Xuemei Sui, MD, MPH, PhDAssistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
Medical Research: What are the main findings of the study?Dr. Sui:
First, blood pressure is inversely associated with cardiorespiratory fitness levels among men. People in higher fitness categories had lower blood pressure than those in lower fitness categories.
Second, fitness is a strong effect modifier for the systolic blood pressure aging trajectory.
A higher fitness level can significantly delay the natural age-associated increase in blood pressure.
(more…)
MedicalResearch.com Interview with Prof Richard McManus MA PhD FRCGP
NIHR School for Primary Care Research,
Nuffield Department of Primary Care Health
Sciences, University of Oxford,
Oxford, Oxfordshire United Kingdom
Medical Research: What are the main findings of the study?Prof. McManus: The TASMIN-SR clinical trial followed 552 patients with an average age of 70 and high blood pressure with pre-existing cardiovascular disease, diabetes or chronic kidney disease.
After training in how to self-monitor blood pressuring using a readily available device, patients took readings twice each morning for the first week of each month, and following an individualised management plan were able to request additional medication from their general practitioner without the need for consultation.
At the end of the study, patients who self-managed had significantly lower blood pressure (by 9.2 / 3.4 mmHg) than those who were visiting their GP for blood pressure monitoring, which would be expected to lower stroke risk by around 30% if sustained.
(more…)
MedicalResearch.com Interview with Karen Margolis, M.D., M.P.H.
Senior Investigator (Director of Clinical Research)
HealthPartners Institute for Education and Research
Minneapolis, MN, 55440-1524
Medical Research: What are the main findings of the study?Dr. Margolis: The study compared falls and fractures in patients aged 40-79 with diabetes who were treated for high blood pressure. One group received treatment that aimed at getting systolic blood pressure under 120, while the other group received treatment to achieve systolic blood pressure under 140. The results show that patients who received intensive blood pressure treatment did not fall more than less intensively treated patients, nor did they incur more fractures over an average follow-up of about five years.
(more…)
MedicalResearch.com Interview with: Dr. Rodrigo Modolo
Department of Pharmacology
Faculty of Medical Sciences University of Campinas–UNICAMP
Campinas, SP, Brazil;
Medical Research: What are the main findings of the study?Dr. Modolo: The main findings of this study are the encounter of a high prevalence of silent myocardial ischemia (assessed by myocardial perfusion scintigraphy) in resistant hypertension and the identification of predictors of this alteration in this population.
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MedicalResearch.com Interview with: Dr. John J. Sim
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center, Los Angeles,
Medical Research: What are the main findings of the study? Dr. Sim: Among a large diverse population of treated hypertensive people, those who achieved systolic blood pressures (SBP) in the ranges of 130-139mm Hg had the lowest risk for death and end stage renal disease (kidney failure). Not surprisingly, those with SBP above 139 had incrementally greater risk, but somewhat surprising was that those with SBP under 130 also had a greater risk for death and kidney failure.
(more…)
MedicalResearch.com Interview with: Alejandro Arrieta, PhD
Assistant Professor
Department of Health Policy and Management
Florida International University
Medical Research: What are the main findings of the study?Dr. Arrieta: We found that it makes business sense for insurance companies to reimburse patients for the cost of blood pressure monitors that they can use at home. In just the first year, we estimate that insurance companies can produce returns that range from $0.85 to $3.75 per dollar invested in blood pressure monitors provided to their members.
(more…)
MedicalResearch.com Interview with: Dr. Michele Callisaya
Faculty of Medicine, Nursing & Health Sciences
Monash University, ClaytonMedicalResearch: What are the main findings of the study?
Dr. Callisaya: Falls are common in older people and can lead to hip fracture and loss of mobility. Blood pressure reducing medications are commonly taken by older people to protect against heart attacks and stroke, but may have some unwanted side effects such as light-headedness and loss of balance. We found that older people who were on large doses of such medications were at increased risk of falling.(more…)
MedicalResearch.com Interview with Carlos J. Rodriguez, MD, MPH
Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
MedicalResearch: What are the main findings of the study?Dr. Rodriguez: As a clinician there is a notion suggesting that lower blood pressure is better but our current research to date is controversial and not conclusive. We wanted to study a large group of people with hypertension and see whether over 20 years of follow up, if a lower systolic blood pressure would be associated with lower cardiovascular events (heart attack, stroke, heart failure, angina). We hypothesized that there would be a linear association between blood pressure and events, that lower blood pressure would be associated with lower events and that as the blood pressure went up there would be more events. We found this was not the case but that hypertensives with a blood pressure between 120-138mmhg have the greatest benefit and those with a blood pressure less than 120mmhg did not have additional benefit.
(more…)
MedicalResearch.com Interview with:Dr. Price Kerfoot MD, EdM
Rabkin Fellow in Medical Education
Associate Professor of Surgery, Harvard Medical School
MedicalResearch: What are the main findings of the study?Dr. Kerfoot:
(1) An online spaced education game improved clinicians' knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension.
(2) As a method to increase clinicians' long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders).
(more…)
MedicalResearch.com Interview with:Dr. Feng He
Wolfson Institute of Preventive Medicine
Barts and The London School of Medicine and Dentistry
Queen Mary University of London, London, UKMedicalResearch.com: What are the main findings of the study?Dr. He:
The UK salt reduction program has led to a fall in population blood pressure and thereby contributed to the reduction in stroke and heart disease deaths.
In 2003, the UK Food Standards Agency and CASH (Consensus Action on Salt & Health) developed a salt reduction program. As approximately 80% of the salt in the diet is added to food by the food industry i.e. in processed foods, fast foods, canteen and restaurant foods etc, the public have no choice about eating it. Therefore progressive incremental targets to limit the amount of salt for each food category were set, which the industry had to achieve in a specified time. Reductions first started in 2003 and are continuing to this day.
The salt reduction program has been very successful and led to a 15% reduction in the average salt intake of the population, from 9.5g per day in 2003 to 8.1g per day in 2011 (P<0.05).
Over the same time period, blood pressure fell in the adult population by 3 mm Hg systolic and 1.4 mm Hg diastolic (P<0.0001). Stroke and heart disease deaths fell by 42% (P<0.0001) and 40% (P<0.0001) respectively.
It is possible that these falls in blood pressure and deaths from stroke and heart disease were attributable to various factors such as changes in diet, lifestyles and the improvement in the treatment of cardiovascular disease and its risk factors. Our further analysis showed that the reduction in salt intake played an important role, particularly in the falls in blood pressure.
In a further analysis, we looked at individuals who were not on any drug treatment for blood pressure and a correction was made for all other variables that could have influenced blood pressure, apart from salt. There was still a fall in adult population blood pressure of 2.7mm Hg systolic/ 1.1mm Hg diastolic, (P <0.0001). This reduction in blood pressure could therefore be largely attributed to the fall in salt intake.
It is well established that raised blood pressure throughout its range is a major cause of stroke and heart disease. The reduction in salt intake that led to a fall in blood pressure would have played an important role in both stroke and heart disease deaths.
Despite considerable progress being made on salt reduction, the average salt intake in England is still high. In 2011, it was 8.1 g/day which is over a third more salt than the recommended level of 6g/day. Therefore continuing and much greater efforts are needed to achieve further reductions in salt intake to prevent the maximum number of stroke and heart disease deaths.
(more…)
MedicalResearch.com Interview with:Finlay A McAlister MD
University of Alberta, Edmonton, Canada
MedicalResearch.com: What are the main findings of the study?Dr. McAlister:We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets).
The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician.
The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians. However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor.
Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .
(more…)
MedicalResearch.com Interview with:Ann Marie Navar-Boggan, MD, PhD
Division of Cardiology,
Duke University Medical Center
Durham, North Carolina
MedicalResearch.com: What are the main findings of the study?Dr. Navar-Boggan: Two groups of adults are really affected by the updated guidelines. First, 13.5 million adults, including one in five adults over the age of 60, were previously considered to have uncontrolled blood pressure but now meet new guideline goals.
Next, 14 million adults over the age of 60 (one in four adults in this age group) are currently on blood pressure lowering therapy and meeting the older, more stringent targets. The guidelines state that no changes are necessary in this group, but they may be eligible for reduced therapy, particularly if they have had side effects or difficulty with the therapies they are taking.
(more…)
MedicalResearch.com Interview with: Dingli Xu, MD
From Department of Cardiology
Nanfang Hospital, Southern Medical University, Guangzhou, China
MedicalResearch.com: What are the main findings of the study?Answer：Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low-range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension.
(more…)
MedicalResearch.com Interview with: Dr. Ido Weinberg MD MSc MHA
Massachusetts General Hospital, Vascular Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Weinberg: The study examined the relationship between blood pressure difference between arms and clinically meaningful outcomes such as death and new-onset (incident) cardiovascular disease including myocardial infarction and stroke. The main finding of the study was that an elevated inter-arm blood pressure difference correlated with these negative outcomes. We have also shown that the correlation was strong enough to be independent from the classic Framingham risk score. Adding an elevated inter-arm blood pressure to the risk score made it a more accurate.
(more…)
MedicalResearch.com Interview with:Yoko Yokoyama, Ph.D., M.P.H.
National Cerebral and Cardiovascular Center, Osaka, Japan,
MedicalResearch.com: What are the main findings of the study?Dr. Yokoyama: We found consistent evidence that a vegetarian diet has a significant blood-pressure-lowering effect, and this was clear both in observational studies of individuals who had chosen vegetarian diets on their own and in intervention trials in which people were asked to make diet changes.
Our meta-analysis included 32 observational studies and 7 controlled clinical trials. In the observational studies, vegetarian diets were associated with blood pressures that were about 7 mmHg lower systolic and 5 mmHg lower diastolic. In the clinical trials, the reductions were about 5 mmHg systolic and 2 mmHg diastolic. These are pooled averages, so for some individuals, particularly those with higher body weights or higher blood pressures at the beginning, the blood-pressure-lowering effects could be much greater.
(more…)
MedicalResearch.com Interview with:Maria Lorenza Muiesan
Department of Clinical and Experimental Sciences
University of Brescia, Internal Medicine
Brescia, Italy.
MedicalResearch.com: What are the main findings of the study?Dr. Muisean: An increase in the ratio of retinal arteries wall thickness to lumen diameter may serve as an in-vivo parameter of microvascular damage. We conducted a study that examined the relationship between changes in retinal arterioles wall thickness/ lumen diameter and several measures of blood pressure, including clinic brachial blood pressure, 24 hours brachial blood pressure and central aortic blood pressure. We found that the an increase of wall-to-lumen ratio of retinal arterioles was most closely related to 24 hours blood pressure.
(more…)
MedicalResearch.com Interview with: Dr. Miguel-Ángel Martínez-García
Respiratory Department, Hospital Universitario y Politécnico La Fe
Valencia, Spain
MedicalResearch.com: What are the main findings of this study:Answer: The main findings of the study are:
1. The treatment with CPAP
(continuous positive airway pressure) achieves a clinically and
statistically significant reduction of blood pressure in patients with
resistant hypertension (blood pressure that remains above goal in spite of
the use of at least three antihypertensive drugs) and obstructive sleep apnea.
(more…)
MedicalResearch.com Interview with Dr. Moa Wolff
Center for Primary Health Care Research
Department of Clinical Sciences in Malmö, Lund University
Jan Waldenströms gata 35, Skåne University Hospital, Malmö 205 02, Sweden
MedicalResearch.com: What are the main findings of the study?Dr. Wolff: We investigated the effects of two yoga interventions on blood pressure and quality of life in patients in primary health care diagnosed with hypertension. Our study showed that a short yoga program practiced daily at home had an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls.
(more…)
MedicalResearch.com Interview with:
Dr Sandosh Padmanabhan Institute of Cardiovascular and Medical Sciences University of Glascow, Scotland
MedicalResearch.com: What are the main findings of the study?Dr. Padmanabhan: In the study "Serum Chloride Is an Independent Predictor of Mortality in Hypertensive Patients" we analysed data on 12,968 patients with hypertension followed up at the Glasgow Blood Pressure Clinic. We found that patients in the lowest quintile of serum Cl− (<100 mmol/L), compared with all other patients, had a 23% higher mortality (all-cause, cardiovascular, and non-cardiovascular). Each 1-mmol/L increase in serum Cl− was associated with a 1.1% to 1.5% lower all-cause mortality, cardiovascular mortality and non-cardiovascular mortality. This was independent of serum concentrations of sodium, bicarbonate or potassium. We did not find any association with longitudinal blood pressure control.
(more…)
MedicalResearch.com Interview with:Dr. Marc Jaffe, MD
Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program
Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group
Associate Clinical Professor of Medicine, UCSF
Endocrinology and Internal Medicine
Kaiser South San Francisco Medical Center
1200 El Camino Real
South San Francisco, California 94080
MedicalResearch.com: What are the main findings of the study?Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates.
If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.
(more…)
MedicalResearch.com Interview with: Marcos A Sanchez-Gonzalez, M.D., Ph.D., EPC
Postdoctoral AssociateDepartment of Biomedical Sciences
College of Medicine
The Florida State University
1115 W Call Street BMS 2300-24 &
The Family Institute
Behavioral Cardiology Laboratory
Longmire 301
Tallahassee, FL 32306
MedicalResearch.com: What are the main findings of the study?Answer:
The findings of our study were the following:
(1) The low frequency component of systolic blood pressure variability (LFSBP; a marker of sympathovagal tone) was a stronger predictor of depressive symptoms than conventional measures of cardiovascular functioning such as laboratory measurement of blood pressure and heart rate variability as well as home based ambulatory blood pressure monitoring
(2) Depressive symptoms were associated with a blunted LFSBP response to sympathetic stimulation via cold pressor test; and
(3) Participants with acute depression (a score of ≥16 using the CES-D scale) had higher LFSBP than those with normal depressive symptom scores. These findings suggest that depressive symptoms evoke alterations in vascular sympathetic activity, and more importantly, this alteration is occurs early in the progression of the disease. This is fascinating owing to the fact that we have documented a common pathway of disease between depression and cardiovascular diseases.
(more…)
MedicalResearch.com Interview with: Miles D. Witham, PhD
Aging and Health, University of Dundee, Dundee, United Kingdom
MedicalResearch.com: What are the main findings of the study?Answer: We gave high dose vitamin D3 (100,000 units) or placebo every 3 months to people aged 70 or over, who all had isolated systolic hypertension (ISH). The main focus of the trial was to test whether vitamin D supplementation could reduce blood pressure in this group of patients – this pattern of blood pressure, whether the systolic (top number) is high, and the diastolic (bottom number) is normal, is very common in older people. Previous studies have suggested a link between low vitamin D levels and higher blood pressure, but no trial has yet tested this idea in older patients with ISH.
Despite the treatment causing a significant increase in circulating vitamin D levels, we saw no significant reduction in blood pressure with vitamin D supplementation, despite the trial running for a year. We tested whether certain groups might still benefit – e.g. those with very high blood pressure or very low vitamin D levels, but even these groups did not show a reduction in blood pressure.
We also tested whether vitamin D supplementation reduced the health and stiffness of arteries – both important predictors of future heart attack or stroke. Unfortunately, vitamin D did not affect these measures either, and didn’t reduce cholesterol or glucose levels.
On the more positive side, vitamin D supplements did appear safe, and the number of falls in the vitamin D group was slightly lower than in those people who received placebo. This is reassuring, as an earlier study (Sanders et al) had suggested that very high doses of vitamin D might make falls more likely, in contrast to previous low dose studies that show a protective effect of vitamin D against falls.
(more…)
MedicalResearch.com Interview with:Igor F. Tsigelny, Ph.D.
Department of Neurosciences, University of California at San Diego
San Diego Supercomputer Center, University of California at San Diego
Moores Cancer Center, University of California at San Diego
La Jolla, California 92093
MedicalResearch.com: What are the main findings of the study?Dr. Tsigelny: We find a new set of possible very effective drug-candidates for cure of hypertension. According to our preliminary testing these molecules are not toxic and can start a new series of drugs.
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MedicalResearch.com Interview with: Dr. Bernard Rosner
Harvard School of Public Health
Professor in the Department of Biostatistics
Department of Biostatistics
Channing Laboratory 180 Longwood Avenue
Boston, Massachusetts 02115
MedicalResearch.com: What are the Main Findings of this study?Dr. Rosner: The risk of elevated blood pressure (BP) among children has increased 27% over a 13-year period based on a study among 11,636 children ages 8-17 seen in the NHANES study from 1988-2008. In NHANES III (1988-1994) the risk was 15.8% among boys and 8.2% among girls. In NHANES 1999-2008 (1999-2008) the risk was 19.2% among boys and 12.6% among girls.
Important risk factors for elevated BP were BMI, waist-circumference and sodium intake.
Risk approximately doubled for children in the highest age-sex-specific quartile of BMI vs. children in the lowest quartile
Risk approximately doubled for children in the highest age-sex-specific quartile of waist circumference vs. children in the lowest quartile
Risk increased 36% among children with dietary Na intake > 3450 mg/day vs. children with intake <2300 mg/day. Na intake was normalized per 2000 calories.
There were large increases in both mean BMI and mean waist circumference over the 13-year period, especially for girls.
(more…)
MedicalResearch.com Interview Invitation Dr. Gang Hu, MD, PHD
Pennington Biomedical Research Center, Baton Rouge, Louisiana
MedicalResearch.com: What are the main findings of...
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Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
Medical Research: What are the main findings of the study?
Dr. Sui:
First, blood pressure is inversely associated with cardiorespiratory fitness levels among men. People in higher fitness categories had lower blood pressure than those in lower fitness categories.
Second, fitness is a strong effect modifier for the systolic blood pressure aging trajectory.
A higher fitness level can significantly delay the natural age-associated increase in blood pressure.
(more…)
