Study Suggests Isolated Systolic Hypertension In Young Adults Should Be Treated To Prevent Damage To Aorta

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D.</strong> Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Vongpatanasin

Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center
Dallas, TX 75390-8586

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

Response: It is well know that treatment of isolated systolic hypertension (ISH), a subtype of hypertension with elevated systolic BP 140 or above but normal diastolic BP of < 90 mmHg, improves cardiovascular outcomes in older adults after the sixth decade of life. However, it is controversial if ISH in young adults requires treatment because it was suggested that elevated systolic BP in these individuals are related to high stroke volume, rather than increased aortic stiffness. In earlier case series, ISH in young adults were particularly common in athletes with long arms and legs, suggesting that pulse wave amplification coupled with high stroke volume were responsible for elevated brachial systolic blood pressure but the true central BP was normal. Thus,  isolated systolic hypertension was proposed to be a spurious condition in young adults that can be ignored.

However, previous studies used only indirect technique in assessing aortic structure and function. Furthermore, none of these studies were conducted in the U.S. Population.

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SPRINT Trial: Intensive Blood Pressure Control Reduces Risk of LVH

MedicalResearch.com Interview with:

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC Director, Epidemiological Cardiology Research Center (EPICARE) Professor, Department of Epidemiology and Prevention Professor, Department of Internal Medicine, Cardiology Section Wake Forest School of Medicine Medical Center Blvd, Winston Salem, NC 27157

Dr. Soliman

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC
Director, Epidemiological Cardiology Research Center (EPICARE)
Professor, Department of Epidemiology and Prevention
Professor, Department of Internal Medicine, Cardiology Section
Wake Forest School of Medicine
Medical Center Blvd, Winston Salem, NC 27157

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

Response: We already know that left ventricular hypertrophy (LVH, which is the most common complication of high blood pressure, is associated with an increased risk of cardiovascular disease (CVD). We also know that successful management of high blood pressure (BP) leads to regression of LVH and improved CVD outcomes in patients with hypertension. However, it is unknown whether intensive BP lowering beyond that recommended would reduce the risk of LVH in patients with hypertension, and whether reducing the risk of LVH explains the reported CVD benefits of intensive BP lowering in this population. Therefore, we examined the differential impact of intensive BP lowering (target systolic BP (SBP).

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Risk Factors for Nonadherence to Antihypertensive Treatment

MedicalResearch.com Interview with:

Dr. Gupta Pankaj

Dr.Gupta

Dr. Gupta Pankaj
Consultant Metabolic Physician/Chemical Pathologist

Dr. Patel Prashanth - Consultant Metabolic Physician/Chemical Pathologis

Dr. Patel

Dr. Patel Prashanth – Consultant Metabolic Physician/Chemical Pathologist

Department of Metabolic Medicine and Chemical Pathology
University Hospitals of Leicester NHS Trust, UK

 

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

Response: Non-adherence or patients not taking their medications as prescribed is known since the time of Hippocrates. It is the key reason why blood pressure is well controlled in only around 50% of patients with hypertension, despite the availability of good medicines. Non-adherence leads to poorer cardiovascular outcomes and is thought to cost $100 billion to the US health economy. A crucial reason for the lack of progress in improving adherence has been the previous lack of a clinically useful objective measure.

We and others have developed a robust and reliable biochemical screening method to assess for non- adherence to antihypertensive medications in urine or blood using a technique called liquid chromatography-tandem mass spectrometry.  We have previously reported a single centre study that demonstrated high rates of non-adherence in patients attending a hypertension clinic.

Since, then we have set up a National Centre for Adherence Testing (NCAT, ncat@uhl-tr.nhs.uk) in the Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust (UHL) and receive samples from around 25 hypertension clinics across UK. This study analysed data from~1400 patients consisting of samples received in UHL and also from a cohort of patients in the Czech Republic.

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Rotational Shift Work Linked To Increased Risk of Hypertension, Especially in Men

MedicalResearch.com Interview with:

Sandhya Manohar, MBBS, Nephrology Fellow Project mentor: Sandra M. Herrmann, MD Department of Nephrology and Hypertension Mayo Clinic, Rochester, MN

Dr. Sandhya Manohar

Sandhya Manohar, MBBS, Nephrology Fellow
Project mentor: Sandra M. Herrmann, MD
Department of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

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

Response: In the last few decades advances in the field of industrialization and technology has turned our world into a 24-7 work zone. Many organizations have turned to a shift system to keep up with the demands of the new world. The consequent changes to our circadian rhythm have resulted in dramatic effects to our body’s physiology. Reports have been surfacing of higher rates of diabetes, obesity, and even cancer in this shift work population.

The risk of hypertension though was controversial and so we set out to review this in our meta-analysis.

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Blood Pressure Medications In Elderly Require Personalized Approach

MedicalResearch.com Interview with:

Dr. Rathi Ravindrarajah PhD Division of Health and Social Care Research Faculty of Life Sciences & Medicine  Guy’s Campus King’s College London

Dr. Ravindrarajah

Dr. Rathi Ravindrarajah PhD
Division of Health and Social Care Research
Faculty of Life Sciences & Medicine
Guy’s Campus
King’s College London

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

Response: Clinical trials show that it is beneficial to lower systolic blood pressure (SBP) in adults aged 80 and over, but non-randomized epidemiological studies suggest that lower systolic blood pressure may be associated with a higher risk of mortality.

Our main findings were that there was a terminal decline in systolic blood pressure in the final 2 years of life suggesting that the higher mortality in those with a low SBP shown in non-randomized epidemiological studies might be due to reverse causation.

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Pregnant Women Should Have Blood Pressure Screening for Preeclampsia Throughout Pregnancy

MedicalResearch.com Interview with:

Dr. Maureen Phipps, USPTS Task Force member Department chair and Chace-Joukowsky professor of obstetrics and gynecology Assistant dean for teaching and research on women's health Warren Alpert Medical School of Brown University

Dr. Phipps

Dr. Maureen Phipps, USPTS Task Force member
Department chair and Chace-Joukowsky professor of obstetrics and gynecology
Assistant dean for teaching and research on women’s health
Warren Alpert Medical School of Brown University

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

Response: Preeclampsia, which includes high blood pressure after 20 weeks of pregnancy, is one of the most serious health problems affecting pregnant women. After reviewing the evidence, the Task Force found the benefits of screening for preeclampsia outweighed the harms and recommended screening pregnant women for preeclampsia with blood pressure measurements throughout pregnancy. The evidence showed mothers and their babies are likely to benefit from screening, as screening leads to treatment that reduces their risk of severe complications, including death.

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Blood Pressure Variability May Trigger Stroke, Especially During Sleep

MedicalResearch.com Interview with:

Shyam Prabhakaran, MD, MS</strong> Department of Neurology Feinberg School of Medicine Northwestern University Chicago, IL

Dr. Prabhakaran

Shyam Prabhakaran, MD, MS
Department of Neurology
Feinberg School of Medicine
Northwestern University
Chicago, IL

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

Response: Wake-up stroke, or stroke onset during sleep, accounts for one-quarter of stroke presentations. Yet, there are few studies exploring mechanisms or triggers of onset during sleep. We explored whether blood pressure variability which is known to have circadian patterns could trigger wake-up stroke. We found that in the first 24 hours after stroke, those with wake-up stroke had greater blood pressure variability than non-wake up stroke patients.

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Men and African Americans More Likely To Transition to Hypertension At Younger Age

MedicalResearch.com Interview with:

Shakia Hardy, MPH, CPH. PhD

Dr. Hardy

Shakia Hardy, MPH, CPH. PhD
Department of Epidemiology
The University of North Carolina at Chapel Hill

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

Response: Previous studies characterizing blood pressure levels across the life course have relied on prevalence estimates at a given age.

Our study was interested in identifying critical ages at which net transitions between levels of blood pressure occurred. We used data from the National Health and Nutrition Examination Survey (2007-2012) to estimate age-, race-, and sex-specific annual net transition probabilities between ideal blood pressure, prehypertension and hypertension.

We found that African Americans and men were more likely to transition from ideal levels of blood pressure in childhood or early adulthood compared to white Americans and women, which puts them at increased risk of developing prehypertension and hypertension earlier in life.

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Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With CKD

MedicalResearch.com Interview with:
Hon-Yen Wu, MD, PhD, on behalf of all authors

Attending Physician and Assistant Professor, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Assistant Professor, National Taiwan University Hospital and College of Medicine,
National Taiwan University, Taipei, Taiwan.
Assistant Professor, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 

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

Response: The effect of intensive blood pressure (BP) control in nondiabetic patients with chronic kidney disease (CKD) has long been a topic of debate. We summarized the published information comparing intensive BP control (< 130/80 mmHg) with standard BP control (< 140/90 mmHg) on major renal outcomes in CKD patients without diabetes. We pooled data from 9 randomized clinical trials with more than 8000 patients and over 800 events of kidney disease progression. We found that targeting blood pressure below the current standard did not provide additional benefit for renal outcomes compared with standard BP control, but may benefit nonblack patients or those with heavy proteinuria.

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

Response: For the optimal blood pressure target in CKD patients without diabetes, an individually tailored treatment rather than a general rule to control hypertension is suggested.

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Intensive Systolic Blood Pressure Control Would Risk Side Effects But Save Lives

MedicalResearch.com Interview with:

Dr. Adam Bress, PharmD, MS. Assistant Professor, Population Health Sciences Division of Health System Innovation and Research University of Utah

Dr. Adam Bress

Dr. Adam Bress, PharmD, MS.
Assistant Professor, Population Health Sciences
Division of Health System Innovation and Research
University of Utah

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

  • Observational studies show a strong and graded association between higher blood pressure, beginning at 115 mm Hg systolic, and increased cardiovascular disease events.
  • Despite this, hypertension is diagnosed and treated among people with a blood pressure threshold, typically 140/90 mm Hg SBP/DBP.
  •  Until recently, randomized trials did not provide definitive evidence supporting lower SBP goals in high-risk sub-populations.
  • The Systolic Blood Pressure Intervention Trial showed that among U.S. adults at high cardiovascular disease risk but without diabetes, stroke, or heart failure, treating to a systolic blood pressure goal of 120 mm Hg compared to the standard goal of 120 mm Hg compared to the standard goal of <140 mm Hg, resulted in a 27 % reduction in all-cause mortality.
  • However, intensive treatment cause a higher rate of treatment-related serious adverse events (SAEs).

MedicalResearch.com: What are the main findings?

  • To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess SAEs incurred if the SPRINT intensive SBP goal (i.e., – Based on population estimates of U.S adults that would have been eligible for the SPRINT trial and their observed 5-year mortality rate and the treatment effects observed in SPRINT, we found that if intensive treatment is widely adopted and achieved in all of these people, about 100,000 deaths per year could be prevented.
  • It could also give rise to about 56,100 episodes of hypotension, 34,400 episodes of syncope, 43,400 serious electrolyte disorders, and 88,700 cases of acute kidney injury per year compared to standard blood pressure treatment.

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

  • The public health impact of wide-spread implementation of intensive blood pressure treatment in the right patients is large.
  • However, careful patient selection and implementation are important because intensive treatment is associated with increased risk of hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

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

  • More research is needed to determine which patients derive the largest absolute benefit from intensive blood pressure treatment in order to maximize health benefits and minimize harms.
  • Research and development of tools to enhance shared decision making between providers and patients is also needed to maximize the positive public health impact of intensive blood pressure treatment.

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

Response: I am a member of the SPRINT Research Group

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

Citation:

Circulation. 2017 Feb 13. pii: CIRCULATIONAHA.116.025322. doi: 10.1161/CIRCULATIONAHA.116.025322. [Epub ahead of print]
Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES.
Bress AP1, Kramer H2, Khatib R3, Beddhu S4, Cheung AK4, Hess R5, Bansal VK6, Cao G3, Yee J7, Moran AE8, Durazo-Arvizu RA3, Muntner P9, Cooper RS3

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

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Over 100 Genetic Signals Influence Blood Pressure

MedicalResearch.com Interview with:

Helen R Warren PhD</strong> Analysis, Statistics, Genetic Epidemiology Queen Mary, University of London

Dr. Helen Warren

Helen R Warren PhD
Analysis, Statistics, Genetic Epidemiology
Queen Mary, University of London

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

Response: This study analysed data from UK Biobank, which is a large cohort including over 500,000 male and female participants from across the UK, aged 40-69 years. We performed a genetic association study for blood pressure, which analysed ~140,000 individuals of European ancestry (as currently interim genetic data is only available for ~150,000 participants).

Our study identified 107 genetic regions associated with blood pressure, which had not been previously reported at the time of our analysis. All our new findings were robustly validated within independent replication data resources, comprising a large, total sample size of up to 420,000 individuals.

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Hypertension Is Global Risk For Disability and Premature Death

MedicalResearch.com Interview with:

Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington

Dr. Gregory Roth

Dr. Gregory Roth MD
Assistant Professor of Medicine
Institute for Health Metrics and Evaluation and
Division of Cardiology at the University of Washington

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

Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time.

In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased.

Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).

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