Author Interviews, Blood Pressure - Hypertension, NEJM, Stroke / 09.06.2016

MedicalResearch.com Interview with: Adnan I. Qureshi, M.D Zeenat Qureshi Stroke Research Center University of Minnesota Minneapolis, MN MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Qureshi: An acute hypertensive response in patients with intracerebral hemorrhage is common and may be associated with hematoma expansion and increased mortality. The Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial was designed to determine the efficacy of rapidly lowering systolic blood pressure in patients in an earlier time window after symptom onset than evaluated in previous trials. The trial was based on evidence that hematoma expansion and subsequent death or disability might be reduced with very early and more aggressive reduction in systolic blood pressure in those at higher risk due to presence of high systolic blood pressure at presentation. The trial randomized eligible subjects with intracerebral hemorrhage to test the superiority of intensive (goal 110-140 mmHg) over standard (goal 140-180 mmHg) systolic blood pressure reduction using intravenous nicardipine within 4.5 hours of symptom onset. Of a total of 1000 subjects that were recruited with a mean (standard deviation) baseline systolic blood pressure of 200.6 (27.0) mmHg, 500 were assigned to intensive-treatment and 500 to standard-treatment. Enrollment was stopped following a pre-specified interim analysis because of futility. The primary endpoint of death or disability at 3 months post-randomization was observed in 38.7% (186/481) of subjects receiving intensive treatment and 37.7% (181/480) subjects receiving standard treatment (relative risk: 1.03; 95% confidence interval: 0.85 to 1.27), adjusted for age, initial Glasgow Coma scale, and presence or absence of intraventricular hemorrhage. The rate of renal adverse events within 7 days of randomization was significantly higher among subjects randomized to intensive treatment. Compared to a target systolic blood pressure of 140-180 mmHg, treating subjects with intracerebral hemorrhage to a target systolic blood pressure of 110-140 mmHg did not lower the rate of death or disability.
Author Interviews, Blood Pressure - Hypertension, Compliance / 04.06.2016

MedicalResearch.com Interview with: [caption id="attachment_24931" align="alignleft" width="200"]Dr Prashanth Patel MSc, FRCP, FRCPath Consultant Metabolic Physician/ Chemical Pathologist and Head of Service Department of Chemical Pathology and Metabolic Diseases Honorary Senior Lecturer, Dept of Cardiovascular Sciences University of Leicester Dr. Patel Prashanth[/caption] Dr Prashanth Patel MSc, FRCP, FRCPath Consultant Metabolic Physician/ Chemical Pathologist and Head of Service Department of Chemical Pathology and Metabolic Diseases Honorary Senior Lecturer Dept of Cardiovascular Sciences University of Leicester MedicalResearch.com: What is the background for this study? Dr. Patel: Hypertension (HTN) is one of the most important and common chronic treatable condition. It affects nearly one third of the adult population. Nearly one fifth of patients treated for hypertension are thought to be resistant to treatment and these patients have a high mortality from cardiovascular diseases. Percutaneous radiofrequency catheter-based renal sympathetic denervation (renal denervation, RD) may be a potential treatment for resistant hypertension. Although RD is a safe procedure, it is irreversible and expensive. It is important that patients’ suitability for renal denervation is carefully assessed to maximise the potential benefits of the procedure. Therefore causes of pseudo-resistant hypertension namely white-coat hypertension, suboptimal pharmacological antihypertensive treatment and non-adherence to antihypertensive medications and secondary hypertension are needed to be robustly ruled out before considering a patient as suitable for renal denervation.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Environmental Risks / 01.06.2016

MedicalResearch.com Interview with: Tao Liu Ph.D Guangdong Provincial Institute of Public Health Guangdong Provincial Center for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypertension is the most important cause of disability and the leading risk factor for death globally and causes approximately 16.5% of all deaths. Since the 1990s, many epidemiological studies have investigated the associations between air pollution exposure and hypertension, the two most common public health concerns. However, their results remain controversial. Some studies found an association between them, while other studies sowed either no association or an association only for selected pollutants. In order to quantitatively synthesize and interpret these inconsistent and controversial results, here we used a new analysis method (Meta-analysis) to combine results from different previous studies to estimate the overall effect of every air pollutant on hypertension. This is the first study to simultaneously estimate the effects of short-term and long-term exposure to air pollutants on hypertension by meta-analysis. These results could provide more explicit information for policy decisions and clinical use.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues / 25.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24508" align="alignleft" width="200"]Bo (Bonnie) Qin, Ph.D. Postdoctoral Scholar Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903 Dr. Bo Qin[/caption] Bo (Bonnie) Qin, Ph.D. Postdoctoral Scholar Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Qin: Preventing or delaying the age-related cognitive decline that typically precedes the onset of dementia is particularly important considering that no effective strategies for dementia treatment have been identified. Vascular conditions such as hypertension are thought to be risk factors for cognitive decline, but important gaps in the literature on this topic remain. Randomized clinical trials of blood pressure-lowering treatments for reducing the risk of cognitive decline or dementia have largely failed to achieve beneficial effects. However, over the past 6 years, scientific evidence has accumulated that blood pressure variability over monthly or yearly visits may lead to greater risk of stroke and small and larger vessel cerebrovascular diseases. They could lead to subsequent changes related to cognitive dysfunction among older adults. We, therefore, hypothesized that blood pressure variability between visits is associated with a faster rate of cognitive function among older adults.
AHA Journals, Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Stroke / 23.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24599" align="alignleft" width="200"]Kazem Rahimi, DM, MSc Oxford Martin School University of Oxford United Kingdom Dr. Kazem Rahimi[/caption] 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.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Lancet, Salt-Sodium / 22.05.2016

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).
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Columbia, Cost of Health Care / 19.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24488" align="alignleft" width="150"]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[/caption] 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)
Aging, Author Interviews, Blood Pressure - Hypertension, Melatonin / 19.05.2016

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.
Author Interviews, Blood Pressure - Hypertension, BMJ, Brigham & Women's - Harvard, Nutrition / 18.05.2016

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.
Author Interviews, Blood Pressure - Hypertension, Lifestyle & Health, Sleep Disorders / 15.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24376" align="alignleft" width="150"]Wisit Cheungpasitporn, MD, Nephrology Fellow Project mentor: Stephen B. Erickson, MD Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN Dr. Wisit Cheungpasitporn[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Insomnia, Sleep Disorders / 28.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23900" align="alignleft" width="150"]Haicong Li Director and Professor, Department of Geriatrics China-Japan Friendship Hospital Beijing, China. Dr. Haicong Li[/caption] 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<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 < 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<0.001) and the compliance rate of goal BP (<140/90 mmHg) was 74.8% with Estazolam, compared to 50.5% with placebo (P<0.001). Thus, our findings indicated that the improvement of insomnia can significantly help lower the blood pressure in hypertensive patients.
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 22.04.2016

MedicalResearch.com Interview with: [caption id="attachment_16840" align="alignleft" width="124"]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[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Brain Cancer - Brain Tumors / 22.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23703" align="alignleft" width="180"]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[/caption] 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.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Diabetes, NIH, Nutrition, OBGYNE / 20.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23530" align="alignleft" width="158"]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[/caption] 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).
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Stroke / 06.04.2016

MedicalResearch.com Interview with: [caption id="attachment_22962" align="alignleft" width="200"]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[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Kidney Disease, Salt-Sodium / 31.03.2016

MedicalResearch.com Interview with: [caption id="attachment_23038" align="alignleft" width="150"]Matthew Bailey PhD Faculty Principal Investigator British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh, Edinburgh, United Kingdom. Dr. Mathew Bailey[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 30.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22972" align="alignleft" width="133"]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[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA, Weight Research / 18.03.2016

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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, OBGYNE / 14.03.2016

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). 
Author Interviews, Blood Pressure - Hypertension, BMJ, Diabetes / 26.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22121" align="alignleft" width="200"]Dr-Mattias-Brunström Dr-Mattias-Brunström[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 19.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21777" align="alignleft" width="80"]Dr. Adnan Quershi MD Professor of Neurology, Neurosurgery and Radiology University of Minnesota Dr. Adnan Qureshi[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Nutrition / 05.02.2016

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).
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, NIH / 03.02.2016

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.
Author Interviews, Blood Pressure - Hypertension, Kaiser Permanente, OBGYNE / 01.02.2016

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH  [caption id="attachment_21205" align="alignleft" width="146"]MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101 Dr. Kristi Reynolds[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Lancet / 24.12.2015

[caption id="attachment_11475" align="alignleft" width="150"]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[/caption] 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. 
Author Interviews, Blood Pressure - Hypertension, Coffee / 03.12.2015

[caption id="attachment_19771" align="alignleft" width="177"]Wenji Li, MMed, PhD Postdoc Associate Department of Pharmaceutics Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey Dr. Wenji Li[/caption] 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. 
Author Interviews, Blood Pressure - Hypertension, Emergency Care, Vanderbilt / 24.11.2015

[caption id="attachment_19585" align="alignleft" width="144"]Candace D. McNaughton, Dr. McNaughton[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, CDC, Pediatrics, Weight Research / 20.11.2015

[caption id="attachment_19511" align="alignleft" width="180"]Quanhe Yang, PhD Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta, GA 30341 Dr. Yang[/caption] 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.