Author Interviews, Blood Pressure - Hypertension, Diabetes, Diabetes Care, Sleep Disorders / 08.07.2014

MedicalResearch.com Interview with:Vincenza Spallone MD PhD Endocrinology and Neurology Department of Systems Medicine Tor Vergata University, Rome, Italy Vincenza Spallone MD PhD Endocrinology and Neurology Department of Systems Medicine Tor Vergata University, Rome, Italy   Medical Research: What are the main findings of the study? Dr. Spallone:To investigate a possible relationship between painful diabetic polyneuropathy (PDPN) and the circadian pattern of blood pressure (BP), we performed ambulatory blood pressure monitoring in 113 diabetic patients with PDPN, with painless diabetic polyneuropathy (DPN) and without DPN. In addition, we evaluated neuropathic pain, sleep, risk for obstructive sleep apnoea (OSA), autonomic function, and in a subgroup of patients, depressive symptoms. The main finding was that patients with painful diabetic polyneuropathy displayed impaired nocturnal fall in BP compared to those without neuropathy, and higher nocturnal systolic blood pressure than the other two groups. Although the day-night change (∆) in blood pressure failed to reach a significant difference between painful diabetic polyneuropathy and DPN groups, nondipping (the loss of nocturnal fall in systolic BP) was more strictly associated with painful diabetic polyneuropathy than DPN and in multivariate analysis, including comorbidities and most potential confounders, neuropathic pain was an independent determinant of ∆ BP and nocturnal systolic blood pressure. In summary, we showed a novel association of peripheral diabetic neuropathic pain with nondipping and higher systolic nocturnal blood pressure, which was not entirely explained through pain dependent sleep problems or other pain- or diabetes-related comorbidities, like CAN, OSA and depression.
Author Interviews, Blood Pressure - Hypertension, Geriatrics / 23.06.2014

Dr. Michele Callisaya Faculty of Medicine, Nursing & Health Sciences Monash University, ClaytonMedicalResearch.com Interview with:  Dr. Michele Callisaya Faculty of Medicine, Nursing & Health Sciences Monash University, Clayton MedicalResearch: What are the main findings of the study? Dr. Callisaya: Falls are common in older people and can lead to hip fracture and loss of mobility.  Blood pressure reducing medications are commonly taken by older people to protect against heart attacks and stroke, but may have some unwanted side effects such as light-headedness and loss of balance.  We found that older people who were on large doses of such medications were at increased risk of falling.
Author Interviews, Blood Pressure - Hypertension, JAMA / 19.06.2014

Carlos J. Rodriguez, MD, MPH Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaMedicalResearch.com Interview with Carlos J. Rodriguez, MD, MPH Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina MedicalResearch: What are the main findings of the study? Dr. Rodriguez: As a clinician there is a notion suggesting that lower blood pressure is better but our current research to date is controversial and not conclusive. We wanted to study a large group of people with hypertension and see whether over 20 years of follow up, if a lower systolic blood pressure would be associated with lower cardiovascular events (heart attack, stroke, heart failure, angina). We hypothesized that there would be a linear association between blood pressure and events, that lower blood pressure would be associated with lower events and that as the blood pressure went up there would be more events. We found this was not the case but that hypertensives with a blood pressure between 120-138mmhg have the greatest benefit and those with a blood pressure less than 120mmhg did not have additional benefit.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Lancet / 03.06.2014

​MedicalResearch.com Interview with: Eleni Rapsomaniki, PhD The Farr Institute of Health Informatics Research Department of Epidemiology & Public Health University College London London MedicalResearch: What are the main findings of the study? Dr. Rapsomaniki: Our data shows that hypertension is associated with considerable reduction in CVD-free life expectancy. Based on our estimates a 30-year old with hypertension suffered from CVD 5 years earlier compared to a similarly aged individual with normal blood pressure. We noted substantial heterogeneity in the associations of blood pressure with specific cardiovascular outcomes. For example a 20 mmHg increase in systolic blood pressure was associated with ~40% higher risk of stable angina, and intracerebral or subarachnoid haemorrhage but less than 10% increase in risk of abdominal aortic aneurysm. In all age groups from 30 to over 80 people with a systolic blood pressure 90–114 mm Hg and a diastolic blood pressure of 60–74 mm Hg had the lowest risk of all cardiovascular diseases, and we found no J-shape associations.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Education / 21.05.2014

Dr. Price Kerfoot MD, EdM Rabkin Fellow in Medical Education Associate Professor of Surgery, Harvard Medical SchoolMedicalResearch.com Interview with: Dr. Price Kerfoot MD, EdM Rabkin Fellow in Medical Education Associate Professor of Surgery, Harvard Medical School   MedicalResearch: What are the main findings of the study? Dr. Kerfoot: (1) An online spaced education game improved clinicians' knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension. (2) As a method to increase clinicians' long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders).
Author Interviews, Blood Pressure - Hypertension, BMJ, OBGYNE / 30.04.2014

MedicalResearch.com Interview with: Dr Kate Bramham Division of Women's Health King's College London Women's Health Academic Centre KHP London, SE1 7ER MedicalResearch.com: What are the main findings of the study? Dr. Bramham: This meta-analysis of nearly 800,000 pregnancies from 55 studies has shown that women with chronic hypertension have a significantly increased incidence of pregnancy complications including superimposed pre-eclampsia, preterm delivery, low birth weight infants, perinatal loss and neonatal unit admission.
Author Interviews, Blood Pressure - Hypertension, BMJ, Salt-Sodium / 15.04.2014

Dr. Feng He Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UKMedicalResearch.com Interview with: Dr. Feng He Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry Queen Mary University of London, London, UK
MedicalResearch.com: What are the main findings of the study? Dr. He:
  • The UK salt reduction program has led to a fall in population blood pressure and thereby contributed to the reduction in stroke and heart disease deaths.
  •  In 2003, the UK Food Standards Agency and CASH (Consensus Action on Salt & Health) developed a salt reduction program. As approximately 80% of the salt in the diet is added to food by the food industry i.e. in processed foods, fast foods, canteen and restaurant foods etc, the public have no choice about eating it. Therefore progressive incremental targets to limit the amount of salt for each food category were set, which the industry had to achieve in a specified time. Reductions first started in 2003 and are continuing to this day.
  • The salt reduction program has been very successful and led to a 15% reduction in the average salt intake of the population, from 9.5g per day in 2003 to 8.1g per day in 2011 (P<0.05).
  • Over the same time period, blood pressure fell in the adult population by 3 mm Hg systolic and 1.4 mm Hg diastolic (P<0.0001). Stroke and heart disease deaths fell by 42% (P<0.0001) and 40% (P<0.0001) respectively.
  • It is possible that these falls in blood pressure and deaths from stroke and heart disease were attributable to various factors such as changes in diet, lifestyles and the improvement in the treatment of cardiovascular disease and its risk factors. Our further analysis showed that the reduction in salt intake played an important role, particularly in the falls in blood pressure.
  •  In a further analysis, we looked at individuals who were not on any drug treatment for blood pressure and a correction was made for all other variables that could have influenced blood pressure, apart from salt. There was still a fall in adult population blood pressure of 2.7mm Hg systolic/ 1.1mm Hg diastolic, (P <0.0001). This reduction in blood pressure could therefore be largely attributed to the fall in salt intake.
  •  It is well established that raised blood pressure throughout its range is a major cause of stroke and heart disease. The reduction in salt intake that led to a fall in blood pressure would have played an important role in both stroke and heart disease deaths.
  • Despite considerable progress being made on salt reduction, the average salt intake in England is still high. In 2011, it was 8.1 g/day which is over a third more salt than the recommended level of 6g/day. Therefore continuing and much greater efforts are needed to achieve further reductions in salt intake to prevent the maximum number of stroke and heart disease deaths.
Author Interviews, Blood Pressure - Hypertension, CMAJ, McGill, Stroke / 14.04.2014

Finlay A McAlister MD Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit Epidemiology Coordinating and Research (EPICORE) Centre McGill University, Montréal, QuebecMedicalResearch.com Interview with: Finlay A McAlister MD University of Alberta, Edmonton, Canada MedicalResearch.com: What are the main findings of the study? Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets). The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician. The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians.  However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor. Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .
AHA Journals, Author Interviews, Blood Pressure - Hypertension, NIH, Nutrition, Salt-Sodium / 03.04.2014

MedicalResearch.com Interview with: Niels Graudal, MD, DrMSc Senior Consultant Department of Internal medicine/Infectious Medicine/Rheumatology IR4242 Copenhagen University Hospital, Rigshospitalet Denmark Dr. Graudal: There are no studies, which show what happens with the risk of cardiovascular death or mortality if you change your sodium intake. Our study shows the association of sodium intake as it is with cardiovascular disease and mortality, which is only the second best way to consider the problem, but as the best way does not exist we have accepted this approach. There have been two different assumptions concerning the risks of sodium intake. One is that there is an increasing risk of heart disease, stroke and death of salt intake above 2300 mg, and one is that salt is not dangerous at all. Our study shows that both positions partially may be true, as a salt intake above 4900 mg is associated with increased risk of cardiovascular disease and mortality, whereas the present normal salt intake of most of the world’s populations between 2300 mg and 4900 mg is not associated with any increased risks. In addition our study shows that a low sodium intake below 2300 mg is also associated with increased risk of cardiovascular disease and death.
Author Interviews, Blood Pressure - Hypertension, Duke, JAMA / 29.03.2014

MedicalResearch.com Interview with: Ann Marie Navar-Boggan, MD, PhD Division of Cardiology, Duke University Medical Center Durham, North Carolina MedicalResearch.com: What are the main findings of the study? Dr. Navar-Boggan: Two groups of adults are really affected by the updated guidelines. First, 13.5 million adults, including one in five adults over the age of 60, were previously considered to have uncontrolled blood pressure but now meet new guideline goals. Next, 14 million adults over the age of 60 (one in four adults in this age group) are currently on blood pressure lowering therapy and meeting the older, more stringent targets. The guidelines state that no changes are necessary in this group, but they may be eligible for reduced therapy, particularly if they have had side effects or difficulty with the therapies they are taking.
Author Interviews, Blood Pressure - Hypertension, Stroke / 12.03.2014

MedicalResearch.com Interview with: Dingli Xu, MD From Department of Cardiology Nanfang Hospital, Southern Medical University, Guangzhou, China MedicalResearch.com:  What are the main findings of the study? Answer:Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low-range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension.
Author Interviews, Blood Pressure - Hypertension, Nutrition, Weight Research / 06.03.2014

Beverly B. Green, MD, MPH GroupHealth Research Institute Seattle WAMedicalResearch.com Interview with: Beverly B. Green, MD, MPH GroupHealth Research Institute Seattle WA   MedicalResearch.com: What are the main findings of the study? Dr. Green: We found that Group Health patients who were overweight and had hypertension were more likely to have lost 10 pounds in six months if they had secure online access to a dietitian than if they received only information and usual care. The patients really loved this intervention—and having access to a dietitian to work with them toward a healthier lifestyle. Although blood pressure and heart risk trended lower in the intervention group, the differences weren’t significant—unlike their weight.
Author Interviews, Blood Pressure - Hypertension, Diabetes, Genetic Research, University of Pennsylvania / 05.03.2014

MedicalResearch.com Interview with: Brendan Keating D.Phil Assistant Professor, Dept of Pediatrics and Surgery, University of Pennsylvania Lead Clinical Data Analyst, Center for Applied Genomics Children's Hospital of Philadelphia,Brendan Keating D.Phil Assistant Professor, Dept of Pediatrics and Surgery, University of Pennsylvania Lead Clinical Data Analyst, Center for Applied Genomics Children's Hospital of Philadelphia Michael V. Holmes, MD, PhD, MSc, BSc, MRCP Transplant Surgery Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USAMichael V. Holmes, MD, PhD, MSc, BSc, MRCP Transplant Surgery Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA MedicalResearch.com: What are the main findings of the study? Answer: We found that individuals with a genetically-elevated BMI had higher blood pressure, inflammatory markers, metabolic markers and a higher risk of type 2 diabetes, although there was little correlation with coronary heart disease in this study population of over 34,500 European-descent individuals of whom over 6,000 had coronary heart disease.
Author Interviews, Blood Pressure - Hypertension / 27.02.2014

Dr. Ido Weinberg MD MSc MHA Massachusetts General Hospital, Vascular MedicineMedicalResearch.com Interview with: Dr. Ido Weinberg MD MSc MHA Massachusetts General Hospital, Vascular Medicine MedicalResearch.com: What are the main findings of the study? Dr. Weinberg: The study examined the relationship between blood pressure difference between arms and clinically meaningful outcomes such as death and new-onset (incident) cardiovascular disease including myocardial infarction and stroke. The main finding of the study was that an elevated inter-arm blood pressure difference correlated with these negative outcomes. We have also shown that the correlation was strong enough to be independent from the classic Framingham risk score. Adding an elevated inter-arm blood pressure to the risk score made it a more accurate.
Author Interviews, Blood Pressure - Hypertension, JACC, Kidney Disease / 25.02.2014

Dr. Csaba P. Kovesdy, MD FASN Clinical Associate Professor of Medicine Chief of Nephrology, Salem VA Medical CenterMedicalResearch.com Interview with: Dr. Csaba P. Kovesdy, MD FASN Clinical Associate Professor of Medicine Chief of Nephrology, Salem VA Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Kovesdy: We describe significantly lower all-cause mortality rates in 141,413 non-dialysis dependent CKD (chronic kidney disease) patients who were de-novo users of ACEI/ARB.
Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness, Menopause / 25.02.2014

MedicalResearch.com Interview with: Michael Nyberg Ph.D. Post-doc  Human Physiology and Exercise Physiology Integrated Physiology Group Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen and Jens Bangsbo, Dr. Sci., Ph.D. Professor of Human Physiology and Exercise Physiology Head of Integrated Physiology Group, Section of Human Physiology Head of Copenhagen Centre of Team Sports and Health Deputy Head of Department, research Copenhagen Denmark MedicalResearch.com: What are the main findings of the study? Answer: The main findings of the study were that despite being of similar age, the postmenopausal displayed higher blood pressure and higher blood levels of an early marker of atherosclerosis than women that had not reached menopause. Furthermore, just 12 weeks of floorball training twice a week for one hour improved the women’s conditions and reduced their blood pressure significantly. In addition, there was positive development in levels of substances vital to blood vessel function, including a decrease in the early marker of atherosclerosis.
Author Interviews, Blood Pressure - Hypertension, JAMA, Vegetarians / 24.02.2014

MedicalResearch.com Interview with: Yoko Yokoyama, Ph.D., M.P.H. National Cerebral and Cardiovascular Center, Osaka, Japan, MedicalResearch.com: What are the main findings of the study? Dr. Yokoyama: We found consistent evidence that a vegetarian diet has a significant blood-pressure-lowering effect, and this was clear both in observational studies of individuals who had chosen vegetarian diets on their own and in intervention trials in which people were asked to make diet changes. Our meta-analysis included 32 observational studies and 7 controlled clinical trials. In the observational studies, vegetarian diets were associated with blood pressures that were about 7 mmHg lower systolic and 5 mmHg lower diastolic. In the clinical trials, the reductions were about 5 mmHg systolic and 2 mmHg diastolic. These are pooled averages, so for some individuals, particularly those with higher body weights or higher blood pressures at the beginning, the blood-pressure-lowering effects could be much greater.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Ophthalmology / 18.02.2014

MedicalResearch.com Interview with: Maria Lorenza Muiesan Department of Clinical and Experimental Sciences University of Brescia, Internal Medicine Brescia, Italy. MedicalResearch.com: What are the main findings of the study? Dr. Muisean: An increase in the ratio of retinal arteries wall thickness to lumen diameter may serve as an in-vivo parameter of microvascular damage. We conducted a study that examined the relationship between changes in retinal arterioles wall thickness/ lumen diameter and several measures of blood pressure, including clinic brachial blood pressure,  24 hours brachial blood pressure and central aortic blood pressure. We found that the an increase of wall-to-lumen ratio of retinal arterioles was most closely related to 24 hours blood pressure.
Author Interviews, Blood Pressure - Hypertension, Gender Differences, Wake Forest / 02.01.2014

Carlos M Ferrario, MD, FAHA, FASH, FACC Dewitt-Cordelll Professor of Surgical Sciences Professor, Internal Medicine-Nephrology Professor, Physiology-Pharmacology Wake Forest University School of Medicine Winston-Salem, NC 27157-1032 Vice-President, Consortium Southeastern Hypertension Control Editor-in-Chief Therapeutic Advances in Cardiovascular DiseaseMedicalResearch.com Interview with: Carlos M Ferrario, MD, FAHA, FASH, FACC Dewitt-Cordelll Professor of Surgical Sciences Professor, Internal Medicine-Nephrology Professor, Physiology-Pharmacology Wake Forest University School of Medicine Winston-Salem, NC 27157-1032 Vice-President, Consortium Southeastern Hypertension Control Editor-in-Chief, Therapeutic Advances in Cardiovascular Disease MedicalResearch.com: What are the main findings of the study? Dr. Ferrario: A significant and unexpected difference in the hemodynamic mechanisms that account for the elevated blood pressure between untreated hypertensive men and women. The main findings were: "Despite there being no differences between women and men in terms of office blood pressure, heart rate and body mass index, men demonstrated lower values of pulse pressure, systemic vascular resistance, brachial artery pulse wave velocity and augmentation index. In each of the three hypertension categories, the increased blood pressure in men was associated with significant augmentations in stroke volume and cardiac output compared with women. Sex-related hemodynamic differences were associated in women with higher plasma levels of leptin, hs-CRP, plasma angiotensin II and serum aldosterone. In women but not men, hs-CRP correlated with plasma concentrations of transforming growth factor β1 (TGFβ1) and body weight; in addition, plasma TGFβ1 correlated with levels of serum vascular cell adhesion molecule 1."
Blood Pressure - Hypertension, JAMA, Sleep Disorders / 16.12.2013

MedicalResearch.com Interview with: Dr. Miguel-Ángel Martínez-García Respiratory Department, Hospital Universitario y Politécnico La Fe Valencia, Spain MedicalResearch.com: What are the main findings of this study: Answer: The main findings of the study are: 1. The treatment with CPAP (continuous positive airway pressure) achieves a clinically and statistically significant reduction of blood pressure in patients with resistant hypertension (blood pressure that remains above goal in spite of the use of at least three antihypertensive drugs) and obstructive sleep apnea.
Author Interviews, Blood Pressure - Hypertension / 13.12.2013

MedicalResearch.com Interview with Dr. Moa Wolff Center for Primary Health Care Research Department of Clinical Sciences in Malmö, Lund University Jan Waldenströms gata 35, Skåne University Hospital, Malmö 205 02, Sweden MedicalResearch.com: What are the main findings of the study? Dr. Wolff: We investigated the effects of two yoga interventions on blood pressure and quality of life in patients in primary health care diagnosed with hypertension. Our study showed that a short yoga program practiced daily at home had an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls.
Author Interviews, Blood Pressure - Hypertension, Compliance, JACC, Outcomes & Safety, UT Southwestern / 10.12.2013

Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section Cardiology Division UT Southwestern Medical CenteMedicalResearch.com Interview with; Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section, Cardiology Division UT Southwestern Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Vongpatanasin: We found that more than 50% of patients with resistant hypertension were non-adherent to at least one drug prescribed by their primary care physicians for blood pressure control. When we provided this information back to the patients, as part of care in our hypertension specialty clinic, we found that many patients report difficulty taking prescribed medications due to either associated side effects or cost of the medication. When we adjusted patient's medications to fit their needs, BP levels were substantially improved during subsequent visits without increasing the number of medications.
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension / 23.11.2013

MedicalResearch.com Interview with: Dan Nation Assistant Professor, Department of Psychology at University of Southern California Veterans Affairs San Diego Healthcare System MedicalResearch.com: What are the main findings of the study? Answer:   The main study findings indicate that high blood pressure, specifically pulse pressure (systolic - diastolic pressure), is associated with increased markers of Alzheimer's disease in the cerebral spinal fluid of healthy middle-aged adults.  These results suggest a connection between blood pressure and Alzheimer's disease prior to the onset of any symptoms of the disease.
Author Interviews, Blood Pressure - Hypertension, University of Michigan / 05.11.2013

Jeremy Sussman, MD, MS Division of General Internal Medicine University of Michigan Staff Scientist, Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare SystemMedicalResearch.com Interview with: Jeremy Sussman, MD, MS Division of General Internal Medicine University of Michigan Staff Scientist, Center for Clinical Management Research Ann Arbor Veterans Affairs Healthcare System MedicalResearch.com: What are the main findings of the study? Dr. Sussman: We could prevent up to 180,000 more heart attacks and strokes in America every year using less medication overall.
Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness, JAMA / 03.10.2013

MedicalResearch.com Interview Ma, Wei Department of Epidemiology and Health Statistics School of Public Health Shandong University Jinan, Shandong Province, 250012 China MedicalResearch.com: What are the main findings of the study? Answer: The results of this meta-analysis suggested that there was an inverse dose-response association between levels of recreational physical activity and risk of hypertension. Individuals who participated in high levels of recreational physical activity had a 19% lower risk of hypertension than those who didn’t exercise much. In addition, those with moderate levels of recreational physical activity had an 11% lower risk of hypertension. However, there was no significant association between occupational physical activity and risk of hypertension.
Author Interviews, Baylor College of Medicine Houston, Blood Pressure - Hypertension, Cost of Health Care, JAMA / 16.09.2013

Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) 2002 Holcombe Blvd. Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine www.houston.hsrd.research.va.govAshley Motter HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical CenterMedicalResearch.com Interview with: Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical Center Houston, Texas 77030 MedicalResearch.com: What are the main findings of the study? Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension.  The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups.  Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year.  The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant.  None of the incentives resulted in increased incidence of hypotension compared with controls.  While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group.  The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000.
Blood Pressure - Hypertension, Mineral Metabolism, Salt-Sodium / 14.09.2013

MedicalResearch.com Interview with: Dr Sandosh Padmanabhan Institute of Cardiovascular and Medical Sciences University of Glascow, ScotlandMedicalResearch.com Interview with: Dr Sandosh Padmanabhan Institute of Cardiovascular and Medical Sciences University of Glascow, Scotland   MedicalResearch.com: What are the main findings of the study? Dr. Padmanabhan: In the study "Serum Chloride Is an Independent Predictor of Mortality in Hypertensive Patients" we analysed data on 12,968 patients with hypertension followed up at the Glasgow Blood Pressure Clinic. We found that patients in the lowest quintile of serum Cl (<100 mmol/L), compared with all other patients, had a 23% higher mortality (all-cause, cardiovascular, and non-cardiovascular). Each 1-mmol/L increase in serum Cl was associated with a 1.1% to 1.5% lower all-cause mortality, cardiovascular mortality and non-cardiovascular mortality. This was independent of serum concentrations of sodium, bicarbonate or potassium. We did not find any association with longitudinal blood pressure control.
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Medical Research Centers, PLoS, Social Issues / 05.09.2013

Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, UtahMedicalResearch.com Interview with: Bert Uchino PhD Department of Psychology and Health Psychology Program University of Utah, Salt Lake City, Utah, MedicalResearch.com: What are the main findings of the study? Dr. Uchino: The main findings from our paper is that independent of one’s own social network quality, the quality of a spouse’s social network was related to daily life ambulatory blood pressure (ABP) levels.  More specifically, the more supportive (positive) ties, and the less aversive (negative) or ambivalent (both positive and negative) ties in a spouse’s social network, the lower was one’s own  ABP.  In addition, looking at the social networks of couples as a whole showed that couples who combined had more supportive ties and less aversive or ambivalent ties showed lower ABP.
Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF / 29.08.2013

MedicalResearch.com Interview with: Dr. Marc Jaffe, MD Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group Associate Clinical Professor of Medicine, UCSF Endocrinology and Internal Medicine Kaiser South San Francisco Medical Center 1200 El Camino Real South San Francisco, California 94080 MedicalResearch.com:    What are the main findings of the study? Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates. If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.