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. (more…)
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. (more…)
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. (more…)
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. (more…)
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). (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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. (more…)
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.  (more…)
Author Interviews / 19.03.2015

Yuichiro Yano MD Dept of Preventive Medicine, Northwestern University, ChicagoMedicalResearch.com Interview with: Yuichiro Yano MD Dept of Preventive Medicine, Northwestern University, Chicago   Medical Research: What is the background for this study? What are the main findings? Response: Previous research has suggested that nocturnal blood pressure (blood pressure during sleep) is more predictive of cardiovascular events than daytime blood pressure. However, the effect of nocturnal blood pressure on cognitive function in midlife, especially for young adults, has not been studied before. The long-term clinical significance of the findings is that nocturnal blood pressure measurements in younger adults could be potentially useful to identify those who may be at risk for developing lower cognitive function in midlife. (more…)
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. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Kidney Disease / 11.03.2015

Dr. Borja Quiroga MD Ph.D. Nephrology Unit, Hospital General Universitario Gregorio Marañón Madrid, SpainMedicalResearch.com Interview with: Dr. Borja Quiroga MD Ph.D. Nephrology Unit, Hospital General Universitario Gregorio Marañón Madrid, Spain Medical Research: What is the background for this study? What are the main findings? Dr. Quiroga: Chronic kidney disease patients are at high-risk for the development of cardiovascular events. Although several strategies have been tried for identifying those patients with poorer prognosis, no one has demonstrated by itself being the best one. This could be explained by the fact that several factors are implied in the cardiovascular profile of  chronic kidney disease patients. With this background, in our study we hypothesized if differences in the interarm systolic blood pressure could detect patients with enhanced cardiovascular risk early, and, consequently therapies could be initiated. Our results provide interesting data on this regard, as we have concluded that an interarm systolic blood pressure difference higher that 10 mmHg is an independent prognosis factor for cardiovascular events. (more…)
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics, JAMA / 03.03.2015

MedicalResearch.com Interview with: Dr. Enrico Mossello Research Unit of Medicine of Ageing Department of Experimental and Clinical Medicine University of Florence MedicalResearch: What is the background for this study? What are the main findings? Dr. Mossello: In spite of the high prevalence of high blood pressure (HBP) and cognitive impairment in old age, their relationship is still controversial. While several (but not all) studies have identified high blood pressure as a risk factor for incident cognitive impairment, evidence regarding the prognostic role of blood pressure in cognitively impaired older subjects is scarce and inconsistent. To our knowledge, no longitudinal study has been published up to now regarding Ambulatory Blood Pressure Monitoring (ABPM) in subjects with cognitive impairment. Moreover recent European and American guidelines on HBP leave decisions on antihypertensive therapy of frail elderly patients to the treating physician and do not provide treatment targets for cognitively impaired patients. In the present cohort study of subjects with dementia and Mild Cognitive Impairment (MCI) low values of day-time systolic blood pressure measured with ABPM were associated with greater progression of cognitive decline after a median 9-month follow-up. This association was limited to subjects treated with anti-hypertensive drugs and was independent of age, vascular comorbidity and baseline cognitive level, holding significant both in dementia and in Mild Cognitive Impairment subgroups. A similar trend of association was observed for office systolic blood pressure, although this was weaker and did not reach statistical significance in all analyses. (more…)
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA / 10.02.2015

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School | University of Oxford Oxford United KingdomMedicalResearch.com Interview with: Prof. Kazem Rahimi  DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease. We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes. (more…)
Author Interviews, Blood Pressure - Hypertension, BMJ, Heart Disease / 25.01.2015

MedicalResearch.com Interview with: Dr. Maria Guzman-Castillo Department of Public Health and Policy University of Liverpool, Liverpool, UK Medical Research: What is the background for this study? What are the main findings? Dr. Guzman-Castillo: The UK has experienced a remarkable 60% reduction in coronary heart disease (CHD) mortality since the 1970s. However CHD remains the leading cause of premature death. The aim of our study was to analyse the recent falls in coronary heart disease mortality and quantify the relative contributions from preventive medications and from population-wide changes in blood pressure and cholesterol levels, particularly exploring the potential effects on socioeconomic inequalities, an aspect not well explored in the past. Our study found that, approximately 22,500 fewer deaths were attributable to reductions in blood pressure and cholesterol in the English population between 2000-2007. The substantial decline in blood pressure was responsible for approximately 13,000 fewer deaths. Approximately 1,800 fewer deaths came from medications and some 11,200 fewer deaths from population-wide changes. Reduction in population blood pressure fewer deaths in the most deprived quintile compared with the most affluent. Reduction in cholesterol resulted in substantially smaller gains, approximately 7,400 fewer deaths; approximately 5,300 fewer deaths were attributable to statin use and approximately 2,100 DPPs to population-wide changes. Interestingly, statins prevented more deaths in the most affluent quintile compared with the most deprived. Conversely, population-wide changes in cholesterol prevented threefold more deaths in the most deprived quintile compared with the most affluent. (more…)
Author Interviews, Blood Pressure - Hypertension, Ophthalmology / 12.01.2015

MedicalResearch.com Interview with: Zheng He and Bang V. Bui Department of Optometry & Vision Sciences University of Melbourne, Parkville, Australia Medical Research: What is the background for this study? What are the main findings? Response: Glaucoma, the second leading cause of blindness in the world, is a condition that occurs when too much pressure builds up inside the eye. This excess pressure injures the optic nerve (the wire that transmits visual information to the brain) resulting in vision loss. Many risk factors for glaucoma are not well understood. High blood pressure (> 140/90 mmHg) is probably the most common comorbidity in patients presenting to optometry clinics. The overall prevalence of hypertension worldwide is over 26%, and increases dramatically with advancing age. Long-term hypertension leads to remodeling of the heart and blood vessels, promoting the risk of multiple end organ damage. Whilst chronic hypertension is a well-documented risk factor for stroke, the link between hypertension and glaucoma remains unclear. Previously, it was thought that high blood pressure could counteract high intraocular pressure, which is a clear risk factor for glaucoma. However, this issue may be more complicated than first thought. The Baltimore Eye Survey compared the prevalence of glaucoma in young and older patients with hypertension. They found that young patients with high blood pressure were at lower risk of glaucoma compared to the entire cohort. This outcome is consistent with the idea that higher blood pressure provides better perfusion pressure to the eye. Paradoxically systemic hypertension in older subjects actually increased the risk of glaucoma. Its seems that longer durations of systemic hypertension impact glaucoma risk negatively. One explanation for this is that any benefit from high blood pressure counteracting high eye pressure is lost as damage to blood vessels — a consequence of hypertension — becomes more dominant. This hypothesis was tested by comparing the effect of acute (one hour) and chronic (four weeks) hypertension in lab rats with elevated eye pressure. When blood pressure was raised for four weeks, there was less functional protection against eye pressure elevation compared with the one-hour case. This shows that having high blood pressure for a longer time compromises the eye's capacity to cope with high eye pressure. This impairment was associated with thicker and narrower blood vessels and a reduced capacity for the eye to maintain blood flow at normal levels in response to eye pressure elevation (this process is known as autoregulation). Thus in chronic hypertension, smaller reduction in ocular perfusion pressure can result in blood flow deficiency. (more…)
Author Interviews, Blood Pressure - Hypertension, Nutrition, Salt-Sodium / 08.01.2015

MedicalResearch.com Interview with: Zvonko Rumboldt, MD, PhD Professor emeritus Split University School of Medicine; Split, CroatiaMedicalResearch.com Interview with: Zvonko Rumboldt, MD, PhD Professor emeritus Split University School of Medicine; Split, Croatia Medical Research: What is the background for this study? What are the main findings? Dr. Rumboldt: Arterial hypertension is the major common denominator of a number of cardiovascular diseases and untoward outcomes including stroke, myocardial infarction, terminal renal insufficiency, heart failure and death. Excessive salt intake is the leading causative factor of blood pressure elevation across the world. It has been shown beyond any reasonable doubt that reduction in salt consumption decreases the prevalence of arterial hypertension and eases its management. Therefore many endeavors and campaigns aimed at moderation in salt ingestion have been launched with fair but less than expected results. The main source of ingested salt in developed countries is processed food, while in transitional and developing countries it is addition during food preparation (cooking), serving and salting at the table. This study, executed in Mostar, Bosnia and Herzegovina, and Split, Croatia, was designed to evaluate the effects of emphasized warning, consisting in self-adhesive stickers with clear, short message, put on household salt containers. Analyzed were 150 treated hypertensives, randomized in two groups, both receiving oral information and written leaflet concerning salt-hypertension relationship; the intervention group received in addition warning labels to be put on salt containers. In both groups measured were 24-hour urinary sodium excretion (natriuria), blood pressure, and several other parameters at inception of the trial, and one and two months later. In the intervention group observed was a marked decrease in sodium excretion (e.g. from 211 mmol/l at the beginning to 176 mmol/l at two months), much less (from some 207 to 200 mmol/l) in the control group. At the same time, the  mean blood pressure (already fairly well controlled) was reduced by additional 4 mm Hg in the intervention group (from 104 to 100 mm Hg), which was not the case in the control group (from 104 to 103 mm Hg). (more…)
Author Interviews, Blood Pressure - Hypertension, Stroke / 24.12.2014

Dr. Johan Sundström MD PhD Department of Medical Sciences & Uppsala Clinical Research Center, Uppsala University Uppsala, Sweden.MedicalResearch.com Interview with: Dr. Johan Sundström MD PhD Department of Medical Sciences & Uppsala Clinical Research Center Uppsala University Uppsala, Sweden.   Medical Research: What is the background for this study? What are the main findings? Dr. Sundström: High blood pressure is the most important risk factor for premature death globally. The number of people with hypertension is increasing, with one billion people currently affected worldwide. Most of these have mild hypertension (a systolic blood pressure of 140 to 159 mm Hg and/or a diastolic blood pressure of 90 to 99 mm Hg) and no previous cardiovascular disease. The optimal management of this large group is uncertain, as no single trial of blood pressure lowering has provided clear evidence of treatment benefits for such persons. In this systematic review and meta-analysis of 13 randomized controlled trials including more than 15000 people with mild hypertension and without previous known cardiovascular disease, blood pressure-lowering drug therapy decreased strokes by 28%, cardiovascular deaths by 25%, and total deaths by 22%. Achieved blood pressure reduction and numbers of events were small. (more…)
Author Interviews / 20.12.2014

MedicalResearch.com Interview with: Charlotta Ljungman, MD, PhD Sahlgrenska University Hospital/Cardiology Gothenburg, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Ljungman: The background of this study is the known differences between women and men regarding antihypertensive therapy. In studies both in Europe and the United States it has been shown that women are more often treated with diuretics and men with ACE-inhibitors. The reasons for these differences is not known but it has been suggested that differences in comorbidities between women and men can contribute to this finding. In our study we tested if comorbidities could explain the differences but could conclude that the differences persist even after taking comorbidities (mainly diabetes mellitsu and cardiovascular comorbidity) into account. Women were more often treated with thiazide diuretics and beta blockers and men with ACE inhibitors and Ca channel blockers. Further women with diabetes and hypertension were not treated with ACEinhibitors and ARBS as often as their male counterparts. (more…)
Author Interviews, Blood Pressure - Hypertension, Weight Research / 18.12.2014

Mohammed Elfaramawi , MD PhD MPH MSc Assistant Professor Epidemiology Department College of Public Health University of Arkansas for Medical Sciences Little rock, AR 72205 MedicalResearch.com Interview with: Mohammed Elfaramawi , MD PhD MPH MSc Assistant Professor Epidemiology Department College of Public Health University of Arkansas for Medical Sciences Little rock, AR 72205 Medical Research: What is the background for this study? What are the main findings? Dr. Elfaramawi: A substantial increase in prevalence of obesity has been documented globally. In the USA, overweight and obesity are the second leading cause of preventable death in the USA, affecting ∼97 million adults. Evidence has accumulated showing that visit-to-visit blood pressure variability is associated with adverse cardiovascular outcomes. This study is one of few studies which explored the relationship between obesity and visit-to-visit blood pressure variability. (more…)
Author Interviews, Blood Pressure - Hypertension, Toxin Research / 10.12.2014

MedicalResearch.com Interview with: Yun-Chul Hong MD, PhD Chair, Department of Preventive Medicine Director, Institute of Environmental Medicine College of Medicine Seoul National University MedicalResearch: What is the background for this study? What are the main findings? Dr. Yun-Chul Hong: Because there are some reports showing Bisphenol-A exposure increase when we eat or drink canned food or beverage and at the same time it has been known that Bisphenol-A exposure is associated with blood pressure increase, we conducted this study to examine whether consuming canned beverage and consequent increase of Bisphenol-A exposure actually increase blood pressure. We found that drinking 2 canned beverages increase in 5 mmHg of systolic blood pressure. (more…)
Blood Pressure - Hypertension / 16.11.2014

Swapnil Hiremath, MedicalResearch.com Interview with: Swapnil Hiremath, MD, MPH Assistant Professor Nephrologist, The Ottawa Hospital Faculty of Medicine at University of Ottawa Medical Research: What are the main findings of the study? Dr. Hiremath: Our study was a retrospective analysis of the data from the Nephrology Nurse BP assessment clinic at the Ottawa Hospital. Patients from the nephrology clinic were referred to this clinic not just for validation of their home BP machines, but also for lifestyle education and teaching the correct technique. We validated the monitors brought in by patients using a set protocol (including: confirming equal blood pressure in both arms, measuring BP simultaneously in both arms by an RN using proper technique, taking three resting readings and averaging them). Firstly, there was a statistically significant difference when we compared the average blood pressure measurement (both systolic and diastolic) values from the home monitor compared to the mercury monitor. Secondly, when we calculated the proportions of home BP machines that were accurate (using different thresholds of 3 mm, 5 mm and 10 mm Hg difference between home and mercury monitors) a significant proportion of home monitors were inaccurate. These findings have important implications – if clinicians are using data from home monitors to make therapeutic decisions, then some patients may be undertreated – or over treated needlessly. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Duke, Race/Ethnic Diversity / 29.10.2014

Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research InstituteMedicalResearch.com Interview with: Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research Institute   Medical Research: What are the main findings of the study? Dr. Thomas: The number of participants with controlled blood pressure (readings of less than 140/90) increased by 12 percent in the six months between the first and last readings. Mean systolic blood pressure for the population decrease by 4.7mmHg. The number of participants who had high blood pressure in the range of 140-149/90-99 decreased systolic blood pressure by a mean of  8.8mmHg and those with readings in the higher range of 150/100 or above decreased systolic blood pressure by 23.7percent. The study concluded that a program that followed this type of approach was associated with improved blood pressures across a diverse  high-risk community.” (more…)
Author Interviews, Blood Pressure - Hypertension, BMC / 29.09.2014

MedicalResearch.com Interview with: Prof. Dr. med. Alain Nordmann Innere Medizin FMH Basel, Switzerland Medical Research: What are the main findings of the study? Dr. Nordmann: Based on available randomised controlled trials, garlic preparations seem to lower blood pressure in individuals with hypertension in the short term. However, the quality of the studies and the lack of long-term data preclude the routine use of garlic preparations to lower blood pressure in individuals qualifying for antihypertensive drug therapy. (more…)
Author Interviews, Blood Pressure - Hypertension, General Medicine, JAMA, Kidney Disease / 22.09.2014

Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical CentMedicalResearch.com: Interview Invitation Dr. Csaba P. Kovesdy, MD Professor of Medicine University of Tennessee Health Science Center Chief of Nephrology Memphis Veterans Affairs Medical Center Medical Research: What are the main findings of the study? Dr. Kovesdy: We applied the structure of a clinical trial of hypertension management to our cohort of >600,000 patients with prevalent Chronic Kidney Disease (CKD). We first identified patients with baseline uncontrolled hypertension (using the definition applied by the SPRINT trial), then isolated the ones who had a decline in their baseline systolic blood pressure to two different levels (<120 and 120-139 mmHg) in response to a concomitant increase in prescribed antihypertensives, similar to what would happen in a trial examining two different systolic blood pressure targets. We then matched patients in the two groups to end up with identical baseline characteristics, similar to a randomized trial. When we examined the all-cause mortality of these two groups, we found that the group with follow-up systolic blood pressure of <120 had a 70% higher mortality. (more…)
Author Interviews, Blood Pressure - Hypertension, Protein / 20.09.2014

Lynn L. Moore, DSc, MPH Co-Director, Nutrition and Metabolism Assoc Prof of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118MedicalResearch.com Interview with: Lynn L. Moore, DSc, MPH Co-Director, Nutrition and Metabolism Assoc Prof of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118 Medical Research: What are the main findings of the study? Response: Our data were derived from 1,361 adults (aged 30-54 years) enrolled in the Framingham Offspring Study and showed that men and women who consumed higher amounts of protein had lower blood pressures (both systolic and diastolic blood pressures) after four years of follow-up. We then followed them for an average of about 11 years and found that those who consumed the most protein (approximately 103 g/day) had about a 40% lower risk of developing high blood pressure than those consuming about half that amount. These beneficial effects were even more pronounced when higher protein intakes were combined with high fiber intakes. (more…)