Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Neurology, UCSF / 10.08.2020

MedicalResearch.com Interview with: Laure Rouch, PharmD PhD Department of Psychiatry Dr. Kristine Yaffe, MD (Senior Author) Departments of Psychiatry, Neurology, and Epidemiology University of California San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA MedicalResearch.com: What is the background for this study? Response: Worldwide, around 50 million people have dementia and this number is set to triple by 2050. Prevention of dementia and identification of potentially modifiable risk factors are, therefore, critically important. Postural changes in blood pressure increase with advancing age and affect 20% to 30% of older adults. Yet it has not been explored deeply how orthostatic hypotension and blood pressure postural changes variability over time are associated with dementia risk. As multiple pharmacologic and nonpharmacologic interventions may improve orthostatic symptoms, this question has major public health implications. (more…)
Author Interviews, Blood Pressure - Hypertension, Social Issues / 01.08.2020

MedicalResearch.com Interview with: Dr. Shingo Yanagiya Hokkaido University Graduate School of Medicine Sapporo, Japan MedicalResearch.com: What is the background for this study? Response: Thank you very much for your question. Hypertension is a major risk factor for cardiovascular diseases including stroke and ischemic heart disease. Due to the relatively high prevalence of hypertension, there is an increased public burden resulting mainly from cardiovascular disease. It is well known that hypertension is associated with several lifestyle factors, including excessive intake of salt or alcohol, obesity, inactivity, and other personal attributes. Since socioeconomic status affects individual lifestyles and other factors, differences in socioeconomic status may influence the risk of hypertension. Therefore, it is important to clarify whether the risk of hypertension varies among socioeconomic classes when considering an effective strategy for preventing hypertension. Based on my research of previous reports about the relationship between household income and incident hypertension, evidence is scarce for Japan. So, we investigated this in an employed population in Japan. (more…)
Author Interviews, Blood Pressure - Hypertension, UT Southwestern / 15.04.2020

MedicalResearch.com Interview with: DaiWai Olson, PhD, RN Professor of Neurology and Neurotheraputics UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? Response: This study resonates across nursing. Kat Siaron is a Neuroscience nurse who had questions about the ‘best’ location for checking blood pressure. Like so many studies this started with a clinical question: “does it make a difference where you check the blood pressure?” She applied for a nursing research fellowship and was one of 6 nurses selected. She spent about 3 months reading articles on blood pressure and looking to see if there are any similar studies. After confirming that this has not been done, she submitted her study for approval from the Institutional Review Board and started data collection. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Weight Research / 08.04.2020

MedicalResearch.com Interview with: Zhen Yang MD PhD Department of Endocrinology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai, China   MedicalResearch.com: What is the background for this study? Response: Hypertension is a major public health problem affecting more than 1 billion people worldwide. And it is the leading cause of mortality and disability globally. Startlingly, more than half of people with elevated blood pressure were unaware of their hypertensive status in numerous surveys, partly owing to hypertension rarely shows symptoms in the early stages. Hence, hypertension is a silent killer. (more…)
Author Interviews, Blood Pressure - Hypertension, COVID -19 Coronavirus / 01.04.2020

MedicalResearch.com Interview with: Fabian Sanchis-Gomar, MD, MSc, PhD Department of Medicine Stanford University Medical Center Stanford, California Department of Physiology, School of Medicine, University of Valencia INCLIVA Biomedical Research Institute Valencia, Spain MedicalResearch.com: What is the background for this study? How does the RAAS system interface with the COVID-19 virus? Response: Angiotensin-converting enzyme (ACE)2 is a functional receptor for coronaviruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The exponential growth of contagion by the SARS-CoV-2 all around the world has contributed to raising speculations and concerns about whether two commonly used anti-hypertensive drugs, i.e., ACE inhibitors and angiotensin receptor blockers (ARBs), have positive or negative effects in coronavirus disease 2019 (abbreviated “COVID-19”) patients with arterial hypertension on-going treatment with some of the former drugs. In effect, many professional health organizations have published statements claiming that there is not enough evidence to change the use of ACE-inhibitors or ARBs for the management of raised blood pressure (BP) in the context of avoiding or treating COVID-19 infection. (more…)
Author Interviews, Blood Pressure - Hypertension, Columbia, Heart Disease, JAMA / 17.02.2020

MedicalResearch.com Interview with: George Hripcsak, MD, MS Vivian Beaumont Allen Professor of Biomedical Informatics Chair, Department of Biomedical Informatics Columbia University Director, Medical Informatics Services NewYork-Presbyterian Hospital/Columbia MedicalResearch.com: What is the background for this study? Response: Diuretics are considered among the best drugs to treat hypertension, but there are no randomized studies to tell us which diuretic is best. Hydrochlorothiazide is the most frequently used diuretic for hypertension, but another drug, chlorthalidone, is gaining favor, with the most recent US hypertension guideline expressing a preference for it. Chlorthalidone is known to be longer acting and therefore perhaps more effective. Other (non-randomized) studies have been inconsistent, and some of them imply that chlorthalidone may be more effective. But other studies have shown that chlorthalidone may have more side effects. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Gout / 28.01.2020

MedicalResearch.com Interview with: Stephen P. Juraschek, MD, PhD Assistant Professor, Harvard Medical School Beth Israel Deaconess Medical Center Division of General Medicine, Section for Research Boston, MA  02215 MedicalResearch.com: What is the background for this study? Response: Gout is a common complication of blood pressure treatment. Furthermore, 75% of adults with gout have hypertension. There are several classes of medications uses to treat hypertension. While prior studies have reported that calcium channel blockers like amlodipine lower uric acid, its effects on gout risk compared to other common first-line antihypertensive agents are unknown.  (more…)
Author Interviews, Blood Pressure - Hypertension, Duke, Pediatrics / 22.01.2020

MedicalResearch.com Interview with: Yuichiro Yano MD Assistant Professor in Family Medicine and Community Health Duke University  MedicalResearch.com: What is the background for this study? Response: The blood pressure (BP) guideline in the US recommend using an “average” of multiple BP measurements over time for screening for and management of high BP in young adults. While it is well known that BP varies across visits, that “variability” (i.e., visit-to-visit blood pressure variability) is dismissed as a random fluctuation in the clinical setting. Little is known regarding the clinical relevance of visit-to-visit blood pressure variability over time in young adults. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA / 26.11.2019

MedicalResearch.com Interview with: Brian S. Alper, MD, MSPH, FAAFP, FAMIA Board Certifications: Family Medicine, Clinical Informatics Founder of DynaMed Vice President of Innovations and Evidence-Based Medicine Development EBSCO Health  MedicalResearch.com: What is the background for this study? Response: We often use clinical practice guidelines as a “source of truth” for decision support for healthcare professionals and even as a standard of care for medical legal considerations.  However our experience evaluating guidelines for clinical reference support finds they are often inconsistent.  We picked one of the most common conditions managed in healthcare (ie hypertension, or high blood pressure) and sought out the top clinical practice guidelines that guide care around the world.   We systematically evaluated these guidelines against 70 specific recommendations to see how often the guidelines agreed or disagreed. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease / 05.11.2019

MedicalResearch.com Interview with: Rachel E. Climie PhD INSERM U970, Paris Cardiovascular Research Center (PARCC) Integrative Epidemiology of Cardiovascular Disease Team, University de Paris, Paris, France.  MedicalResearch.com: What is the background for this study? Response: It is well known that physical activity (PA) is beneficial for cardiovascular health. However, little consideration is given as to whether different domains of PA have differing associations with health outcomes. Indeed, recent work has shown that high amounts of PA at work are associated with increased risk of early death, however the underlying mechanisms are unknown. In this study, we explored the relationship between physical activity at work, during leisure time and as structured sport with baroreflex sensitivity. We distinguished between the mechanical (dependent on the stiffness of the arterial wall) and neural (nerve impulses sent by the receptors on the walls of the artery) components of the baroreflex. Importantly, baroreflex sensitivity is crucial for short- term blood pressure control and reduced baroreflex function is related to higher risk of cardiac mortality and sudden death.  (more…)
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA, OBGYNE / 18.10.2019

MedicalResearch.com Interview with: Haitham M. Ahmed, MD, MPH Chair of Cardiology, Advantage Care Physicians Brooklyn, New York MedicalResearch.com: What is the background for this study? Response: This was a meta-analysis of more than a quarter m illion mothers looking at the long-term cardiovascular risk reduction of mothers who breastfed their babies.  (more…)
Author Interviews, Blood Pressure - Hypertension, Dental Research / 24.09.2019

MedicalResearch.com Interview with: Dr Eva Muñoz Aguilera BDS MFDS MClinDent (Dist) MPerio RCSEd EFP Diploma in Periodontology and Implant Dentistry Senior Clinical Teaching Fellow in Periodontology UCL Eastman Dental Institute, London MedicalResearch.com: What is the background for this study? Response: High blood pressure and periodontitis are highly prevalent conditions that affect more than one third of the adult population worldwide. High blood pressure is the leading global cause of premature death and is the main preventable cause of cardiovascular disease,  while gum disease - also known as periodontitis - leads to severe inflammation of the gums and tooth loss. It impairs aesthetics and function and reduces quality of life. Most importantly, there is increasing evidence that periodontitis increases risk for future cardiovascular disease. Both diseases share common risk factors such as obesity and smoking and are major health problems that significantly impact on health costs.  (more…)
Author Interviews, Blood Pressure - Hypertension, Obstructive Sleep Apnea / 13.09.2019

MedicalResearch.com Interview with: Mireia Dalmases Cleries, MD Hospital Universitari Arnau de Vilanova and Santa Maria Group of Translational Research in Respiratory Medicine Lleida, Cataluña, Spain MedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea has been associated with poor blood pressure control and resistant hypertension. Moreover, it has been described that its treatment with continuous positive pressure (CPAP) could be an effective means of controlling blood pressure in this population. Nevertheless, studies assessing OSA prevalence, characteristics and association with blood pressure control in resistant hypertensive patients are limited and that’s the reason why we decided to perform this study. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, University of Pennsylvania / 09.09.2019

MedicalResearch.com Interview with: Jordana Cohen, MD, MSCE Assistant Professor of Medicine and Epidemiology Renal-Electrolyte and Hypertension Division Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: In the June 18, 2019 issue of Annals of Internal Medicine, we published a systematic review and meta-analysis evaluating the cardiovascular risks of white coat hypertension (WCH; i.e. elevated office blood pressure and normal out-of-office blood pressure). The goal of the meta-analysis was to clarify previous mixed results regarding the risks of untreated WCH and treated WCH. The meta-analysis examined 27 studies – including 64,273 patients – and demonstrated that untreated WCH is associated with an increased risk of cardiovascular events (36%), all-cause mortality (33%), and cardiovascular mortality (109%) compared to normotension. This risk was strongest in studies with a mean age ≥55 years or that included participants with cardiac risk factors, such as diabetes and chronic kidney disease. We found no increased cardiovascular risk associated with treated white coat hypertension. (more…)
Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JAMA, Race/Ethnic Diversity / 14.08.2019

MedicalResearch.com Interview with: Yuichiro Yano MD Assistant Professor in Family Medicine and Community Health Duke University  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: African Americans are disproportionally affected by hypertension-related cardiovascular disease compared with other racial/ethnic groups in the United States and have higher blood pressure levels inside and outside the clinic than whites and Asians. However, little is known, among African Americans, regarding whether higher mean blood pressure measured outside of the clinic setting on 24-hour ambulatory blood pressure monitoring is associated with an increased risk for cardiovascular disease events, independent of blood pressure measured in the clinic setting. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Technology / 07.08.2019

MedicalResearch.com Interview with: Kang Lee, PhD Dr Eric Jackman Institute of Child Study University of Toronto Toronto, Canada MedicalResearch.com: What is the background for this study? Response: We use a technology called transdermal optical imaging I and my postdoc invented to record facial blood flow using a regular video camera on the smartphone. This technology capitalizes on the fact that light travels beneath the facial skin and reflect off the hemoglobin under the skin. Our technology captures the minute reflected photons to decode facial blood changes due to our pulses and other physiological activities. Using machine learning, a neural network model learns to use the facial blood flow to predict blood pressures taken with a FDA approved scientific blood pressure measurement instrument. We then use the final model to predict the blood pressures of a new group of participants whose data had never been used in the model training. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, Stroke / 29.07.2019

MedicalResearch.com Interview with: "Blood Pressure Monitor" by Medisave UK is licensed under CC BY 2.0Kazuo Kitagawa, MD PhD Department of Neurology Tokyo Women's Medical University Tokyo, Japan MedicalResearch.com: What is the background for this study? What are the main findings Response:   Reduction in blood pressure (BP) reduces the rates of recurrent stroke, but the optimum BP target remained unclear. The results of RESPECT Study together with up-dated meta-analysis showed the benefit of intensive blood pressure lowering (<130/80 mmHg) compared with standard BP lowering (<140/90 mmHg).  (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 12.07.2019

MedicalResearch.com Interview with: Dr Kazem Rahimi Deputy Director of the George Centre for Healthcare Innovation James Martin Senior Fellow in Essential Healthcare Honorary Consultant Cardiologist at the John Radcliffe Hospital Deputy Director of the George Institute for Global Health MedicalResearch.com: What is the background for this study? Response: In the last century, we have witnessed a dramatic change in the spectrum of valvular heart disease and the prevalence of this condition has been rapidly increasing, due to population ageing, with poor patient outcomes and high healthcare costs associated with the only effective treatment available, which is valve repair or replacement. However, modifiable risk factors for valvular heart disease remain largely unknown, which limits prevention and treatment. We used a state-of-the-art, gene-based method called Mendelian randomization to determine the causality of the association between systolic blood pressure and risk of valvular heart diseases.  (more…)
Author Interviews, Blood Pressure - Hypertension, NEJM, Race/Ethnic Diversity / 20.03.2019

MedicalResearch.com Interview with: Dike B. Ojji, M.D., Ph.D, FWACP, FACP Department of Medicine Faculty of Clinical Sciences University of Abuja MedicalResearch.com: What is the background for this study? Response: We decided to do this research because there were no large RCTs before now that have compared the efficacy of contemporary combination therapies among any black populations in spite of the high burden of hypertension and its complications (such as heart failure, cerebrovascular accident and chronic kidney) in this population, and also the fact that majority require 2 or more medications to control their blood pressure. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA / 12.03.2019

MedicalResearch.com Interview with: Alexander A. Leung, MD, MPH Department of Community Health Sciences Department of Medicine University of Calgary Calgary, Alberta, Canada MedicalResearch.com: What is the background for this study? Response: The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure guidelines redefined hypertension according to a blood pressure cutoff of ≥130/80 mm Hg, compared to the traditional cutoff of ≥140/90 mm Hg. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Sleep Disorders / 07.03.2019

MedicalResearch.com Interview with: Dr Manolis S Kallistratos MD, PhD, FESC,EHS Asklepeion General Hospital Greece  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Lifestyle changes represent the cornerstone of treatment of arterial hypertension. Alcohol and salt reduction may decrease blood pressure levels by 2 to 8 mmHg. In our study 60 minutes of midday sleep decrease 24 hours systolic blood pressure levels by up to 3 mmHg in well controlled hypertensives. That is an effect as potent as other well-established life style changes. The magnitude of blood pressure decrease might seem small, but a drop in blood pressure as small as 2 mmHg can reduce the risk of cardiovascular events by up to 10 percent.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness / 22.02.2019

MedicalResearch.com Interview with: Michael J. Wheeler Baker Heart and Diabetes Institute Melbourne, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted this study because separate lines of inquiry have determined that a bout of exercise can acutely lower blood pressure, and more recently that prolonged sitting can increase blood pressure over the space of a day. We wanted to know whether the blood pressure lowering effects of an exercise bout would be diminished by a subsequent period of prolonged sitting or enhanced by a subsequent period of sitting that is regularly interrupted with short walking breaks. We found an additive blood pressure lowering effect when exercise was combined with breaks in sitting as opposed to exercise plus prolonged sitting. However, this was only true for women. Men had equal blood pressure lowering effects following exercise regardless of whether-or-not subsequent sitting was interrupted (more…)
Author Interviews, Beth Israel Deaconess, Blood Pressure - Hypertension, Salt-Sodium / 13.02.2019

MedicalResearch.com Interview with: Stephen P. Juraschek, MD, PhD Assistant Professor, Harvard Medical School Beth Israel Deaconess Medical Center Division of General Medicine, Section for Research Boston, MA  02215 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lightheadedness with standing is an important risk factor for falls. Sodium is often considered a treatment for lightheadedness with standing. We examined this in the setting of a monitored feeding study where adults ate each of 3 different sodium levels for 4 weeks at a time. Participants took 5 day breaks between sodium levels and ate the sodium levels in random order. We tested the hypothesis that lowering sodium would worsen how much lightheadedness the study participants reported. (more…)
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, JAMA / 25.01.2019

MedicalResearch.com Interview with: Jeff D. Williamson, MD Geriatric Medicine - Sticht Center Wake Forest Baptist Medical Center MedicalResearch.com: What is the background for this study? Response: A growing amount of epidemiologic research has suggested that higher blood pressure is associated with higher risk for dementia, including Alzheimer’s dementia. MedicalResearch.com: What are the main findings? Response: More than 9,300 ambulatory, community dwelling persons over age 50, 30% of whom were over the age of 75, were randomly assigned to a blood pressure goal of 120 vs 140.  Persons in the 120 group had a 19% lower risk for developing MCI an transitional stage between normal and dementia (P<.008).  There was a 17% lower risk for developing dementia but this only achieved a p value = 0.10.  The combined risk for both MCI and dementia was 15% lower in the 120 group (p<0.04).  The dementia outcome was the primary outcome but all the outcomes were pre-specified in the protocol at the beginning of the trial.  Unfortunately the blood pressure intervention was stopped after only 3.3 years due to CVD and mortality benefit and this may well have influenced the ability to reach the expected number of dementia cases.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Emory, Obstructive Sleep Apnea, Race/Ethnic Diversity, Sleep Disorders / 26.12.2018

MedicalResearch.com Interview with: Dayna A. Johnson PhD Department of Epidemiology Emory University Atlanta, GA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are several studies that have determined that African Americans have the highest prevalence of hypertension and are the most likely to have uncontrolled hypertension compared to other racial/ethnic groups. We were interested in studying whether sleep apnea contributed to hypertension control among African Americans. We found that participants with sleep apnea were more likely to have resistant hypertension than those without sleep apnea. In particular, individuals with severe sleep apnea had the highest risk of resistant hypertension. Most of the participants with measured sleep apnea were undiagnosed (96%).  (more…)
Author Interviews, Blood Pressure - Hypertension, Critical Care - Intensive Care - ICUs, Emergency Care, JAMA / 17.12.2018

MedicalResearch.com Interview with:
"intravenous" by thorney torkelson is licensed under CC BY-NC-ND 2.0 <a href="https://creativecommons.org/licenses/by-nc-nd/2.0"> CC BY-NC-ND 2.0</a>Daniel J. Lane PhD
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health, University of Toronto
Rescu, Li Ka Shing Knowledge Institute, St Michael’s Hospital
Toronto, Ontario, Canada

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

Response: Early resuscitation and early antibiotics have become the mainstay treatment for patients with sepsis. The time to initiation of these treatments is thought to be an important factor in patients surviving their disease; however, the independent benefits or harms of intravenous fluid resuscitation, in particular a more aggressive versus more conservative approach to this therapy, remains difficult to evaluate given the concurrent use of these therapies in hospital.

To gain a better understanding of this treatment independent of antibiotic use, we assessed intravenous fluid resuscitation by paramedics on the in-hospital mortality of patients with sepsis. By accounting for the interaction between initial systolic blood pressure and the treatment, we found that earlier resuscitation by paramedics was associated with decreased mortality in patients with low initial blood pressures but not associated with mortality for patients with normal or higher initial blood pressures. 

(more…)

Author Interviews, Blood Pressure - Hypertension / 13.12.2018

MedicalResearch.comInterview with:

Eric J. BELIN de Chantemèle, D.Sc. Associate Professor Department of Medicine, Cardiology Augusta University

Eric J. Belin de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Vascular Biology Center
Medical College of Georgia at Augusta University

Jessica L Faulkner, PhD
Post-doctoral Fellow
Vascular Biology Center
Medical College of Georgia at Augusta University

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

Response: It is generally accepted in the medical community that women are more salt sensitive than men. By “salt sensitive” we mean that blood pressure increases with increases in salt in the diet.

While we have known for a long time that women are more likely to experience problems with their blood pressure that are associated with the salt that they eat, the reasons why remain largely unknown and, therefore, the best way to treat it is also unknown. With the average American eating roughly twice the salt recommended by the American Heart Association guidelines, the effects of dietary salt on blood pressure are very important. Our latest publication in the journal American Heart Association’s journal Hypertension shows that female mice are more prone to high blood pressure when on a high salt diet than males.

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

Response: Our report begins to shed some light on why women may have a greater risk of developing high blood pressure due to eating too much salt. We recently found that a hormone, termed “aldosterone” is acting inappropriately in females in response to a lot of salt in the diet. In healthy individuals who are not salt sensitive, aldosterone is decreased by salt in the diet and is protective to the blood vessels. However, in female mice it is less likely that aldosterone will be decreased, and this lack of decrease of aldosterone leads to blood vessel damage and high blood pressure in our study.In contrast, our male mice in our study suppressed aldosterone when given a high salt diet, and did not develop blood vessel damage or high blood pressure.We believe this variation in aldosterone production in women may be a reason why they are clinically more likely to have a blood pressure response to high salt diets.

(more…)

Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JAMA / 05.12.2018

MedicalResearch.com Interview with: Taku Inohara MD, PhD Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina Department of Cardiology Keio University School of Medicine, Tokyo, Japan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) has been increasingly used for treating patients with severe aortic stenosis. Owing to the advancement of TAVR technology, the mortality and heart failure (HF) readmission after TAVR is decreasing over time, but 4.3% experienced readmission due to HF and 23.7% died within 1 year after TAVR. Inhibition of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin-receptor blockers (ARBs) is known to improve clinical outcomes in patients with heart failure, but there remains unknown whether a RAS inhibitor is associated with a reduction in mortality and heart failure readmission after TAVR. Using the STS/ACC TVT Registry, a nationwide TAVR Registry in the US, we analyzed 15896 propensity-matched patients who underwent TAVR and found that receiving a prescription for a RAS inhibitor at discharge, compared with no prescription, was associated with a reduced risk for mortality ( 12.5% vs 14.9%) and HF readmission (12.0% vs 13.8%). (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 29.11.2018

MedicalResearch.com Interview with: Pratyaksh K. Srivastava, MD Division of General Internal Medicine, UCLA Gregg C. Fonarow, MD Ahmanson-UCLA Cardiomyopathy Center UCLA  Medical Center, Los Angeles Associate Editor, JAMA Cardiology MedicalResearch.com: What is the background for this study?  Response: Angiotensin Receptor-Neprilysin Inhibitors represent a novel class of heart failure therapeutics that have been shown to significantly improve mortality among patients with heart failure with reduced ejection fraction (HFrEF). In the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with Angiotensin Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, sacubitril-valsartan was associated with a 20% relative risk reduction in the primary outcome of death from cardiovascular causes or first hospitalization for worsening heart failure over a median follow up of 27 months. In our current study, we present long term (5-year) absolute risk reductions associated with the addition of angiotensin receptor-neprilysin inhibition to standard HFrEF background therapy using data from PARADIGM-HF. We utilize the number needed to treat (NNT) to quantify absolute risk reduction, and ultimately compare 5-year NNT values for sacubitril-valsartan to those of well-established HFrEF therapeutics for the outcome of all-cause mortality. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension / 20.11.2018

MedicalResearch.com Interview with: Adam Bress, Pharm.D Department of Population Health Sciences School of Medicine University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? o   The background here is that the new 2017 ACC/AHA BP guidelines lowered the threshold for antihypertensive medication initiation and intensification from <140 mmHg in most patients to <130 mm Hg. o   We used contemporary, population-based studies of US adults to estimate the potential population health impact of achieving and maintaining the lower treatment targets recommended in the 2017 ACC/AHA BP guidelines compared to previous guidelines. o   We found that achieving and maintain the lower thresholds recommended in the 2017 ACC/AHA BP guidelines over 10 years would:
  • Prevent 3.0 million CVD events compared to currently blood pressure and treatment levels
  • Prevent 0.5 million more events compared to achieving and maintain JNC7 goals
  • Prevent 1.4 million more events compared to achieving and maintain JNC7 goals
o   We estimated the size of the population health impact of achieving and maintaining the lower blood pressure treatment targets in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
  • Achieving and maintaining the lower blood pressure thresholds for antihypertensive medication initiation and titration by the 2017 guidelines, are projected to prevent ~20% and ~90% more CVD events over ten years compared to achieving and maintaining JNC7 or JNC8 goals respectively.
o   Although we estimated more adverse events with the lower treatment goal, what our analysis found is that the benefits of achieving and maintaining the 2017 high blood pressure treatment recommendations far outweighs the risks. Many adverse events from high blood pressure treatment can be managed medically – and the lower threshold for treatment could potentially help millions of Americans lower their chances of developing heart disease or dying from heart attacks, strokes and other cardiovascular events, (more…)