Keeping you up to date on recent headlines in cardiovascular healthcare:
Notes on studies reported at last week's American Society of Hypertension (New York) meeting in San Francisco.
Ambulatory BP monitoring in children identifies risk factors . . . . Ambulatory BP monitoring/staging can more accurately predict a child's risk for left ventricular hypertrophy (LVH), a precursor to cardiovascular disease (CVD), than current diagnostic methods using casual blood pressure measurements, according to a new study. A total of 241 children (ages 8-18) were included in a retrospective study. A study of 241 children, ages 8-18, showed a significant association between severe ambulatory hypertension and left ventricular hypertension, independent of age, gender, race and body mass index; this same relationship was not detected when participants were classified according to casual blood pressures alone. Lead study author, Alisa Acosta, MD, Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Medical School (Houston), said that despite the growing popularity of ABP monitoring, its value "for the clinical evaluation of children with BP abnormalities have remained unexplored."
Mobile health screening identifies at-risk populations . . . . Hypertension is disproportionally prevalent in African-American women living in Boston's inner city, despite recent improvements in diagnostic and treatment options. Study authors looked at results for nearly 15,000 women who utilized the Family Van, a mobile health program of Harvard Medical School (Boston). Among these women, 10,147 were screened for hypertension, with 42% found to have pre-hypertension. Among the women with stage I or higher BP, 1,240 (38%) were newly diagnosed. Hypertension (stage I or higher) was more prevalent in the African-American population (60%), compared to the Caucasian (5%), Hispanic (7%) and Asian (1%) populations. Compared with Caucasian and other races, African-American women also had higher mean systolic BP.
Patients satisfied with going online to get BP in line . . . . While receiving Web-based pharmacist care, patients with hypertension are more engaged and no less satisfied with their care than when receiving usual care, according to the Electronic Communications and Home Blood Pressure Monitoring (e-BP) trial, published last year. Based on these results, Group Health Cooperative (Seattle), a non-profit health system that coordinates care and coverage, is rolling out home monitoring and Web-based pharmacist care for its patients with hypertension. Group Health reported that BP control among its patients improved more when they monitored it from home and received Web-based pharmacist care. "We have known for a while that a key factor in improving treatment outcomes involves encouraging patients to actively participate in their own care," said lead author Beverly Green, MD, a family doctor and researcher at Group Health.
Study of youth hypertension confirms environmental impacts . . . . The relationship between low birth weight and hypertension becomes stronger as individuals become older, particularly in white males as opposed to females or blacks, according to the Bogalusa Heart Study. In addition, a separate analysis revealed that variations in BP measurements in children are related to the development of hypertension in adulthood, especially in blacks. Both sets of data indicate that responses to environmental factors as children grow into adults may play an important role in the development of hypertension. The researchers recommend low-dose medication for young individuals tracking above the 90th percentile, exercise and a nutritional diet for at risk children, especially when obese, along with comprehensive health education, said Gerald Berenson, MD, professor of cardiology at the Tulane Center for Cardiovascular Health (New Orleans). "We have developed the public health model Health Ahead/Heart Start Program for elementary school children, and it is hoped that such measures can be implemented to help to reduce children's risk."
Low BP may increase risks for those with heart disease despite lowering of LDL-cholesterol . . . . Data from the Treating to New Targets (TNT) trial show that low blood pressure levels may lead to increased risk of cardiovascular events, including heart attack and stroke. These data supplement previous findings from the TNT trial of atorvastatin showing aggressive LDL cholesterol-lowering reduced cardiovascular events. Researchers analyzed 10,001 people with coronary artery disease who received either 10 mg of atorvastatin (n=5,006) or 80 mg of atorvastatin daily (n=4,995) for a primary composite endpoint of death from coronary disease, non-fatal myocardial infarction , resuscitation after cardiac arrest, fatal or nonfatal stroke. Authors concluded that among a high-risk population with CAD in the TNT trial, despite substantial lowering of LDL-cholesterol, a J-curve relationship existed between both systolic and diastolic BP and the risk of future cardiovascular events, suggesting that low BP levels may be harmful.
Key anti-hypertensive findings from recent trials . . . . Data was presented summarizing the optimal initial anti-hypertensive treatment to reduce two common cardiovascular events related to BP, stroke and coronary heart disease. Researchers conducted two separate and stringent types of meta-analyses that included all clinical trials, including those done very recently, to better estimate the overall benefits achieved with initial drug treatments for hypertension. They concluded that for stroke prevention, all antihypertensive drugs were superior to placebo or no treatment, but an initial diuretic, ARB or calcium channel blocker (CCB) was slightly but significantly better than a beta-blocker or angiotensin-converting enzyme (ACE) inhibitor.
Studies of radical disparities in community-based treatment of hypertension . . . . Two studies presented underscore the importance of addressing racial disparities in treatment provided by community-based practices (CBP).
Researchers at the Medical University of South Carolina (Charleston) evaluated the control of diabetes, hyperlidipemia and hypertension in more than 96,489 diabetic, hypertensive patients (ages 41 - 81) seen at 150 CBPs between 2006 and 2008. Despite high control rates for individual risk factors in this CBP, only 17% of patients with diabetes, hyperlidipemia and hypertension attained simultaneous control of all three. Overall, control rates were lower for African-Americans than Caucasians.
Treatment-resistant hypertension (TRH) – BP above goal on three or more medications or at goal on four or more medications – occurs in 20% to 30% of patients in clinical trials. In 2007, the Hypertension Initiative obtained data from 264,967 hypertensives seen at 150 CBPs. In 64% of patients without diabetes, blood pressure was controlled to <140/90 mm Hg, and in 40% of patients with diabetes and/or chronic kidney disease, BP was controlled to <130/80 mm Hg. Patients with diabetes and chronic kidney disease received more medications and achieved lower blood pressure, even though they were less likely to be controlled to the more stringent goal. African-Americans were comparatively over-represented in the uncontrolled group. "These data suggest therapeutic inertia remains an obstacle to better BP control, as many uncontrolled hypertensives are receiving below recommended number of medications," said Egan. "Improvement in care is urgently needed to address the burden of uncontrolled blood pressure and reduce racial disparities . . ."
— Compiled by Don Long, MDD National Editor