Tag: hypertension

Categories : Cardiovascular DiseaseTags :

ARB Has Slight Edge Over ACE Inhibitors for Hypertension Treatment

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A huge multinational study found that while angiotensin-converting enzyme (ACE) inhibitors are just as effective as angiotensin receptor blockers (ARBs) for hypertension treatment, ARBs have slightly fewer side effects.

The study, led by researchers at Columbia University Vagelos College of Physicians and Surgeons and encompassing millions of electronic health records, is the largest to compare the safety and efficacy of these two types of drugs. The findings were published online in Hypertension.

“Physicians in the United States and Europe overwhelmingly prescribe ACE inhibitors, simply because the drugs have been around longer and tend to be less expensive than ARBs,” said senior study author George Hripcsak, MD, the Vivian Beaumont Allen Professor and chair of biomedical informatics at Columbia University Vagelos College of Physicians and Surgeons.

“But our study shows that ARBs are associated with fewer side effects than ACE inhibitors. The study focused on first-time users of these drugs. If you’re just starting drug therapy for hypertension, you might consider trying an ARB first. If you’re already taking an ACE inhibitor and you’re not having any side effects, there is nothing that we found that would indicate a need for a change.”

“U.S. and European hypertension guidelines list 30 medications from five different drug classes as possible choices, yet there are very few head-to-head studies to help physicians determine which ones are better,” Dr Hripcsak said. “In our research, we are trying to fill in this information gap with real-world observational data.”

ACE inhibitors and ARBs are among the choices, and they have a similar mechanism of action. Both reduce the risk of stroke and heart attacks, though it’s known that ACE inhibitors are associated with increased risk of cough and angioedema.

“We wanted to see if there were any surprises–were both drug classes equally effective, and were ARBs producing any unexpected side effects when used in the real world?” Hripcsak says. “We’re unlikely to see head-to-head clinical trials comparing the two since we are reasonably sure that both are effective.”

To tackle the problem, the researchers analysed insurance claims and electronic health records from approximately 3 million patients in Europe, Korea, and the United States who were starting antihypertensive treatment with either an ACE inhibitor or an ARB.

The researchers employed a variety of cutting-edge mathematical techniques to dramatically reduce the bias and deal with information gaps from electronic health records, balancing the two treatment groups as if they had been enrolled in a prospective study.

The researchers tracked four cardiovascular outcomes–heart attack, heart failure, stroke, and sudden cardiac death–and 51 adverse events in patients after they started antihypertensive treatment.

They found that the vast majority of patients–2.3 million–were prescribed an ACE inhibitor, but found no significant difference between the two drug classes in reducing major cardiovascular complications in people with hypertension. As expected, patients taking ACE inhibitors had a higher risk of cough and angioedema, but the risk of pancreatitis and gastrointestinal bleeding was slightly higher as well.

“Our study largely confirmed that both antihypertensive drug classes are similarly effective, though ARBs may be a little safer than ACE inhibitors,” Hripcsak said. “This provides that extra bit of evidence that may make physicians feel more comfortable about prescribing ARBs versus ACE inhibitors when initiating monotherapy for patients with hypertension. And it shows that large-scale observational studies such as this can offer important insight in choosing among different treatment options in the absence of large randomised clinical trials.”

Source: EurekAlert!

Categories : Cardiovascular DiseaseTags :

Do Heart Hormones Drive Nighttime Hypertension?

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In a new series of studies, University of Alabama at Birmingham researchers have described the reasons behind low levels of natriuretic peptides (NPs) in obese individuals. 

First reported six decades ago, NPs are beneficial hormones produced by the heart, and are responsible for blood pressure regulation and the overall cardiovascular and metabolic health of humans. This study also addresses how the disturbance of an individual’s diurnal rhythm of these hormones contributes to poor cardiovascular health in obese individuals.

High blood pressure at nighttime is seen commonly in obese individuals, who already have higher risk of hypertension and poor cardiovascular outcomes. This can contribute to outcomes such as stroke, heart failure, heart attack and cardiac death. But why this impairment of this day-night blood pressure rhythm is not well understood — however, scientists believe that part of the reason lies with NPs.

“All the hormones in the human body have a day-night rhythm,” noted Vibhu Parcha, MD, a clinical research fellow in the Division of Cardiovascular Disease and the first author of both the studies. “It has been hypothesised the NP hormones should also have this rhythm, but this had not yet been demonstrated in humans. Our clinical trial assessed the 24-hour cycle of the NP hormones and compared it to the 24-hour cycle of blood pressure. We also studied how these cycles differ between lean and obese individuals and studied the reasoning behind why obese individuals experience lower levels of NPs.”

Following a rigorous clinical trial of healthy individuals, researchers found that NP hormones have a diurnal rhythm with higher levels in the afternoon and lower levels at nighttime — similar to the 24-hour cycle of blood pressure. In obese individuals however, researchers observed that the relationship between NPs and blood pressure does not function the same way. This leads to higher nighttime blood pressure and increased risk of cardiovascular disease. The low production of NPs combined with a relatively higher elimination of NPs from an obese individual’s system leads to low levels of these beneficial hormones in circulation, which may explain the NP deficiency.

“This is the first time we have seen that NPs, like other hormones, have a 24-hour rhythm,” said senior author Pankaj Arora, MD, a physician-scientist in UAB’s Division of Cardiovascular Disease. “These studies give us a better understanding of NPs and of the reasoning behind the NP deficiency in obese individuals. We now have an FDA-approved medication (LCZ696) that improves circulating NP levels. This medication is considered a first-line treatment for heart failure and may be used to increase NP levels.”

This medication could specifically target NPs and blood pressure if given at the right time of day and could control hypertension with precision, Dr Arora added. These findings point to using a physiologically-driven precision ‘chronopharmacotherapy’ approach to improve the diurnal blood pressure profile in obese individuals.

Source: University of Alabama at Birmingham

Journal information: Vibhu Parcha et al, Chronobiology of Natriuretic Peptides and Blood Pressure in Lean and Obese Individuals, Journal of the American College of Cardiology (2021). DOI: 10.1016/j.jacc.2021.03.291

Categories : Metabolic DisordersTags :

Zinc’s Surprising Role in Blood Pressure

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Researchers have discovered that a trace element, zinc, plays a previously unknown role in the regulation of blood pressure.

While the role of metals like potassium and calcium have been long known in this process, a new discovery about zinc’s critical and underappreciated role offers a potential new pathway for therapies to treat hypertension. While hypertension had been known to be associated with low zinc levels, it was not clear as to why.

The findings were published recently in Nature Communications.

The smooth muscle cells lining blood vessels regulate the speed at which the blood travels around the body. As smooth muscles contract, they narrow the artery, increasing blood pressure, and as the muscle relaxes, the artery expands and blood pressure falls. Too low a blood pressure, and the blood flow will be insufficient to sustain body tissues. If blood pressure is too high, the blood vessels risk being damaged or even ruptured.

“Fundamental discoveries going back more than 60 years have established that the levels of the calcium and potassium in the muscle surrounding blood vessels control how they expand and contract,” said lead author Ashenafi Betrie, PhD, and senior authors Scott Ayton, PhD, and Christine Wright, PhD, of the Florey Institute of Neuroscience and Mental Health and The University of Melbourne in Australia.

Specifically, the researchers explained, potassium regulates calcium in the muscle, and calcium is known to induce the narrowing of the arteries and veins that elevate blood pressure and restrict blood flow. Other cells surrounding the blood vessel, including endothelial cells and sensory nerves, also regulate the calcium and potassium within the muscle of the artery, and are themselves regulated by the levels of these metals contained within them.

“Our discovery that zinc is also important was serendipitous because we’d been researching the brain, not blood pressure,” said Dr Betrie. “We were investigating the impact of zinc-based drugs on brain function in Alzheimer’s disease when we noticed a pronounced and unexpected decrease in blood pressure in mouse models treated with the drugs.”

The investigators discovered that coordinated action by zinc within sensory nerves, endothelial cells and the muscle of arteries triggers lower calcium levels in the muscle of the blood vessel. This causes the vessel to relax, decreasing blood pressure and increasing blood flow. The scientists found that the brain and heart’s blood vessels were more sensitive to zinc than blood vessels in other areas of the body, warranting further research.

“Essentially, zinc has the opposite effect to calcium on blood flow and pressure,” said Dr Ayton. “Zinc is an important metal ion in biology and, given that calcium and potassium are famous for controlling blood flow and pressure, it’s surprising that the role of zinc hasn’t previously been appreciated.”

This research also explains the fact that the genes that control intracellular zinc levels are known to be associated with cardiovascular diseases including hypertension, and hypertension is also a known side effect of zinc deficiency.

“While there are a range of existing drugs that are available to lower blood pressure, many people develop resistance to them,” said Dr Wright, who added that a number of cardiovascular diseases, including pulmonary hypertension, are poorly treated by currently available therapies. “New zinc-based blood pressure drugs would be a huge outcome for an accidental discovery, reminding us that in research, it isn’t just about looking for something specific, but also about just looking.”

Source: Medical Xpress

Categories : Gender Neurodegenerative DiseasesTags :

High Blood Pressure Dementia Risk Found for Women

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Differences in blood pressure’s influence on dementia risk in men and women may provide clues to help slow the rapid progress of the disease, according to new research.

In a study involving half a million people, researchers found that although the link between several mid-life cardiovascular risk factors and dementia was similar for both sexes, for blood pressure it was not. Low and high blood pressure were both shown to be associated with a greater risk of dementia in men, but for women the risk of dementia increased as blood pressure went up.

Lead author Jessica Gong said that while more research was needed to verify these findings, they may point to better ways of managing risk.

“Our results suggest a more tailored approach to treating high blood pressure could be more effective at preventing future cases of dementia,” she said.

Dementia is fast becoming a global epidemic, currently affecting an estimated 50 million people worldwide. This is projected to triple by 2050 – mainly driven by aging populations. Rates of dementia and associated deaths are both known to be higher in women than men.

In 2016 it overtook heart disease as the leading cause of death in Australian women and it is the second leading cause of death for all Australians.

With no treatment breakthroughs of any significance, the focus has therefore been on cutting the risk of developing the disease. Cardiovascular risk factors are increasingly recognised as contributors to different types of dementia.

To explore differences in major cardiovascular risk factors for dementia between the sexes, George Institute researchers accessed data from the UK Biobank, a large-scale biomedical database that recruited 502 489 dementia-free Britons 40-69 years old between 2006 and 2010.

They found that, to a similar degree in women and men, smoking , diabetes, high body fat levels, prior stroke history, and low socio-economic status were all linked to a greater risk of dementia.

But when it came to blood pressure, the relationship with dementia risk between the sexes was different. Although the reason for this wasn’t clear, the authors proposed some possible explanations.

“Biological differences between women and men may account for the sex differences we saw in the relationship between blood pressure and the risk of dementia,” said Ms Gong.

“But there may also be differences in medical treatment for hypertension. For example, women are less likely to take medication as prescribed by their healthcare provider than men and may be taking more medications and experiencing more side effects.”

While there are no effective treatments for dementia, trying to reduce the burden of the disease by encouraging healthier lifestyles is the priority, and the strongest evidence points to blood pressure management.

“Our study suggests that a more individualised approach to treating blood pressure in men compared to women may result in even greater protection against the development of dementia,” said study co-author Professor Mark Woodward.

“It also shows the importance of ensuring sufficient numbers of women and men are recruited into studies and that the data for women and men should be analysed separately,” he added.

Source: George Institute

Categories : Cardiovascular DiseaseTags :

Some Meds May be Raising Blood Pressure Unnecessarily

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New research has found that nearly a fifth of adults with high blood pressure are taking a drug that may be raising their blood pressure further.

The findings presented at the American College of Cardiology’s 70th Annual Scientific Session. The results highlight the need for patients to regularly review all of the medications they take with their care team, including over-the counter drugs, to ensure none might interfere with blood pressure lowering efforts.

The research found that three most common culprits were antidepressants; nonsteroidal anti-inflammatory drugs (NSAIDs) that include ibuprofen and naproxen; and oral steroids used to treat conditions such as gout, lupus, rheumatoid arthritis or after an organ transplant. These drugs were reported by 9%, 7% and 2% of participants, respectively. Other drugs associated with blood pressure elevation included antipsychotics, certain oral contraceptives and popular decongestants.

Researchers said these findings raise concerns, especially as nearly half of Americans diagnosed with high blood pressure do not have it sufficiently controlled. Dr. Vitarello explained the goal blood pressure for hypertension patients is a reading of less than 130 mmHg over 80 mmHg, based on the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

“These are medications that we commonly take—both over-the-counter and prescribed medications—that may have the unintended side effect of raising blood pressure and could have adverse effects on our heart health,” said John Vitarello, MD, an internal medicine resident at Beth Israel Deaconess Medical Center in Boston and the study’s lead author. “We know that high blood pressure leads to cardiovascular disease, stroke and death and even small increases in blood pressure can have meaningful impacts on cardiovascular disease. Based on our findings, we need to be more aware of polypharmacy (the use of multiple medications by a single patient) in older adults who also have the highest burden of high blood pressure.”

The study examined data from 27 599 participants in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018. About half of the participants (49%) had hypertension (average age 55 years, 48% female), defined in the study as a blood pressure reading of ≥ 130 mmHg (systolic) or ≥80 mmHg (diastolic) or ever having been told they have high blood pressure. Researchers identified medications associated with blood pressure elevation based on those listed in the ACC/AHA guideline and examined use of these medications by hypertensive adults

Among hypertensive participants, 19% reported using one or more blood pressure raising medications and 4% reported using multiple. Nearly one-quarter (24%) of women with high blood pressure reported using a blood pressure raising medication compared with 14% of men. Older adults were more likely to be using blood pressure raising medications than younger adults (19% of participants over age 65 vs. 18% of participants under age 65).

Vitarello said the findings suggest that there may be opportunities to treat hypertension by switching out the drugs raising blood pressure rather than adding more anti-hypertensives. Some drugs may have the same benefit but impact on blood pressure less. Still, some patients may not have another medication option, so monitoring and talking to their care team is advised over stopping medications.

The researchers also estimated that if half of hypertensive US adults taking blood pressure raising drugs were to discontinue one of them, 560 000 to 2.2 million patients could be able to reach blood pressure goals without additional drugs. But Vitarello cautioned that this is only a preliminary analysis, and individual responses to stopping blood pressure drugs are variable, so the real-world benefit and tradeoffs of stopping these medications need to be further studied.

The study is limited in that it relies on participants’ self-report of having high blood pressure and an accurate accounting of all the medications they take. The study was funded by the National Institute on Aging and an ACC Fellows Career Development Award.

Source: American College of Cardiology

Categories : Ageing Cardiovascular DiseaseTags :

Cannabis can Lower Hypertension in Older Adults

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Adding to a growing body of evidence as to its health benefits, medical cannabis may lower blood pressure in older adults, according to research from Ben-Gurion University of the Negev (BGU) and its affiliated Soroka University Medical Center.

This is the first such study to investigate cannabis’  effect on blood pressure, heart rate and metabolic parameters in hypertensive adults 60 and older.

“Older adults are the fastest growing group of medical cannabis users, yet evidence on cardiovascular safety for this population is scarce. This study is part of our ongoing effort to provide clinical research on the actual physiological effects of cannabis over time,” said Dr Ran Abuhasira, BGU Faculty of Health Sciences and BGU-Soroka Cannabis Clinical Research Institute

Before and three months after beginning medical cannabis therapy, patients in the study were evaluated using 24-hour ambulatory blood pressure monitoring, ECG, blood tests, and body measurements. Patients ingested cannabis either orally in the form of oil extracts or by smoking.

The findings included a significant drop in 24-hour systolic and diastolic blood pressure values, with the lowest point occurring three hours after ingesting cannabis. Both daytime and nighttime reductions in blood pressure were observed, with more greater changes at night. Higher nighttime than daytime blood pressure may also raise the risk of Alzheimer’s disease, so lowering it at night may offer that benefit.

The pain relief from taking cannabis, often a reason for prescriptions, may also have resulted in a reduction of blood pressure, the BGU researchers postulated.

“Cannabis research is in its early stages and BGU is at the forefront of evaluating clinical use based on scientific studies,” said Doug Seserman, chief executive officer of American Associates, BGU. “This new study is one of several that has been published recently by BGU on the medicinal benefits of cannabis.”

Source: News-Medical.Net

Journal information: Abuhasira, R., et al. (2021) Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study. European Journal of Internal Medicine.doi.org/10.1016/j.ejim.2021.01.005.

Categories : UncategorizedTags :

Hypertension at Night Raises Cardiovascular Disease Risk

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An eight year long study conducted in Japan added to the evidence that hypertension during the night raises cardiovascular disease risk, especially compared to the daytime. 

Hypertension levels are usually assessed during the day, and do not give an accurate snapshot of a person’s circadian rhythm.  According to lead author of the study, Kazuomi Kario, MD, PhD, hypertension at night, especially when blood pressure is lower during the day, raises cardiovascular disease risk and is increasingly being recognised as a risk factor. Kario said, “This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure and different nighttime blood pressure phenotypes than have been reported previously.”

The Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study enrolled 6359 patients and measured daytime and nighttime levels using an at-home, wearable, ambulatory monitor. They were told to conduct their daily routine as normal, and to rest or sleep during the night. The results showed that elevated blood pressure during the night compared to the day was a significant indicator of raised cardiovascular disease risk. Patients who were hypertensive and then had a large dip in systolic pressure had a greater risk for stroke.

“Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events,” said Dr Kario. “The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period.”

Source: Medical Xpress

Categories : UncategorizedTags :

Algorithm-driven Treatment Lowers LDL-c, Blood Pressure

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Clinicians working at Brigham and Women’s Hospital in the US treated patients with the aid of digital tools and an algorithm which calculated the titration of medication for pharmacists.

Over 5000 patients were enrolled into the study, entering either the cholesterol control program, the hypertension program, or both. Of those in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes without ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-c) >190 mg/dL. 

Study lead author Benjamin Scirica, MD, MPH, a cardiologist at Brigham and Women’s Hospital and associate professor of medicine at the Harvard School of Medicine, said, “To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care.”

Patients with high LDL-c and/or hypertension were identified using electronic patient records, and received a digital blood pressure cuff for at-home monitoring. With the aid of the algorithm, pharmacists and support staff initiated and titrated medication.

For patients who completed the titration phase of the program, a 52mg/dL (42%) decrease in LDL-c was observed, while for all patients, LDL-c levels dropped by 24mg/dL (18%) and 14mmHg systolic and 6mmHg diastolic blood pressure drops were recorded. Patients in high-risk categories saw significant drops in LDL-c.

The research showed that efficient, effective care was possible, while simultaneously reducing the need for physical consultations. Such enabling technology allows access to care delivery to be significantly expanded.

Source: Science Daily

Categories : Cardiovascular DiseaseTags :

A Bad Rap? Statins Have “Nocebo” Effect

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According to an article by the BBC, new research funded by the Imperial Heart Foundation indicates that a significant portion of statins’ adverse side effects are attributable to the “nocebo” effect. 

Statins are one of the most prescribed tablets in the UK, used to lower low-density lipoprotein (LDL) cholesterol and triglycerides levels, and raise high-density lipoprotein (HDL) cholesterol. The effects help prevent heart attacks and stroke, but nearly a fifth of patients stop taking them due to side effects such as joint pain, muscle ache, fatigue and nausea. In 60 patients were recruited, who had all stopped taking statins due to their adverse effects. On a scale of 0 to 100, those taking placebo tablets reported a similarly high score (15.4) to those taking statins (16.3), compared to a group receiving no tablets (8).  The effect was so strong that many patients discontinued the dummy pills. 

The nocebo effect is the inverse of the placebo effect, where patients experience adverse effects even when they are taking a placebo. This is thought to explain why there is such a high prevalence of penicillin allergies when testing proves otherwise. 

Once the patients were talked through the nocebo effect, most were able to resume statins. It is not known as to why statins have such a powerful nocebo effect, although some attribute this to media creating a “self-fulfilling destiny”.

“If you stopped a man in the street and asked how do you feel about an aspirin or a statin a day, I think people would be much more positive about the aspirin,” said one of the researchers, Dr James Howard.