.

We and others have found that in addition to their cardiovascular benefits, ARBs are strongly neuroprotective. The present study was designed to explore in depth the neuroprotective effects of one member of the ARB class, candesartan. To this effect we cultured neurons extracted from the rat brain. These neurons were exposed to high concentrations of glutamate, a recently identified early injury mechanism in Alzheimer’s disease. We found that candesartan prevented glutamate-induced neuronal injury.

We conducted in-depth examination of our results by genome-wide expression profile analysis. We found that candesartan normalized glutamate-induced alterations in expression of hundreds of genes, including many involved in neuronal inflammation, cardiovascular disease, diabetes and alterations in amyloid metabolism a hallmark for Alzheimer’s disease. This was evidence of direct neuroprotective effects of relevance for this disorder.

When we compared our results with published databases obtained from autopsy samples from Alzheimer’s disease patients, we found impressive correlations. The expression of more than 400 genes altered by glutamate and normalized by candesartan in our cultures was similarly changed in the Alzheimer’s databases.

The conclusion was that our cell culture results represented alterations found in the human condition. Our observations provide novel evidence of neuroprotection from early mechanisms of injury in Alzheimer’s disease and support testing candesartan in controlled clinical studies including individuals at the early stages of the illness, to unequivocally demonstrate their therapeutic effect.

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Postpartum Screening Important For Women With Hypertension During Pregnancy

MEDICALRESEARCH.COM INTERVIEW WITH:
KRISTI REYNOLDS, PHD, MPH 

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101

Dr. Kristi Reynolds

KAISER PERMANENTE RESEARCH
RESEARCH & EVALUATION
PASADENA, CA 91101 

Medical Research: What is the background for this study?

Dr. Reynolds: Hypertensive disorders during pregnancy are common, affecting up to 10 percent of all pregnant women, and include gestational hypertension, preeclampsia (which is a combination of high blood pressure and protein in the urine), and eclampsia, which includes seizures in women with severe preeclampsia. Research has shown that hypertensive disorders in pregnancy are associated with long-term cardiovascular disease risk, but little is known about the effect of these conditions in the early years after delivery.

As part of our study, we examined the electronic health records of 5,960 women who had prenatal care and delivered a baby at the Kaiser Permanente Southern California Bellflower Medical Center between 2005 and 2010. Women with high blood pressure before their pregnancy were excluded from the analysis.

Medical Research: What are the main findings?

Dr. Reynolds: We found that women who had a hypertensive disorder during pregnancy were 2.4 times more likely – and women with pre-eclampsia/eclampsia 2.5 times more likely – to develop pre-hypertension or hypertension in the year after delivery than those who maintained a normal blood pressure during their pregnancy, after controlling for differences between the groups.

In comparison to women with normal blood pressure during pregnancy, women with pregnancy-related hypertension tended to be slightly younger and overweight or obese before pregnancy. In addition, they were more likely to have had one or more children previously and to gain excess weight and develop gestational diabetes during their pregnancy.

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Lower Blood Pressure Target May Reduce Heart Disease and Save Lives

Kazem Rahimi | FRCP DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust

Prof. Kazem Rahimi

MedicalResearch.com Interview with:
Kazem Rahimi | FRCP DM MSc FESC
Associate Professor of Cardiovascular Medicine, University of Oxford
Deputy Director, The George Institute for Global Health
James Martin Fellow in Healthcare Innovation, Oxford Martin School
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust

Medical Research: What is the background for this study? What are the main findings?

Prof. Rahimi: Although the benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established, the extent to which these effects differ by baseline blood pressure, presence of co-morbidities (such as stroke or diabetes), or drug class is less clear.

Medical Research: What should clinicians and patients take away from your report?

Prof. Rahimi: Our study has several implications for clinical practice. Our findings suggest that blood pressure lowering to levels below those recommended in current guidelines (ie, systolic

blood pressure of less than 140 mm Hg) will reduce the risk of cardiovascular disease. By showing no evidence for a threshold below which blood pressure lowering ceases to work, the findings call for blood pressure lowering based on an individual’s potential net benefit from treatment rather than treatment of the risk factor to a specific target. Furthermore, the differences we identified between classes of drugs support more targeted drug use for individuals at high risk of specific outcomes (eg, calcium channel blocker therapy for individuals at high risk of stroke or and diuretics are more eff ective for prevention of heart failure).

Overall, our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease and potentially save millions of lives if the treatment was widely implemented. The results provide strong support for reducing systolic blood pressure to less than 130 mmHg, and blood pressure-lowering drugs should be offered to all patients at high risk of having a heart attack or stroke, whatever their reason for being at risk.  Continue reading

Drinking Tea Linked To Lower Hypertension Risk

Wenji Li, MMed, PhD Postdoc Associate Department of Pharmaceutics Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey

Dr. Wenji Li

MedicalResearch.com Interview with:
Wenji Li, MMed, PhD
Postdoc Associate
Department of Pharmaceutics
Ernest Mario School of Pharmacy
Rutgers, The State University of New Jersey

Medical Research: What is the background for this study? What are the main findings?

Dr. Li: Hypertension is a vital risk factor for many serious disorders. Male and age ≥40 years were found to be highly associated with more severe hypertension. In Singapore, the prevalence of hypertension increased markedly from age 40 years onwards. Tea, a popular beverage in Chinese people, has been approved to possess many beneficial pharmacological effects including antihypertension. However, no clinical studies on the correlation between tea drinking and its effect on lowering blood pressure among Singaporeans have been conducted. To find out the potential link, we are the first to investigate the correlation of hypertension and consumption of tea, health supplements, living habits and socio-demographic factors among Singaporean Chinese residents.

By the large scale cross-sectional epidemiology study (N = 1184), we found the prevalence of hypertension among the whole investigated population was 49.73% and the prevalence increased to 66.47% in the sub-population aged ⩾60 years. High risk of hypertension was associated with age ⩾60 years, obesity, family history of hypertension, diabetes history, hyperlipidemia history, male and coffee intake. In contrast, drinking green tea at least 150 ml per week was associated with lower hypertension risk. Drinking combination of green tea and British tea was associated with higher reduction in the risk of hypertension. This study suggests that consumption of tea, especially green tea and British tea, is beneficial for lowering the risk of hypertension while the consumption of coffee may have the opposite effect.  Continue reading

ER Visits For Hypertension Common and Increasing

Candace D. McNaughton,

Dr. McNaughton

MedicalResearch.com Interview with:
Candace D. McNaughton, MD MPH FACEP
Assistant Professor
Emergency Medicine Research
Department of Emergency Medicine, Research Division
Vanderbilt University Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. McNaughton: Hypertension, or high blood pressure, affects 1/3rd of adults in the United States and more than 1 billion people worldwide.  It is also the #1 risk factor for cardiovascular disease such as heart attack and stroke, so it is very important to treat.

The burden of hypertension in the emergency department is not well understood.  The ER is not usually thought of as a place where perhaps we could or should be addressing hypertension; that has traditionally be left up to primary care providers. Through this study, our goals were to gain a better understanding of how many ER visits were either related to hypertension or were solely because of hypertension, and to determine whether this changed from 2006 to 2012.

We found that emergency room visits related to or solely for hypertension were common and that they both rose more than 20% from 2006 to 2012. Visits to the emergency department specifically for hypertension were more common among patients who were younger, healthier, and less likely to have health insurance. Despite increases in the number of ER visits related to hypertension, the proportion of patients who were hospitalized did not increase; this suggests that doctors in emergency departments may be more aware of hypertension and/or may be managing it without having to hospitalize patients.
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CDC Study Finds Childhood High Blood Pressure Prevalence Decreasing

Quanhe Yang, PhD Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta, GA 30341

Dr. Yang

MedicalResearch.com Interview with:
Quanhe Yang, PhD
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention
Atlanta, GA 30341

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

Dr. Yang: Body mass index (BMI) is an important risk factor for high blood pressure among adolescents. Despite a recent leveling off in the numbers of overweight and obese youths, weight-associated health outcomes remain a problem in the U.S. Some researchers have suggested that the increased prevalence of high blood pressure among adolescents is associated with the epidemic of overweight and obesity in the U.S.

As a result, we analyzed trends in pre-high blood pressure and high blood pressure among U.S. youth using data from a series of National Health and Nutrition Examination Surveys. Nearly 15,000 adolescents between the ages of 12 and 19 were included in the surveys, which were conducted between 1988 and 2012.

During that 24-year timeframe, the prevalence of high blood pressure actually decreased overall, while pre-high blood pressure remained largely unchanged. However, those rates differed based on body weight category. For example, pre-high blood pressure was consistently higher among overweight/obese adolescents (18 to 22 percent) than those of normal weight (11 to 12 percent). The observed changes in both pre-high blood pressure and high blood pressure prevalence were consistent across age group, sex and race/ethnicity.

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Should All Patients with Resistant Hypertension Be Screened for Primary Aldosteronism?

Carrie C. Lubitz, MD, MPH Assistant Professor of Surgery, Harvard Medical School Senior Scientist, Institute for Technology Assessment Attending Surgeon, Mass General/North Shore Center for Outpatient Care Danvers, Massachusetts

Dr. Lubitz

MedicalResearch.com Interview with:
Carrie C. Lubitz, MD, MPH
Assistant Professor of Surgery, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Attending Surgeon, Mass General/North Shore Center for Outpatient Care
Danvers, Massachusetts

Medical Research: What is the background for this study? What are the main findings?

Dr. Lubitz: Given reported estimates of resistant hypertension and the proportion of resistant hypertensive patients  with primary hyperaldosteronism (PA) – the most common form of secondary hypertension caused by a nodule or hyperplasia of the adrenal glands – we estimate over a million Americans have undiagnosed PA. Furthermore, it has been shown that patients with PA with the same blood pressure as comparable patients with primary hypertension have worse outcomes.

In our study, we found that identifying and appropriately treating patients with PA can improve long-term outcomes in patients in a large number of patients who have resistant hypertension.

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Study Examines Higher Systolic Blood Pressure and Kidney Disease Progression

MedicalResearch.com Interview with:
Dr Will Herrington MD, MRCP and
Dr Natalie Staplin PhD
Nuffield Department of Population Health,
University of Oxford
Oxford, UK

Medical Research: What is the background for this study? What are the main findings?

Response: These analyses use data from SHARP, a trial of 9000 patients with chronic kidney disease which established that lowering LDL-cholesterol with a statin-based regime (simvastatin 20mg/ezetimibe 10mg) safely reduced risk of a heart attack or stroke in kidney patients.

We have now used the SHARP dataset to investigate the association between blood pressure and rate of renal progression among those with different levels of albumin in the urine. These observations show that higher systolic blood pressure is associated with faster rate of renal progression irrespective of the presence or absence of albumin in the urine.

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White Coat Hypertension Is Not Benign and Should Not Be Ignored

Dr. Wanpen Vongpatanasin MD Program Director, Hypertension Fellowship Program Professor of Internal Medicine Director of the University of Texas Southwestern Hypertension ProgramMedicalResearch.com Interview with:
Dr. Wanpen Vongpatanasin MD
Program Director, Hypertension Fellowship Program
Professor of Internal Medicine
Director of the University of Texas Southwestern Hypertension Program

Medical Research: What is the background for this study? What are the main findings?

Dr. Vongpatanasin: Home blood pressure measurement may reveal very different number when compared to clinic blood pressure in hypertensive patients.  This difference can manifest as white coat hypertension (White Coat Hypertension; elevated office blood pressure with normal ambulatory or home blood pressure), or masked hypertension (MH; elevated ambulatory or home BP with normal office blood pressure).  Although numerous epidemiological studies from Europe and Asia have shown increased cardiovascular risks associated with White Coat Hypertension and masked hypertension, previous studies have not addressed cardiovascular outcomes associated with White Coat Hypertension and masked hypertension in the general population in the United States.

We found that  participants in the Dallas Heart Study, a multiethnic populational-based study in the Dallas County, both White Coat Hypertension and MH are associated with increased aortic stiffness and markers of kidney damage when compared to the group with normal blood pressure both at home and in the clinic. Furthermore, both white coat hypertension and masked hypertension are associated with increased risk of cardiovascular events, including coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death over a median follow-up period of 9 years.

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Beta Blockers May Reduce Ability To Lose Weight

MedicalResearch.com Interview with:
Mirna Azar MD

Division of Endocrinology and Metabolism
University of Ottawa Weight Management Clinic
The Ottawa Hospital Ottawa, ON, Canada 

Medical Research: What is the background for this study? What are the main findings?

Dr. Azar: Previous studies have shown an association between beta-blockers and weight gain but little is known about the effect of beta-blockers on weight loss.

Here we demonstrate that patients treated with beta-blockers exhibit a reduced ability to lose weight in response to a standardized 900 kcal meal replacement program.

From a database of 3,582 patients who participated in a 6-week 900 kcal/day Optifast meal replacement weight loss program, 173 patients were on beta-blockers. We determined differences in rate of weight loss and changes in waist circumference in the first 6 weeks of meal replacement program in these subjects as compared to controls, matched for sex, age and initial weight and to the entire population with adjustment for age, sex, initial body weight, ACE inhibitor and diuretic therapy and existing cardiovascular disease.

In comparison with matched controls, beta-blocker treated subjects lost a mean of 0.67 kg less than their matched controls (P = 0.01) and their percent weight loss was 0.6% lower (P = 0.0001). Differences were also noted for changes in waist circumference (-24.2 vs -25.2 cm, P= 0.04). Findings were not altered after adjustment for cardiovascular indications for beta-blocker therapy.

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Men Have Small Risk of Falls and Fractures When Starting Prostate Alpha Blockers

Blayne Welk MD Assistant Professor in the Division of Urology The University of Western Ontario

Dr. Welk

MedicalResearch.com Interview with:
Blayne Welk MD
Assistant Professor in the Division of Urology
Department of Surgery, Western University Institute for Clinical Evaluative Sciences
Department of Epidemiology and Biostatistics
Western University, London, Ontario 

Medical Research: What is the background for this study? What are the main findings?

Dr. Welk: Alpha blocker medications are used to treat urinary symptoms in men. They are very commonly prescribed, especially among the elderly. One of the potential side effects of these medications is low blood pressure and fainting. Newer medications are designed to be more specific to the prostate, in order to try and reduce these risks. Previous studies have had conflicting results regard the risk of low blood pressure, and whether this risk translates into clinically relevant complications like serious falls, fractures or head injury.

This study demonstrated that there is a small, but significant increase in the risk of falls, fractures and head injury associated with the initiation of prostate specific alpha blockers. Most men, however have a very low risk of these events to begin with, so the absolute change in their risk is very small. The mechanism of these outcomes is likely mediated through hypotension, which was also diagnosed in the majority of men with a fall or fracture.

Medical Research: What should clinicians and patients take away from your report?

Dr. Welk: Men starting alpha blocker medication for urinary symptoms should be counselled about the potential risk of low blood pressure and fainting. While not dangerous most of the time, these medications can lead to fractures and head injuries, which have serious consequences in the elderly. Avoiding dangerous activities when first starting these medications, and taking the mediation at night time may help avoid these risks.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Welk: Further research could examine the the role of 5 alpha reductase inhibitors (also used for male urinary symptoms) in modulating the risk of falls and fractures in men being treated with alpha blockers.

Citation:

Welk Blayne, McArthur Eric, Fraser Lisa-Ann,Hayward Jade, Dixon Stephanie, Hwang Y Joseph et al. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study 2015; 351 :h5398

Blayne Welk MD (2015). Men Have Small Risk of Falls and Fractures When Starting Prostate Alpha Blockers

Beta Blockers Linked To Increased Risk After Non-Cardiac Surgery In Some Hypertensive Patients

Mads Emil Jørgensen Copenhagen University Hospital..., MedicalResearch.com Interview with:
Mads E. Jørgensen, MB
Cardiovascular Research Center
Gentofte Hospital
University of Copenhagen, Denmark

Medical Research: What is the background for this study? What are the main findings?

Response: For many years there has been a wide use of beta blockers in the non-cardiac surgery setting with the intent to protect the heart. Within recent years, this field of research has opened up to new studies evaluating in detail which patient subgroups do benefit from this therapy and which may actually be at increased risk. The current study evaluated chronic beta blocker use and risks of perioperative complications in a rather low risk population of patients with hypertension, but without cardiac, kidney or liver disease.

Among 55,000 patients receiving at least two antihypertensive drugs, we found that patients treated with a beta blocker were at increased risks of complications during surgery and 30-day after surgery, compared to patients treated with other antihypertensive drugs only. In various subgroup analyses (by age, gender, diabetes, surgery risk etc.) the findings were consistent although challenged in power.

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Taking Blood Pressure Meds At Night Decreases Diabetes Risk

Ramon C. Hermida Dominguez, Ph.D. Director, Bioengineering & Chronobiology Labs. Campus Universitario Vigo, PontevedraMedicalResearch.com Interview with:
Ramon C. Hermida Dominguez, Ph.D.

Director, Bioengineering & Chronobiology Labs.
Campus Universitario
Vigo, Pontevedra

Medical Research: What is the background for this study? What are the main findings?

Dr. Hermida Dominguez: Independent studies have shown that the asleep blood pressure (BP) mean is abetter predictor of cardiovascular risk than clinic BP or the awake blood pressure mean derived from ambulatory BP monitoring. Moreover, sleep-time hypertension is highly prevalent among patients with type 2 diabetes. In the first manuscript we tested two novel hypotheses:

(i) whether sleep-time BP is a prognostic marker for future development of diabetes; and (ii) whether progressive reduction of sleep-time blood pressure actually reduces the risk of developing diabetes.

The main findings indicate that sleep-time blood pressure is indeed a highly significant prognostic marker for new-onset diabetes, while clinic blood pressure measurements are not. Most important from the therapeutic point of view, the results from our prospective study also indicate lowering asleep blood pressure could indeed be a significant method for reducing the risk of developing diabetes.

On the other hand, multiple clinical trials have shown that bedtime ingestion of hypertension medications of several classes is associated with improved blood pressure measurements control and increased efficacy in lowering asleep BP. In the second manuscript we investigated whether therapy with the entire daily dose of one or more antihypertensive medications at bedtime exerts better reduction in the risk of developing diabetes than ingesting all medications in the morning upon awakening. The results from this randomized clinical trial indicate a significant 57% decrease in the risk of developing diabetes in the bedtime compared to the awakening treatment regimen.

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Hypertensive Black Patients Have Worse Outcomes From ACE Inhibitor Therapy

Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and Medicine Director, Division of Health and Behavior Director, Center for Healthful Behavior Change Vice Dean, NYU College of Global Public Health NYU Langone School of Medicine Department of Population Health New York, NY 10016MedicalResearch.com Interview with:
Gbenga Ogedegbe, MD, MS, MPH FACP
Professor of Population Health and Medicine
Director, Division of Health and Behavior
Director, Center for Healthful Behavior Change
Vice Dean,  NYU College of Global Public Health
NYU Langone School of Medicine
Department of Population Health
New York, NY 10016

Medical Research: What is the background for this study?

Dr. Ogedebge: Evidence from clinical trials have previously indicated that a common blood pressure medication, angiotensin-converting-enzyme (ACE) inhibitors, (when prescribed as first line treatment) may not provide the same benefits in blacks compared to whites. However blacks are grossly underrepresented in these studies, despite the fact they have disproportionately higher rates of hypertension-related morbidity and mortality than whites. Thus, we chose to study this particular question because it allows us to evaluate this evidence in a large population of hypertensive black patients who receive care in a real-world practice setting. This study evaluates racial differences in cardiovascular outcomes and mortality between hypertensive black and white patients whose treatment was initiated with angiotensin-converting-enzyme (ACE) inhibitors, outside of a clinical trial.  ACE inhibitors are one of several classes of drugs commonly prescribed to individuals with hypertension to prevent deaths, heart attack, kidney failure, heart failure and stroke.

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Brain Damage From Chronic Hypertension Studied

Daniela Carnevale, PhD, Researcher Laboratory of Giuseppe Lembo, MD, PhD Dept. of Molecular Medicine "Sapienza" University of Rome & Dept. of Angiocardioneurology and Translational Medicine IRCCS Neuromed - Technology Park Località CamerelleMedicalResearch.com Interview with:
Daniela Carnevale, PhD, Researcher
Laboratory of Giuseppe Lembo, MD, PhD
Dept. of Molecular Medicine
“Sapienza” University of Rome
& Dept. of Angiocardioneurology and Translational Medicine
IRCCS Neuromed – Technology Park
Località Camerelle

Medical Research: What is the background for this study?

Dr. Carnevale: Nowadays, one of the most demanding challenge in medicine is preserving cognitive functions during aging. It is well known that cardiovascular risk factors have a profound impact on the possibility of developing dementia with aging. However, we have no means to investigate this aspect in patients with cardiovascular diseases. Indeed, although we have clear clinical paradigms to explore target organ damage of vascular diseases like hypertension, we are less prepared to afford the brain damage that may result from chronic vascular diseases and impact on cognitive functions. Thus, we aimed at finding a diagnostic paradigm to assess brain damage that could predict for future development of dementia. Since it is becoming increasingly clear that hypertension may determine cognitive decline, even before manifest neurodegeneration, we elaborated a paradigm of analysis that are essentially focused on brain imaging and cognitive assessment. In particular, we used diffusion tensor imaging (DTI) on magnetic resonance that allows to reconstruct white matter connections that correlate with selective cognitive functions, and specifics tests for the evaluation of subtle alterations of cognitive functions.

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Chronic Inflammation May Predict Why Black Women More Prone To Heart Disease

MedicalResearch.com Interview with:
Carmen De Miguel, PhD | Postdoctoral Scholar
Section of Cardio-Renal Physiology and Medicine
Department of Medicine | Division of Nephrology
UAB | The University of Alabama at Birmingham

Medical Research: What is the background for this study?

Dr. De Miguel: It is known that obesity is a major risk for cardiovascular disease and that cardiovascular disease is more prevalent in the African American population. Specifically, female African Americans have an exceptionally high risk of developing cardiovascular disease. Obesity is known to contribute to the development of diabetes, hypertension, heart disease, etc. All these diseases have in common persistent low-grade inflammation, and we also know that signs of inflammation can be observed in patients with cardiovascular disease years before the disease is diagnosed. A better understanding of the differences within ethnicities regarding the development of cardiovascular disease is needed and will lead to the development of better therapies targeted to each population. Based on all of this knowledge, we hypothesized that obesity would lead to different changes in the immune system of male and female, Caucasian and African American teenagers (14-20 year old).

Medical Research: What are the main findings?

Dr. De Miguel: We found differences in the immune cell profile in white and black teenagers, and within gender in the African American subjects. We believe that monitoring these differences could be used to recognize at an earlier stage those individuals that are at-risk of developing cardiovascular disease in the future, and this could allow for preventive therapies that would reduce such risk.

Specifically, we found that obese white teenagers decrease the numbers of T cells (a kind of immune cell) in the circulation (blood) compared to African American teenagers, which indicates that they have less systemic inflammation than the African Americans subjects in response to obesity. Within the African American subjects, we found that obese males had smaller numbers of T cytotoxic cells (CD8+ cells, a specific kind of T cell) and smaller numbers of activated T cytotoxic cells than lean males, what tells us that obese males are trying to decrease their inflammation levels. However, obese African American females do not decrease those levels, so their inflammation remains elevated. We think that the fact that they do not decrease the activation of T cytotoxic cells (CD8+ cells) could be important in explaining the high risk that black females have of developing cardiovascular disease later in life.

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Orthostatic Hypotension and Blood Pressure Variability Linked to Cognitive Decline

Christine McGarrigle PhD Research Director The Irish Longitudinal Study on Ageing (TILDA) Lincoln Gate Trinity College Dublin Dublin

MedicalResearch.com Interview with:
Christine McGarrigle PhD
Research Director
The Irish Longitudinal Study on Ageing (TILDA)
Lincoln Gate
Trinity College Dublin Dublin

 

Medical Research: What is the background for this study? What are the main findings?
Dr. McGarrigle: Mild cognitive impairment (MCI) is the intermediate state between healthy ageing and dementia and is a stage at which intervention could be effective in reducing conversion to dementia.

Neurocardiovascular instability is an age-related dysregulation of the blood pressure systems manifesting as exaggerated blood pressure variability and orthostatic hypotension (OH). Previous evidence has shown that autonomic dysfunction, blood pressure variation and hypotension are associated with mild cognitive impairment.

Our study found that systolic blood pressure variation was associated with cognitive decline. Mild cognitive impairment participants were more likely to have had OH and more prolonged OH compared to cognitively normal controls. Mild cognitive impairment participants with impaired orthostatic blood pressure responses were twice more likely to convert to dementia than mild cognitive impairment participants without the impaired response over a three year follow-up period.

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Algorithm Attempts To Overcome Medical Intolerance In Hypertensive Patients

Dr M Lobo PhD FRCP Director Barts BP Centre of Excellence Consultant Physician and Hon Senior Lecturer NIHR Barts Cardiovascular Biomedical Research Unit William Harvey Research Institute, London MedicalResearch.com Interview with:
Dr M Lobo PhD FRCP

Director Barts BP Centre of Excellence
Consultant Physician and Hon Senior Lecturer
NIHR Barts Cardiovascular Biomedical Research Unit
William Harvey Research Institute, London

Medical Research: What hypothesis did you set out to investigate and why?

Dr. Lobo: We investigated the clinical utility of a novel treatment algorithm for multi-drug intolerant patients with hypertension who are at very high risk of cardiovascular disease due to uncontrolled blood pressure and inability to take conventional (guideline-based) antihypertensive regiments. These patients are often poorly managed by primary care physicians (or specialists such as cardiologists) because there has been little interest/research in medication intolerance. There has however been a major focus on drug non-adherence as a cause of failure to control hypertension – we believe that a key cause of non-adherence is medication intolerance which patients do not always volunteer.

Medical Research: What is the report’s ultimate take-away message?

Dr. Lobo: Our novel stepwise algorithm was successful in managing uncontrolled hypertension in the majority of patients without needing an increase in their medicines burden. The message therefore is that patients who do not tolerate their antihypertensives do not have to put up with side effects and resultant poor quality of life as we have demonstrated that there are ways to get around medication intolerances.

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Discontinuing Blood Pressure Medication In Older Adults Did Not Improve Cognition

MedicalResearch.com Interview with:
Justine Moonen and Jessica Foster-Dingley

On behalf of the principal investigators:
Roos van der Mast, Ton de Craen, Wouter de Ruijter and Jeroen van der Grond
Department of Psychiatry, Leiden University Medical Center
Leiden, the Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Mid-life high blood pressure is a well-known risk factor for cerebrovascular pathology and, consequently, cognitive decline in old age. However, the effect of late-life blood pressure on cognition is less clear. It has been suggested that at old age not a higher, but a lower blood pressure increases the risk of cognitive decline as well as neuropsychiatric symptoms. Older persons are at risk for impaired regulation of their cerebral blood flow, and stringently lowering their blood pressure may compromise cerebral blood flow, and thereby cognitive function. Therefore, we hypothesized that increasing blood pressure by discontinuation of antihypertensive treatment would improve cognitive and psychological functioning. We performed a community-based randomized controlled trial in a total of 385 participants aged ≥75 years with mild cognitive deficits and without serious cardiovascular disease, and who were all receiving antihypertensive treatment. Persons were randomized to continuation or discontinuation of antihypertensive treatment. Contradictory to our expectation, we found that discontinuation of antihypertensive treatment in older persons did not improve cognitive functioning at 16-week follow-up.

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Electroacupuncture Reduces Blood Pressure in Hypertensive Patients

Stephanie Tjen-A-Looi, MS, PhD Project Scientist Susan Samueli Center for Integrative Medicine Department of Medicine University of Medicine, IrvineMedicalResearch.com Interview with:
Stephanie Tjen-A-Looi, MS, PhD
Project Scientist
Susan Samueli Center for Integrative Medicine
Department of Medicine
University of Medicine, Irvine

Medical Research: What is the background for this study?

Response: Mild to moderate hypertensive patient engaged in a stressful condition can lead to adverse cardiovascular responses such as a heart attack or stroke.  Complementary to conventional medical antihypertensive drug treatments that pose side effects, acupuncture therapy with minimal side effects appears to reduce the high blood pressure.

Medical Research: What are the main findings?

Response: The main findings indicate a reduction in blood pressure in patients with hypertension.  The data show that about 70% of the acupuncture treated patients benefit from this therapy.  Moreover, plasma hormones indexing high sympathetic activity such as nor-epinephrine as well as renin, angiotensin and aldosterone are reduced with acupuncture.

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Blood Pressure Dippers May React Differently to Morning Blood Pressure Surge

MedicalResearch.com Interview with:
Prof. Sante D. Pierdomenico
Associate Professor of Internal Medicine
University “Gabriele d’Annunzio”
Chieti-Pescara – Italy

Medical Research: What is the background for this study? What are the main findings?

Dr. Pierdomenico: Though a peak incidence of cardiovascular events in the morning has
been observed, the independent prognostic value of morning surge (MS)
of blood pressure (BP) is not yet clear. We investigated the
association between morning surge of systolic blood pressure and risk of coronary events in elderly treated hypertensive patients. Subjects were divided according
to tertiles of MS of systolic blood pressure of the population as a whole, by
dipping status (nondippers are at increased risk than dippers) and by
group-specific tertiles of morning surge of systolic blood pressure in dippers and nondippers because these groups have different MS of blood pressure. In elderly treated
hypertensive patients, high MS of systolic BP predicts coronary events
in dippers but not in nondippers. Nondippers, however, show higher
risk of coronary events independently of morning surge in systolic blood pressure.

Medical Research: What should clinicians and patients take away from your report?

Dr. Pierdomenico: Blood pressure should be better controlled after awakening in dippers with high morning surge and during the night in nondippers in order to better prevent
cardiovascular events. Continue reading

Mild Increase in Daily Sodium Increases Risk of Hypertension

Salt-SodiumMedicalResearch.com Interview with:
Tomonori Sugiura, MD, PhD
Department of Cardio‐Renal Medicine and Hypertension
Nagoya City University Graduate School of Medical Sciences
Nagoya  Japan

Medical Research: What is the background for this study? What are the main findings?

Dr. Sugiura: Although there is a close relationship between dietary sodium and hypertension, the concept that individuals with relatively high dietary sodium are at increased risk of developing hypertension compared to those with relatively low dietary sodium, has not been intensively studied in a cohort. Therefore, the present observational study was designed to investigate whether individual levels of dietary sodium critically affect future increases in blood pressure in the general population.

The main findings of this study were that a relatively high level of dietary sodium intake and also a gradual increase in dietary sodium, estimated by urinary sodium excretion, are associated with a future increase in blood pressure and the incidence of hypertension in the general population.

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ACE Inhibitors Not A Good First Choice For Hypertension in Blacks

MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
The Leon H. Charney Division of Cardiology,
Associate Professor of Medicine,
New York University Langone School of Medicine,
Principal Investigator ISCHEMIA-CKD trial

Medical Research: What is the background for this study? What are the main findings?

Dr. Bangalore: Angiotensin converting enzyme inhibitors (ACEi) are a common class of antihypertensive agents used for the management of hypertension. In many national and international hypertension guidelines, they are recommended as a first line agent. However, their efficacy and safety in hypertensive Blacks is not known.

In an analysis of hypertensive blacks we found that ACEi were consistently inferior to that of calcium channel blockers or thiazide diuretics with a higher risk of cardiovascular events.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bangalore: Although ACEi are recommended as first line agents by national and international guidelines, they likely are not a great choice for hypertensive blacks. In fact few of the guidelines recognize this and recommend calcium channel blockers or diuretics for hypertensive blacks–consistent with the results seen in our study.
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Phthalate Replacements May Contribute to High Blood Pressure in Youth

MedicalResearch.com Interview with:
Teresa M. Attina, MD, PhD, MPH and
Leonardo Trasande, MD, MPP

Department of Pediatrics
NYU Langone Medical Center

Medical Research: What is the background for this study?

Response: Phthalates are environmental chemicals widely used in consumer and personal care products, and often found in plastic to increase flexibility. Di-2-ethylhexylphthalate (DEHP) is of particular interest because industrial processes to produce food frequently use plastic products containing DEHP. Because recognition of potential health risks related to DEHP exposure has increased, DEHP is being replaced by di-isononyl phthalate (DINP) and di-isodecyl phthalate (DIDP), two phthalates with similar chemical properties. Specifically, DINP is used in plastic products for food packaging, and DIDP is used in furnishings, cookware, medications, and several other consumer products. These alternatives have not been substantially studied for toxicity in laboratory studies because these studies are not required for regulatory approval: unlike the EU, in the US the current regulatory framework assumes that chemicals are safe until proven toxic.

Medical Research: What are the main findings?

Response: We examined DINP and DIDP levels in urine samples from children and adolescents (6 to 19 years old) who participated in the National Health and Nutrition Examination Survey between 2009 and 2012, to assess if these levels were associated with blood pressure measurements. Diet, physical activity, gender, race/ethnicity, income, and other factors that can contribute to increased blood pressure were also included in the analysis. A significant association was found between high blood pressure and DINP/DIDP levels in study participants. This is not a cause-and-effect relationship but it suggests that phthalates may contribute to increased blood pressure.

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Decrease in Blood Pressure Over Time Linked To Kidney Function Decline

Gijs Van Pottelbergh, MD, PhD Department of Health and Technology Leuven University College Leuven, BelgiumMedicalResearch.com Interview with:
Gijs Van Pottelbergh, MD, PhD
Department of Health and Technology
Leuven University College
Leuven, Belgium

Medical Research: What is the background for this study? What are the main findings?

Response: Earlier research identified arterial hypertension as a cause of chronic kidney disease but in older persons the relation between blood pressure and kidney function is little investigated.This study analyses the relation between dynamic blood pressure measurements and kidney function over time. A decline in blood pressure over time turned out to be a strong risk factor for kidney function decline in all age strata.

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High Blood Pressure In Young Adulthood Increases Risk Of Later Heart Failure

Satoru Kishi, MD Division of Cardiology Johns Hopkins University Baltimore, MarylandMedicalResearch.com Interview with:
Satoru Kishi, MD
Division of Cardiology
Johns Hopkins University
Baltimore, Maryland

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

Dr. Kishi: Blood pressure (BP) at the higher end of the population distribution may represent a chronic exposure that produces chronic injury to the cardiovascular system. Cumulative BP exposure from young adulthood to middle age may adversely influence myocardial function and predispose individuals to heart failure (HF) and other cardiovascular disease (CVD) later in life. The 2005 guidelines for the diagnosis and treatment of HF from the American College of Cardiology and American Heart Association highlight the importance of early recognition of subclinical cardiac disease and the importance of non-invasive tests in the clinical evaluation of heart failure.

Our main objective was to investigate how cumulative exposure to high blood pressure from young to middle adulthood influence LV function. In the Coronary Artery Risk Development in Young Adults (CARDIA) study, multiple repeated measures of BP and other cardiovascular risk factors was recorded over a 25 year time span, starting during early adulthood (ages 18-30). Continue reading

Your Smartphone May Help You Control Your Blood Pressure

MedicalResearch.com Interview with:
Neetika Garg, MD
Fellow in Nephrology
Beth Israel Deaconess Medical Center
Division of Nephrology, Department of Medicine
Boston, MA 02215

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

Dr. Garg: One in every three Americans suffers from hypertension. Since high blood pressure (BP) frequently does not cause any symptoms, self-blood pressure monitoring at home and patient education are critical components of patient management. With more than 58% of the US adults owning a smartphone, mobile-based health technologies (most commonly in the form of applications or “apps”) can serve as useful adjuncts in diagnosis and management of hypertension. At the same time, several smartphone-based applications are advertised as having blood pressure measurement functionality, which have not been validated against a gold standard. In this cross-sectional study, we analyzed the top 107 hypertension related apps available on the most popular smartphone platforms (Google Android and Apple iPhone) to analyze the functional characteristics and consumer interaction metrics of various hypertension related apps.

Nearly three-quarters of the apps record and track blood pressure, heart rate, salt intake, caloric intake and weight/body mass index. These app features can facilitate patient participation in hypertension management, medication adherence and patient-physician communication. However, it was concerning to find that 6.5% of the apps analyzed could transform the smartphone into a cuffless BP measuring device. None of these had any documentations of validation against a gold standard. Furthermore, number of downloads and favorable user ratings were significantly higher for these apps compared to apps without blood pressure measurement function. This highlights the need for greater oversight and regulation in medical device development.

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Blood Pressure Medication ARBs Should Be Resumed As Soon As Possible After Surgery

MedicalResearch.com Interview with:
Susan Ming Lee, MD, FRCPC, MAS (Clinical Research)

Clinical Instructor, Dept. of Anesthesia and Perioperative Care
University of California, San Francisco

Medical Research: What are the main findings?

Dr. Lee: Angiotensin receptor blockers (often referred to as ARBs) are common medications used to treat high blood pressure, heart disease, and kidney disease.  Doctors sometimes stop these medications briefly around the time of surgery, since they are known to cause low blood pressure under general anesthesia.  Doctors may hesitate to restart ARBs after surgery because they are worried about low blood pressure or kidney function.  Prior to our research, there was little information to guide the optimal timing of restarting ARBs after surgery.

Medical Research: What are the main findings?

Dr. Lee: Our study of over 30,000 veterans shows that nearly one third of veterans admitted to hospital for non-cardiac surgery are not restarted on their usual ARBs within two days of their operation.  This delay in resuming ARBs is associated with increased death rates in the first month after surgery.  In fact, even accounting for factors that might contribute to why doctors would withhold ARB (such as low blood pressure, kidney dysfunction, or other comorbidities), 30-day postoperative mortality was increased approximately 50% in those without resumption of ARBs, and this effect was even greater in younger patients under age 60.  Our findings of reduced rates of infections, pneumonia, heart failure, and kidney failure in those that resumed ARBs soon after surgery suggest that early resumption may also reduce complications after surgery.

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Pre-Operative Low Blood Pressure Linked To Increased Mortality After Surgery and Anesthesia

Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, WIMedicalResearch.com Interview with:
Prof. Dr. Robert Sanders MD
Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION)
Department of Anesthesiology
University of Wisconsin, Madison, WI

Medical Research: What is the background for this study? What are the main findings?

Dr. Sanders: While it is known that chronic raised blood pressure exerts important effects on long term health outcomes, it is unclear how pre-operative blood pressure levels effect risk from surgery. In this study we show that after adjustment for other diseases, high blood pressure does not increase perioperative risk. Rather low blood pressure is associated with an increase in risk of death following surgery and anesthesia.
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Elderly Hypertensive Patient With Declining Kidney Function Risk Cardiovascular Events

Enayet Karim Chowdhury, Research Fellow Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University The Alfred Centre Melbourne VIC 3004MedicalResearch.com Interview with:
Enayet Karim Chowdhury, Research Fellow
Department of Epidemiology and Preventive Medicine
School of Public Health and Preventive Medicine
Monash University The Alfred Centre
Melbourne VIC 3004

Medical Research: What is the background for this study? What are the main findings?

Dr. Chowdhury: The study was conducted on elderly treated hypertensive population. Australia is currently undergoing a demographic transition towards having increasing number of older people. As age advances quality of life becomes increasingly affected by a variety of chronic diseases including poor renal function. Therefore early detection and management of the risk associated with these chronic diseases is crucial. Managing hypertension, even though challenging, can significantly improve quality of life of a person by reducing risk of having cardiovascular events. The main finding of the study is that in elderly treated hypertensive people, a rapid decline in renal function was associated with a higher risk of having cardiovascular events irrespective of having chronic kidney disease or not. Continue reading