Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, JAMA / 28.07.2017

MedicalResearch.com Interview with: Stephen P. Juraschek, MD, PhD Instructor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Many adults experience dizziness and light-headedness when they stand up. This is more common in older adults and is related to risk of falling, fractures, fainting, car crashes, and early death. These symptoms are thought to be caused by a drop in blood pressure after standing also called orthostatic hypotension. However, if measured at the wrong time it is possible to miss this important clinical sign. For over 2 decades (since 1996), it has been recommended that orthostatic hypotension be identified by measuring blood pressure within 3 minutes of standing. Furthermore, it was also thought that measurements immediately after standing be avoided because they might be inaccurate (based on fluctuation in blood pressure immediately after standing). As a result, a lot of clinical protocols instructing healthcare staff on measuring orthostatic blood pressure encourage measurement at 3 minutes, but this has not been scientifically evaluated. (more…)
Author Interviews, Blood Pressure - Hypertension, Geriatrics, JAMA / 17.07.2017

MedicalResearch.com Interview with: Donal J. Sexton, BSc, MD The Irish Longitudinal Study on Ageing Trinity College Dublin Health Research Board Clinical Research Facility Galway National University of Ireland Galway, Galway, Ireland Trinity Health Kidney Centre, Tallaght Hospital Department of Nephrology, Beaumont Hospital, Royal College of Surgeons of Ireland Dublin, Ireland MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study we used the inclusion criteria for SPRINT to identify those community dwelling elders who would meet criteria for the trial in clinical practice. Our data are based on a prospective cohort study composed of participants chosen by a national stratified random sampling mechanism. If SPRINT participants were truly representative of the population, then the participants in the standard care arm of the trial should resemble the population to some extent. If this were true then the injurious falls rate might be similar between the two samples also. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Neurological Disorders, Stroke / 22.06.2017

MedicalResearch.com Interview with: Andrea Morotti, M.D. Research Fellow in Neurology Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: The CT angiography (CTA) spot sign is a validated marker of Intracerebral Hemorrhage (ICH) expansion and may identify those subjects more likely to benefit from intensive blood pressure reduction. We observed that less than 20% of ICH patients received a CTA as part of their diagnostic workup in a large, international randomized clinical trial. The performance of the spot sign in predicting ICH growth was suboptimal compared with what was reported in previous studies. Intensive blood pressure reduction did not improve functional outcome in spot sign positive patients. (more…)
Author Interviews, Blood Pressure - Hypertension, Compliance, Cost of Health Care, University Texas / 31.05.2017

MedicalResearch.com Interview with: Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies. (more…)
Abuse and Neglect, Blood Pressure - Hypertension, UT Southwestern / 21.05.2017

MedicalResearch.com Interview with: 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. (more…)
AHA Journals, Author Interviews, Heart Disease / 17.05.2017

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 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). (more…)
Author Interviews, Blood Pressure - Hypertension, Compliance / 15.05.2017

MedicalResearch.com Interview with: Dr. Gupta Pankaj Consultant Metabolic Physician/Chemical Pathologist 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, [email protected]) 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Occupational Health / 05.05.2017

MedicalResearch.com Interview with: 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. (more…)
Aging, AHA Journals, Author Interviews, Blood Pressure - Hypertension / 02.05.2017

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 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. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, OBGYNE / 01.05.2017

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 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Sleep Disorders, Stroke / 30.04.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Gender Differences, JAMA, Race/Ethnic Diversity / 20.04.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Kidney Disease / 13.03.2017

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. (more…)
Author Interviews, Blood Pressure - Hypertension, Genetic Research / 01.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Global Health, JAMA / 11.01.2017

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 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). (more…)
Author Interviews, Blood Pressure - Hypertension, Genetic Research, PLoS, Race/Ethnic Diversity, Social Issues / 25.12.2016

MedicalResearch.com Interview with: Connie J. Mulligan, PhD Professor, Department of Anthropology University of Florida Gainesville, FL MedicalResearch.com: What is the background for this study? Response: Lance Gravlee (UF Dept of Anthropology, UF Genetics Institute) started this research over 10 years ago. As a cultural anthropologist, Lance uses ethnographic (open-ended questions) interviews and discovered that over half of the participants in our study talked about experiences of discrimination that happened to people close to them. As a geneticist (UF Dept of Anthropology, UF Genetics Institute), I came into the project because I was interested in seeing how genetics and sociocultural stressors, like discrimination, interact. In our project, we look at blood pressure because hypertension is a disease that shows racial disparities and also because it is a complex disease that is caused by both genetic and environmental factors (like discrimination). (more…)
Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology / 22.11.2016

MedicalResearch.com Interview with: Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096 MedicalResearch.com: What is the background for this study? Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis. Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified. After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Race/Ethnic Diversity, UT Southwestern / 13.11.2016

MedicalResearch.com Interview with: 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? What are the main findings? Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors. (more…)
Author Interviews, Blood Pressure - Hypertension / 08.11.2016

MedicalResearch.com Interview with: Alejandro de la Sierra, MD, PhD, FESC, FAHA Professor of Medicine Head, Internal Medicine Department Hospital Mutua Terrassa University of Barcelona, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Systolic Blood Pressure Intervention (SPRINT) trial has demonstrated that a strategy of systolic blood pressure (BP) reduction to a goal of 120 mmHg in selected hypertensive patients prevents the development of cardiovascular complications and mortality. The trial used automated office BP measurements. However, ambulatory BP monitoring (ABPM) has demonstrated to be superior to office BP in predicting cardiovascular events and mortality. We aimed to evaluate ambulatory BP values in hypertensive patients from the Spanish ABPM Registry who meet eligibility criteria for the SPRINT trial. The results indicated that one third of our hypertensive population met such eligibility criteria and that ABPM values were considerably lower than office BP, with 42% of subjects having daytime BP below 130 mmHg and 21% with 24-hour BP below 120 mmHg. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease, JACC, Salt-Sodium / 06.10.2016

MedicalResearch.com Interview with: Nancy Cook ScD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School Public Health Brigham & Women’s Hospital Division of Preventive Medicine Boston, MA 02215 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure. In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Kidney Disease / 19.09.2016

MedicalResearch.com Interview with: Elvira Gosmanova MD Department of Nephrology University of Tennessee Health Science Center Memphis TN, 38163 MedicalResearch.com: What is the background for this study? What are the main findings? Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range. In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease. We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease / 19.09.2016

MedicalResearch.com Interview with: Islam Elgendy, MD Cardiology Fellow University of Florida MedicalResearch.com: What is the background for this study? What are the main findings? Response: The optimal systolic blood pressure target in adults with coronary artery disease is not well known. The Eighth Joint National Committee Panel recommended a target therapeutic goal <150 mm Hg for adults aged ≥60 years and <140 mm Hg in those aged <60 years. These recommendations are inconsistent with the different society guidelines (such as American Heart Association/American College of Cardiology, European Society of Cardiology, and American Society of Hypertension) which recommended a therapeutic target < 140 mm Hg. Given that the dyad of hypertension and coronary artery disease is the most prevalent chronic disease dyad among adults, we aimed to assess the long term risk of all-cause mortality with the different systolic blood pressure targets. Using the extended follow-up data from the US cohort of the INVEST trial, we demonstrated that achieving a systolic blood pressure of 130 to <140 mm Hg in the initial 2-3 years of treatment is associated with reduced all-cause mortality after ≈11.6 years of follow-up in hypertensive patients with coronary artery disease. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Heart Disease / 17.09.2016

MedicalResearch.com Interview with: Holly Mattix-Kramer, MD, MPH Public Health Sciences Medicine, Nephrology Associate Professor Loyola Medicine, Illinois MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background is that the Systolic Blood Pressure Lowering Intervention Trial (SPRINT) showed that intensive systolic blood pressure lowering reduces all-cause mortality by 27% compared to standard blood pressure lowering among adults age 50 years and older without diabetes or stroke but with high cardiovascular disease risk. We applied these findings to the U.S. population and asked "What if intensive systolic blood pressure lowering were applied to the U.S. population who meet SPRINT eligibility criteria? We found that approximately 18.1 million U.S. adults meet SPRINT criteria and that their annual mortality rate is 2.2%. If intensive systolic blood pressure lowering reduces all-cause mortality by 27%, then the annual mortality rate would be reduced to 1.6% and approximately 107,500 deaths would be prevented each year. (more…)
Author Interviews, Blood Pressure - Hypertension, JAMA, Stanford / 16.09.2016

MedicalResearch.com Interview with: Ilana B. Richman, MD Palo Alto VA Health Care System, Palo Alto, California Center for Primary Care and Outcomes Research/Center for Health Policy Department of Medicine Stanford University School of Medicine Stanford, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently. Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value. (more…)
Author Interviews, Blood Pressure - Hypertension, Electronic Records, Heart Disease, Primary Care / 18.08.2016

MedicalResearch.com Interview with: Tom Marshall, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Edgbaston, Birmingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action. This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins. (more…)
Author Interviews, Blood Pressure - Hypertension, Vitamin D / 08.07.2016

MedicalResearch.com Interview with: Dr. Nicola Veronese University of Padova Department of Medicine - DIMED, Geriatrics Division Padova, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the last 5 years, some studies investigated the possible association between hypovitaminosis D and orthostatic hypotension. However, all these studies were cross-sectional,  not disentangling if hypovitaminosis D precedes or follows orthostatic hypotension. In our work, we reported that low vitamin D at baseline predict the onset of orthostatic hypotension at follow-up in older people. This association was stronger in women than in men. (more…)
Author Interviews, Blood Pressure - Hypertension, Mineral Metabolism, UT Southwestern / 06.07.2016

MedicalResearch.com Interview with: Wanpen Vongpatanasin, MD Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Research Director, Hypertension Section Cardiology Division UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Inorganic phosphate has been added to our processed food at an enormous amount as food preservatives and flavor enhancer such that typical American diet contains twice as much as the recommended daily allowance. A high phosphate (Pi) diet was recently shown to trigger blood pressure (BP) elevation in otherwise normal rats but the mechanisms are still unknown.We found that rats treated with high phosphate diet that mimics the excess Pi consumed by the general American population developed high BP related to increased sympathetic nerve activity (SNA), resulting in excessive peripheral vasoconstriction. This exaggerated increase in SNA and BP is evident particularly during exercise. This study is conducted in collaboration with Drs. Masaki Mizuno and Scott Smith, the two leading experts in neural control of circulation at UT Southwestern in the Department of Health Care Sciences. (more…)
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Metabolic Syndrome, OBGYNE / 28.06.2016

MedicalResearch.com Interview with: Dr. Jian-Min Niu Department of Obstetrics Guangdong Women and Children Hospita Guangzhou , China MedicalResearch.com: What is the background for this study? Response: Physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the non-pregnant population. The optimal blood pressure levels in pregnant women remain an open question. Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed. (more…)
Author Interviews, Blood Pressure - Hypertension, Cleveland Clinic, JAMA / 16.06.2016

MedicalResearch.com Interview with: Krishna Patel, MD, PG Y3 Resident Internal Medicine Residency Program Cleveland Clinic Cleveland, OH 44195 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Patel: In our outpatient resident clinic practice, we found that patients with poorly controlled hypertension presenting with blood pressures in the hypertensive urgency range (SBP>=180mmHg or DBP >=110 mmHg) but with no symptoms of end-organ damage were common, however there was no clear cut manner in which these patient's blood pressures were treated. According to the comfort level of the physician, these patients were managed in the office and on serial outpatient visits and some of the patients would be referred to the emergency department for management of these elevated blood pressures. Given there was not much prior literature on this topic, we decided to study the prevalence and short term cardiovascular outcomes for this population of patients. We found that hypertensive urgency is quite common in the office setting (4.6% in our study). In absence of symptoms of end organ damage, the short term risk of major cardiovascular events was very low around 1%, and patients who were referred to the ED for management of blood pressures had a lot of unnecessary testing and more hospital admissions than those who were managed as an outpatient. (more…)