A healthcare provider’s presence or absence when blood pressure is measured resulted in similar BP levels and reduction in CVD risk, a new analysis of the SPRINT trial found.
The data, based on SPRINT staff interviews, indicate similar results whether the measurement was taken with a provider present, absent or absent part of the time.
“We saw no heterogeneity between the measurement groups,” said Karen C. Johnson, MD, MPH, FAHA, vice chair of the SPRINT Steering Committee. “The use of a validated, automated blood pressure device, staff training to allow for a quiet rest period, proper positioning, use of proper cuff size and averaging multiple measurements may be more important than whether the measurement is attended or unattended.”
Johnson, Endowed Professor of Women’s Health in the Department of Preventive Medicine at the University of Tennessee Health Science Center in Memphis, reported the ad hoc analysis during the third Late-Breaking Science Session on Monday.
Blood pressure measurement in SPRINT is similar to methods used in virtually all recent hypertension trials and to what’s recommended for clinical practice. Because 99.7 percent of SPRINT blood pressure measurements were taken with a study-provided device, Johnson said it was no surprise that having a second person in the room was of little importance in obtaining an accurate measurement.
The challenge remains translating guideline-based blood pressure measurement from the clinical study setting into clinical practice, she said.
“Follow hypertension guidelines to measure blood pressure,” Johnson said. “That’s how you know how effective your treatment is.”
The more time newly diagnosed hypertension patients stay at blood pressure target, the lower their risk of subsequent events, according to a novel population study in the United Kingdom.
Researchers used the University College London CALIBER data resource to create a cohort of patients newly diagnosed with hypertension in January 1997-March 2010. They used the database to describe the average time per year spent by newly identified hypertensive patients at blood pressure care target.
Patients were at least 18 years old at baseline with no prior cardiovascular disease or hypertension diagnosis, and had at least six months of follow-up. Hypertension was defined as blood pressure at 140/90 mm Hg or higher.
Primary endpoints were a CVD composite of cardiovascular mortality, acute MI and stroke, as well as heart failure and a composite of any cardiovascular incident and death.
The cohort included 150,130 patients with a median of seven blood pressure readings during a median of five years. The average age was 52 and 56 percent were women. During follow-up, 46 percent of patients went on antihypertensive medications, 29 got dietary advice and 2 percent stopped smoking.
The time at target was not surprising, said Mar Pujades-Rodriquez, MBBS, PhD, an academic fellow in health informatics at the University of Leeds and an honorary senior researcher at University College London.
The median time at target was 2.8 months per year and only 4.5 percent of patients spent nine to 12 months at target. The less time at target, the greater the risk of cardiovascular events, Pujades-Rodriquez said.
The odds ratio for the cardiovascular disease composite ranged from 4.51 for those with no time at target to 0.7 for those who spent nine months or more per year at target. The distribution was similar for heart failure, from 3.53 for no time at target to 0.47 for nine months or longer. The association between any cardiovascular disease and death ranged from 2.57 to 0.42.
Bariatric surgery can lower or eliminate the need for anti-hypertensive medications in some obese hypertensive patients, new data suggest.
The Gastric Bypass Surgery to Treat Patients with Steady Hypertension found that 83.7 percent of patients who underwent bariatric surgery had at least a 30 percent reduction in hypertensive medications at one year. Just 12 percent of patients on medical treatment had similar results.
“Over half of bariatric surgery patients — 51 percent— had a complete remission of hypertension with no antihypertensive medication use,” said Carlos Aurelio Schiavon, MD, FACS, from the Center for Surgical Treatment of Morbid and Metabolic Disorders at Hospital Alemão Oswaldo Cruz in São Paulo, Brazil. “None of the patients on medical therapy only showed remission.”
Observational studies and randomized trials focused primarily on diabetes have shown that antihypertensive medications are discontinued and cardiovascular events reduced after bariatric surgery.
GATEWAY is the first randomized controlled trial in a broad population of hypertensive obese patients. The 100 obese patients with hypertension were randomized to gastric bypass or medical therapy. The primary endpoints were at least a 30 percent reduction in antihypertensive while maintaining a blood pressure below 140/90 mm HG.
The bariatric surgery group had significant weight loss over several months, but reductions in antihypertensive medications were clear in the first 30 days after surgery. The underlying reasons for the improvements in hypertension are not clear, Schiavon said.
Bariatric surgery patients also showed significant improvements in metabolic and inflammatory profiles.