Obesity in kids has adult sequelae
CHILDREN with obesity exhibit early signs of worsening cardiometabolic health including end organ effects such as increased left ventricular mass, a meta-analysis shows.
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blood pressure
The following articles have the tag blood pressure
Morning BP surge raises stroke risk in women
AN EXCESSIVE surge in morning blood pressure (BP) increases the risk of non-fatal stroke in women and could have implications for treatment and management, research suggests.
GPs want more progress on addiction, dementia
BLOOD pressure, diabetes and cholesterol have all been nominated by MO’s GP readership as areas in which they and their colleagues have had the greatest impact on patient outcomes during MO’s 25 years of publication.
Teen risk factors lead to higher BP
TEENAGERS do not get away with unfavourable lifestyle behaviours such as alcohol consumption, high salt intake and a lack of exercise, a WA analysis of blood pressure levels has shown.
Barriers remain for routine ambulatory BP monitoring
WORLD Hypertension Day was marked last week by experts calling for more widespread use of ambulatory blood pressure monitoring – but the RACGP says costs and practical considerations remain prohibitive.
Vitamin C could lower BP
HIGH-dose vitamin C significantly reduces blood pressure, according to findings from a meta-analysis of short-term trials.
Watermelon: the new, cool way to lower blood pressure in the obese
WATERMELON has a vasodilatory effect, reducing ankle blood pressure in people with obesity and pre-hypertension, researchers have found.
Patients with CVD not reaching BP targets
MORE than half of patients with established cardiovascular disease are failing to meet currently advised blood pressure targets, an Australian general practice study shows.
Safety warning for ADHD drug
THE TGA has issued a safety advisory warning that patients taking the ADHD medication atomoxetine (Strattera, Eli Lilly) require monitoring due to the risk of increased heart rate and blood pressure.
Cardiac polypill shown to halve major events
THE first polypill, combining four cardiac preventative drugs, could be available in Australia within two years, an expert says, after clinical trial results showed it could halve major cardiovascular events. An international collaborative group, including researchers from Sydney’s George Institute for Global Health, measured the effects of a combined pill in 378 people without an indication for any component of the pill but who had a five-year cardiovascular risk over 7.5%. They found that over 12 weeks, the polypill – containing aspirin 75 mg, lisinopril 10 mg, hydrochlorothiazide 12.5 mg and simvastatin 20 mg – reduced systolic ...
Auto BP monitors headed for GP wait rooms
AUTOMATED machines enabling patients to check their own blood pressure will be installed in 120 GP clinic waiting rooms across the country by year’s end. Thirty of the free machines, sponsored by Boehringer Ingelheim, will be rolled out in a pilot program with more to follow as clinics sign up to the initiative through the High Blood Pressure Research Council of Australia (www.hbprca.com.au). With studies showing up to 35% of Australians have hypertension, Professor Markus Schlaich, a blood pressure research specialist and council member, said the move should encourage more people in the community to “know their ...
Olmesartan safety called into question
A CLOUD hangs over the safety of antihypertensive agent olmesartan (Olmetec) following a clinical trial linking it to an increased risk of fatal cardiovascular events in patients with diabetes. ROADMAP was a randomised controlled trial in more than 4000 type 2 diabetes patients receiving 40 mg of olmesartan or placebo, designed to show whether the antihypertensive agent could delay or prevent microalbuminuria. Microalbuminuria onset was delayed by 23% in the olmesartan group, but 15 patients in the olmesartan group had fatal cardiovascular events compared with only three in the placebo group. All patients were given additional ...
Cholesterol falling in Australia, but we’re fatter than ever
CHOLESTEROL levels fell faster in Australia and New Zealand than in any other region in the world in the last 30 years, a new global study shows. But obesity is still rising, with Australians having the third biggest increases in BMI in the world over the past two decades. Researchers from the US, UK and WHO estimated trends in cholesterol, obesity and blood pressure using health surveys and epidemiological studies from 199 countries between 1980 and 2008. The data showed that total cholesterol levels fell in the global high-income regions of Australasia (Australia and New Zealand), ...
Low vitamin D raises risk of hypertension
YOUNG adult women with inadequate vitamin D intake are at significantly increased risk of developing hypertension later in life, US research suggests. A prospective study of 413 women aged 24 to 44 found those with vitamin D insufficiency (less than 80 nmol/L) at baseline were three times more likely to developed hypertension 14 years later than those with normal vitamin D levels. The association remained significant after adjusting for hypertension, age, body fat percentage, antihypertensive medication use and smoking status. Professor Rebecca Mason, deputy director of the Bosch Institute at the University of Sydney, said the ...
Lizard venom can lower blood pressure
IN AN unlikely discovery, Australian researchers have found that lizard venom can lower blood pressure, opening up the potential for new antihypertensive drug treatments in the future. An international team of researchers led by Dr Bryan Fry (PhD), from the department of pathology at the University of Melbourne, collected venom samples from a unique group of venomous lizards known as anguimorphs, which include monitors, alligators and legless lizards. "We only recently discovered that venom in lizards was not restricted to the Gila monster and beaded lizard, but it was in fact much more widespread - so we ...
Novel treatment for hypertension
AUSTRALIAN researchers say their novel technique for renal nerve deactivation effectively reduces high blood pressure in patients resistant to drug treatments. The renal denervation procedure is “safe, quick and minimally invasive”, and may eventually offer a way to reduce patients’ drug load, say the developers, from Melbourne’s Baker IDI Heart and Diabetes Institute. The procedure involves inserting a catheter through the groin into the renal arteries, where it emits radio frequency energy to deactivate the surrounding renal sympathetic nerves. This results in a sustained reduction in blood pressure. Research supporting the technique’s efficacy was presented to ...
US barber shops cut hypertension in men
ENABLING barbers to monitor blood pressure and dispense basic health education seems to improve hypertension in African-American men, new research confirms. A randomised trial involving 17 African American-owned barbershops in Dallas County, Texas, found almost 9% more of the intervention group achieved hypertension control compared to those attending barber shops where no intervention was offered after 10 months’ follow-up. Barbers in the intervention groups offered BP checks with haircuts to all their clientele and promoted doctor follow up with gender-specific peer-based health messages, compared with controls where barbers distributed standard BP pamphlets to clients. ...
Pre-eclampsia: The CVD connection
Is pre-eclampsia a one-off event or a signal for future cardiac disease for mothers and children? Leigh Parry asks if we should monitor these groups more closely in later life.
Pine bark found not cardioprotective
PINE bark extract, marketed to patients seeking an alternative approach to cardiovascular disease prevention, offers no benefit over placebo, researchers say. Their finding follows a US study in which 130 patients with obesity and hypertension were randomised to receive 200 mg of pine bark extract daily or placebo. The researchers concluded there was no significant reduction in blood pressure in either group after 12 weeks. Nor were there any substantial differences between the two groups in other cardiovascular risk factors including BMI, lipid levels, insulin levels, fasting glucose, liver function and high-sensitivity C-reactive protein. Despite the ...
Lower BP raises risk in pre-existing CAD
A J-CURVE effect, whereby those with the highest and lowest blood pressure levels are both at increased risk of cardiovascular events, has been confirmed in patients with coronary artery disease (CAD), researchers say. A US study of 10,000 patients with CAD, randomised to receive either 80 mg or 10 mg atorvastatin, found an increased risk of death from coronary heart disease or non-fatal myocardial infarction at both low and high BP targets. The authors say it confirms earlier findings and questions the dictum that “with blood pressure, lower is always better”. The CV risk was less with ...
Pressure test for BP monitoring
Just how good is BP monitoring when it comes to gauging the effectiveness of antihypertensives? Chris Brooker looks at the debate that could see the sphygmo’s dominance in the surgery decline.
Immediate drug therapy warranted for confirmed HT
DECISIONS on when to initiate drug treatment for hypertension should be based on a patient’s absolute cardiovascular risk, an Australian expert says. Mark Nelson, professor of general practice at the University of Tasmania, recommended immediate drug treatment if grade three hypertension was confirmed by multiple measures on at least two occasions. Writing in Australian Prescriber, Professor Nelson, also a senior member of the Menzies Research Institute, said this would include patients with a systolic BP of 180 mmHg or greater or diastolic BP 110 mmHg or greater, those with isolated systolic hypertension with widened pulse pressure (systolic ...
Home DIY care shows merit for hypertension
A HOME-BASED ‘self-management’ strategy for patients with hypertension involving telemonitoring and self-titration could offer a new approach to maintaining blood pressure (BP) control. The UK multicentre trial in 527 primary care patients with treatment-resistant hypertension found the ‘self-management’ group had an average decrease in BP of 17.6 mmHg versus a decrease in BP of 12.2 mmHg with ‘standard’ care after one year. The reduction in BP translated into a reduction in stroke risk of more than 20% and in coronary heart disease of more than 10%, the authors estimated. Side-effects were similar in both groups, except ...
Lower BP no benefit in diabetes and CAD
LOWER blood pressure targets for patients with diabetes and coronary artery disease (CAD) may not achieve their aim of improving cardiovascular outcomes. A US secondary analysis of 6400 patients with diabetes and CAD has challenged 2008 Australian Heart Foundation guidelines recommending BP targets of less than 130/80 mmHg in patients with diabetes and/or coronary heart disease. There was little difference in the rate of cardiovascular events between those maintaining systolic BP under 130 mmHg and those with “usual” control (130/80 mmHg to 145/85 mmHg). And when extended follow-up data was included, those in the tighter controlled ...
Lower BP targets for CKD ‘flawed’
CURRENT guidelines that recommend lower blood pressure targets for patients with chronic kidney disease (CKD) could be risky and are based on a lack of evidence, a US expert has argued. After conducting a literature review, Professor Julia Lewis, a nephrologist at Vanderbilt University, Tennessee, argued international guidelines recommending blood pressure targets of less than 130/80 mmHg in patients with CKD were flawed, being based on evidence from observational studies. “No well-powered, randomised, intention-to-treat clinical trials have demonstrated a clinically significant benefit of achieving a BP target of ≤130/80 mm Hg in the setting of CKD,” she ...
Check BP in children with familial hypertension
HYPERTENSION in children is increasingly common, researchers say, highlighting the need for blood pressure checks in children with obesity or a family history of cardiovascular disease. A US/Canadian cross-sectional study of 2000 paediatric primary care practice visits in children aged three to 20 years of age without a history of hypertension found 726 (36%) of children had elevated BP. However, as many as 87% of cases of elevated BP were not recognised by clinicians, most likely in children with more modest BP elevations. “Although obvious signs… may prompt providers to recognise BP elevation in children, cases ...
Ambulatory BP thresholds revised
AUSTRALIA’S first-ever 24-hour ambulatory blood pressure thresholds for moderate to severe hypertension have been set slightly lower than equivalent clinic values. The targets were developed from a collaborative study by the High Blood Pressure Research Council of Australia and the National Heart Foundation. The study compared 24-hour ambulatory BP measurements from 8575 treated and untreated hypertensives across Australia with clinic measurements by 1693 trained staff and doctors. The findings showed average clinic BP measurements by trained staff were 6/3 mmHg higher than daytime ambulatory BP and 10/5 mmHg higher than 24-hour BP, but 9/7 mmHg lower ...
Parents take heart: having children lowers BP
PARENTS dealing with a temper tantrum may disagree, but it appears that having children may actually lower blood pressure. A study of 198 US adults, who wore portable blood pressure monitors for 24 hours, found those who were parents had an average 4.5 points lower systolic blood pressure and three points lower diastolic blood pressure. This was after adjusting for age, BMI, exercise and smoking. The effect was most pronounced for women, with mothers having a 12-point difference in systolic blood pressure and a seven-point difference in diastolic blood pressure compared to women without children. ...
Easter Bunny delivers more than just eggs
THE Easter bunny may be delivering more than just a sweet treat this weekend with research finding consuming just six grams of chocolate per day may lower blood pressure and the risk of stroke and myocardial infarction (MI). German researchers examined the association between chocolate consumption and vascular disease based on food frequency questionnaires and blood pressure measurements in 19,357 participants aged 35 to 65 years and free of MI and stroke. After eight years follow-up, those with the highest chocolate consumption – an average of six grams of chocolate daily – had a 39% lower ...
Experts agree on uniform criteria for metabolic syndrome
A UNIVERSAL definition for metabolic syndrome has been developed by international experts in an effort to end widespread confusion over diagnostic criteria. The clinical utility of the metabolic syndrome has been controversial but a high-profile group of experts, including Professor Paul Zimmet, of the Baker IDI Heart and Diabetes Institute, reaffirmed its importance in a commentary in The Lancet . The article follows an agreement in October by six major international bodies – including the International Diabetes Federation, International Atherosclerosis Society and the American Heart Association - to unify the cut-points for blood pressure, waist circumference, ...
Studies back increased daily vitamin D intake
CURRENT recommendations for daily vitamin D intake are too low to improve physical wellbeing, and vitamin D deficiency is having adverse effects on cardiovascular health, findings from two studies suggest. US researchers found vitamin D levels below 80 nmol/L in premenopausal women tripled the risk of high systolic blood pressure in later life, and, in a separate study, researchers found patients with levels of 25 nmol/L had double the risk of cardiovascular (CVD) mortality. Both research groups said the current recommended dose of 400-800 IU per day was inadequate. Dr Peter Rohl, senior staff specialist in ...
Absolute risk beats BP alone
FOCUSING on an absolute risk score is the optimum way to improve control of hypertension. Professor Mark Nelson, professorial fellow of the Menzies Research Institute in Hobart, said calculating and acting on absolute risk was among five strategies needed to manage the condition in general practice. Professor Nelson’s comments back up those of Professor Bruce Neal, senior director of the George Institute for International Health in Sydney, who last week told MO that a shift away from blood pressure targets towards absolute risk assessment had occurred internationally ( MO , 17 July ). ...
Antihypertensive monitoring challenged
CURRENT recommendations for regular monitoring of patients receiving antihypertensive drugs have been challenged by new Australian research. An international randomised controlled trial of 1709 patients with a history of stroke or transient ischaemic attack who were taking antihypertensives found regular checks of their blood pressure did not accurately reveal their response to treatment. Participants' blood pressure was recorded at diagnosis and at regular intervals for 33 months. The researchers estimated that for every true 10 or 20 mmHg increase in systolic blood pressure over a six-month period, there would be six or 200 patients respectively with ...
Ambulatory blood pressure and hypertension
Therapeutic Guidelines: Cardiovascular version 5 includes new material about ambulatory blood pressure and hypertension related to drugs and other substances. Ambulatory recordings measure blood pressure during daily life and may help identify various patterns of blood pressure elevation. These include ‘white-coat hypertension’, where apparently high blood pressure readings observed at a clinic are not confirmed on ambulatory recording. Other variations include ‘masked hypertension’ where normal clinic measurements are associated with above-normal ambulatory recordings. ‘Non-dippers’ have ambulatory blood pressure patterns that do not show the usual fall in blood pressure below daytime ...
Renal procedure for high BP
PATIENTS with resistant hypertension may achieve a significant decrease in blood pressure following renal denervation. An international research team headed by Professor Henry Krum of Monash University and researchers from the Baker IDI Heart and Diabetes Institute has found that catheter-based, ablation-induced renal denervation leads to substantial and sustained blood-pressure reduction. After one year, 45 patients underwent the treatment in a proof-of-concept study and recorded an average BP reduction of 27 mmHg, with no adverse events. Lancet 2009; 373:1275-81
Dual BP therapy hits the target first up
INITIATING treatment with a combination, fixed-dose, antihypertensive therapy offers greater blood pressure control among patients with hypertension. Canadian researchers randomised 2100 patients to receive either a combination low-dose ACE inhibitor or ARB with a diuretic, or to recommended monotherapy. After six months, 20% more patients in the combination therapy arm had reached the target blood pressure levels, compared with patients in the monotherapy arm. Professor Garry Jennings, director of the Baker IDI Heart and Diabetes Institute, said the results strengthened the case for first-line treatment of hypertension with a low-dose combination therapy. “It is quite ...
Case for less salt boosted
A LOW-salt diet may be cardioprotective beyond the effect of lowering blood pressure, even when used for as little as two weeks. Researchers from the CSIRO randomised 29 overweight and obese adults to either a low-salt diet (50 mmol Na/d) or to a usual salt diet – with similar potassium and saturated fat content but three times the level of salt. After only two weeks, the low-salt group had 30% greater brachial artery flow-mediated dilation, as well as significantly lower systolic blood pressure and reduced 24-hour sodium excretion than the standard diet group. Bruce Neal, associate ...
GPs urged to redouble effort to meet CVD target
THE MAJORITY of patients with cardiovascular disease are not meeting Heart Foundation goals for a range of management targets, research has shown. A study of 2031 stable angina patients attending GP practices around Australia found only 14% achieved both a BMI of less than 25 kg/m 2 and waist measurement of less than 94 cm for men and 80 cm for women. Around 24% of patients met the BMI target alone, and 23% met waist circumference targets. While more than two-thirds of patients achieved their HDL cholesterol target (greater than 1.0 mmol/L), only 50% met ...
‘Revolutionary’ vaccine for hypertension
IMMUNISATION against angiotensin II may offer a radical new approach to the management of hypertension and a solution to the widespread problem of poor compliance with anti-hypertensive medication. Preliminary findings from an ongoing European randomised trial found patients with mild-to-moderate hypertension immunised with 100 µg or 300 µg of CYT006-angQb vaccine had lower blood pressure levels compared to those receiving placebo. Patients in the phase IIa trial reported the vaccine to be safe and well tolerated with no serious adverse effects except for transient influenza-like symptoms. Seventy-two patients aged 18 to 65 years received three subcutaneous ...