AHA Journals, Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease / 12.11.2015

[caption id="attachment_19340" align="alignleft" width="135"]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[/caption] 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.
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 11.11.2015

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.
Author Interviews, Blood Pressure - Hypertension, JACC, University Texas / 11.11.2015

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.
Author Interviews, Blood Pressure - Hypertension, Weight Research / 29.10.2015

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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, Surgical Research / 05.10.2015

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.
Author Interviews, Blood Pressure - Hypertension, Diabetes, Diabetologia / 25.09.2015

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.
Author Interviews, Blood Pressure - Hypertension, JACC, NYU, Race/Ethnic Diversity / 22.09.2015

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.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Mental Health Research / 16.09.2015

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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 16.09.2015

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.
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics / 05.09.2015

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.
Author Interviews, Blood Pressure - Hypertension, Compliance, Pharmacology / 31.08.2015

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.
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics, JAMA / 25.08.2015

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.
Author Interviews, Blood Pressure - Hypertension / 24.08.2015

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.
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 02.08.2015

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.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Salt-Sodium / 31.07.2015

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.
Author Interviews, Blood Pressure - Hypertension, NYU, Race/Ethnic Diversity / 29.07.2015

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.
Author Interviews, Blood Pressure - Hypertension, NYU, Pediatrics, Toxin Research / 10.07.2015

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.
Author Interviews, Blood Pressure - Hypertension, BMJ, Kidney Disease / 10.07.2015

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.
Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JACC / 24.06.2015

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).
Author Interviews, Beth Israel Deaconess, Blood Pressure - Hypertension, Technology / 14.06.2015

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.
Author Interviews, Blood Pressure - Hypertension, JAMA, Surgical Research, UCSF / 10.06.2015

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.
Anesthesiology, Author Interviews, Blood Pressure - Hypertension, Surgical Research / 31.05.2015

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.
Author Interviews, Blood Pressure - Hypertension, Geriatrics, Kidney Disease / 24.05.2015

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.
Author Interviews, Blood Pressure - Hypertension, Technology / 19.05.2015

Dr. Linnea A. Polgreen, Ph.D. Assistant Professor, Health Services Research Department of Internal Medicine, University of Iowa Coralville, IAMedicalResearch.com Interview with: Dr. Linnea A. Polgreen, Ph.D. Assistant Professor, Health Services Research Department of Pharmacy Practice and Science Iowa City, IA Medical Research: What is the background for this study? What are the main findings? Dr. Polgreen: Many patients with hypertension are unaware that they have hypertension. Furthermore, a substantial number of patients diagnosed with hypertension are poorly controlled. Unfortunately there is no point-of-care test to diagnose hypertension. For most patients with multiple to moderate hypertension, multiple measurements are needed over time to confirm the diagnosis. This need to obtain multiple measurement often delays the diagnosis of hypertension, and delays potential for changes in therapy for those who are diagnosed but poorly controlled. Patients are routinely reminded to check their blood pressure measurements at home. However, these measurements often do not occur or are not collected in a timely fashion. Recently electronic medical records (EMRs) have built portals for patients to enter data such as blood pressure measurements, but it is unclear how effective these portals will be for diagnosing and treating high blood pressure.We studied 121 patients with at least one high blood pressure measurement in the past year and randomized them to three groups.
  • The first group received text messages to which they were told to reply with their blood pressure measurements.
  • The second group was sent text messages reminding them to enter their blood pressures measurements in the hospital’s EMR portal.
  • The third group was instructed to enter their blood pressure measurements in the EMR portal, but they were not given reminders. Automated messages were sent to each patient in the bi-directional text messaging and EMR+reminder groups twice daily for up to 15 days. For the EMR only group, only 47.8% of patients successfully recorded a total of 14 blood pressure measurements within 15 days. For the EMR + reminder group, this percentage was 81.2%, and for the bi-directional text messaging group, it was 97.7%.
Author Interviews, Blood Pressure - Hypertension, JAMA, Salt-Sodium / 29.04.2015

Lynn L. Moore, DSc, MPH Department of Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com Interview with: Lynn L. Moore, DSc, MPH Department of Medicine Boston University School of Medicine Boston, Massachusetts Medical Research: What is the background for this study? Dr. Moore: The USDA’s current Dietary Guidelines for sodium intake have become increasingly controversial. Current recommendations include restricting sodium intake after the age of 2 years to no more than 2300 mg per day. For African-American adults and children, intakes should be restricted to no more than 1500 mg per day. Actual intake levels are much higher, with most Americans consuming about 3500 mg per day. Our goal was to estimate the effects of dietary sodium and potassium intakes on the change in blood pressure throughout adolescence. We used data from the National Growth and Health Study, a prospective study of more than 2000 girls who were 9-10 years of age at the time of enrollment. Lifestyle factors were assessed repeatedly throughout the study, and blood pressure was measured annually. Dietary sodium and potassium were assessed using multiple sets of three-day diet records. We used longitudinal modeling to estimate the effects of dietary sodium and potassium on blood pressure change over 10 years. Medical Research: What are the main findings? Dr. Moore: In this study, there was no evidence for a beneficial effect of reduced sodium intake on blood pressure change during adolescence. By 19-20 years of age, girls who consumed more than 4000 mg of sodium per day had systolic and diastolic blood pressure levels that were similar to those seen among girls with lower levels of sodium intake. Specifically, there was no beneficial effect on blood pressure associated with sodium intakes of less than 2500 mg per day. These results were similar for blacks and whites. In contrast, the repeated measures analyses showed that girls who consumed more than 2400 mg of potassium per day had lower blood pressures throughout adolescence compared with girls consuming less than 1800 mg per day of potassium.
Author Interviews, Blood Pressure - Hypertension / 29.04.2015

George S. Stergiou, MD, FRCP Professor of Medicine & Hypertension Hypertension Center STRIDE-7 Third University Department of Medicine Sotiria Hospital Athens, GreeceMedicalResearch.com Interview with: George S. Stergiou, MD, FRCP Professor of Medicine & Hypertension Hypertension Center STRIDE-7 Third University Department of Medicine Sotiria Hospital Athens, Greece Medical Research: What is the background for this study? What are the main findings? Dr. Stergiou: This study explored the relationship among blood pressure measurements taken in the office, at home and with daytime ambulatory monitoring in 642 untreated subjects aged from 5 to 78 years referred to a university hospital hypertension clinic. The main finding is that the relationship between office and out-of-office blood pressure (home and ambulatory) differs across different age groups. More specifically, in children daytime ambulatory blood pressure is higher than both office and home blood pressure. The differences are progressively eliminated with increasing age and after the age of 30 years daytime ambulatory blood pressure is similar to home blood pressure and both are lower than office blood pressure. In individuals aged 60 years and older daytime ambulatory blood pressure may be lower than home blood pressure. Age, gender and hypertension status are the main predictors of the differences among blood pressure values obtained by different methods.
Author Interviews, Blood Pressure - Hypertension, Compliance / 08.04.2015

MedicalResearch.com Interview with: Amneet Sandhu, MD Department of Internal Medicine Division of Cardiovascular Medicine University of Colorado Aurora, CO 80045. Medical Research: What is the background for this study? What are the main findings? Dr. Sandhu: Control of hypertension has improved nationally to guideline recommended levels.  To date, the focus of hypertensive care has been around identification and appropriate treatment to blood pressure goals.  Less emphasis has been placed on maintenance of control or tracking patients with high rates of relapse after achieving control. This study sought to assess the rate of recidivism in a cohort of hypertensive patients with controlled blood pressure and identify patient and process of care factors associated with recidivism.  We found approximately 25% of hypertensive patients with baseline controlled blood pressure relapse over a median time period of 7.3 months.  Patients with diabetes, high normal baseline blood pressure and poor medication adherence were more likely to suffer from recidivism.
Author Interviews, Blood Pressure - Hypertension, Social Issues, University of Michigan / 08.04.2015

Kira S. Birditt, Ph.D. Research Associate Professor Life Course Development Program The Institute for Social Research University of Michigan Ann Arbor, MI MedicalResearch.com Interview with: Kira S. Birditt, Ph.D. Research Associate Professor Life Course Development Program The Institute for Social Research University of Michigan Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Dr. Birditt: We know that negative marital quality (e.g., conflict, irritation) has important implications for physical health but the mechanisms that account for these links are still unclear. This study explored links between negative marital quality (e.g., criticism, demands), stress (long term chronic stresses) and blood pressure among older married couples in  a large longitudinal nationally representative sample of couples in the U.S..  We found that husbands had higher blood pressure when wives reported greater stress and that this link was even greater when husbands felt more negative about the relationship.  In addition, negative marital quality experienced by only one member of the couple was not associated with blood pressure but when both members of the couple reported higher negative marital quality they had higher blood pressure. 
AHA Journals, AHRQ, Author Interviews, Blood Pressure - Hypertension, Electronic Records, NYU / 14.03.2015

Stella Yi, Ph.D., MPH, Assistant Professor Department of Population Health New York University School of MedicineMedicalResearch.com Interview with: Stella Yi, Ph.D., MPH, Assistant Professor Department of Population Health New York University School of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Yi: Self-blood pressure monitoring has been shown to be an effective tool for improving blood pressure control, however most studies have only included white race participants. We were interested in assessing whether distribution of self-blood pressure monitors (intervention) would improve blood pressure and hypertension control over usual care (control) in a 9-month period in a predominantly Hispanic, uninsured population. Systolic blood pressure improved over time in both the intervention (n=409) and the control (n=419) arms by 14.7 mm Hg and 14.1 mm Hg, respectively, as did hypertension control; 39% of study participants overall achieved control at the end of follow-up. However there were no statistical differences between the outcomes in the intervention and usual care groups.