The American Society of Hypertension's 25th Annual Scientific Meeting and Exposition took place May 1 to 4 in New York City, and attracted nearly 3,000 participants from around the world. The conference focused on the prevention and management of hypertension, providing insight into more targeted approaches for treating patients with and at risk for hypertension and associated comorbidities.
Key highlights included results from the intensive blood pressure (BP) control arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. In addition, presentations focused on the comparative efficacy of different BP lowering agents as well as the risk of cardiovascular disease based on genetic variations and risk factors.
In an update of the intensive BP control arm of the ACCORD study, presented during a late-breaking session by William C. Cushman, M.D., of the Veterans Affairs Medical Center (VAMC) in Memphis, Tenn., the researchers showed no conclusive evidence that intensive BP control reduced the rate of major cardiovascular disease events in patients with type 2 diabetes at increased cardiovascular risk. However, they did show that there was a 41 percent reduction in stroke among those undergoing intensive BP control. In addition, a subgroup analysis showed that stroke rates were typically higher in subgroups expected to be at higher risk for stroke, including participants over 65 years of age, African-Americans, and those with higher levels of systolic BP or on more drugs at study entry.
The ACCORD study evaluated the effect of targeting a systolic BP goal of 120 mm Hg as compared to a goal of 140 mm Hg, in patients with type 2 diabetes at increased cardiovascular risk. While Cushman said that getting below 140 mm Hg is very effective in reducing cardiovascular events, the researchers were trying to see if reducing systolic BP even further would lead to even greater cardiovascular benefits, as observational/epidemiologic evidence suggested it might.
"The reduction in stroke did not change our main conclusions since the primary outcome results were not significant. However, this secondary finding is consistent with previous hypertension trials and meta-analyses showing a 10 mm Hg reduction in systolic BP leads to a similar stroke reduction," Cushman said. "This secondary finding does not mean that all patients with diabetes should be treated to a systolic BP goal of 120 mm Hg."
One author of the study disclosed financial ties to several pharmaceutical companies.
Other studies presented at the conference focused on the use of electronic health records with controlled interventions to obtain optimal BP control and reduce adverse events and mortality. In one large study over an eight-year period, Ross D. Fletcher, M.D., of the VAMC in Washington, D.C., and colleagues evaluated 478,191 hypertensive patients with BP above 140/90 mm Hg on three separate days, and 173,946 patients with normal BP, and showed that, overall, yearly BP control increased by 3.7 percent per year. In addition, more than 70 percent of patients with hypertension were controlled at the end of the follow-up period, with the mean percent of controlled patients increasing across all ethnic and age groups.
"With the use of a uniform system for controlling BP aimed at the BP level itself, organized interventions produced high rates of control in all ethnic and age groups in all cities," Fletcher said in a statement.
In another substudy, Vasilios Papademetriou, M.D., of the VAMC in Washington D.C., and colleagues showed that patients who had optimal BP control using a computerized patient record system resulted in a 47 percent reduction in all-cause mortality compared to patients with poorly controlled BP.
"Optimal BP control provided substantial improvement in mortality risk and even partial BP control provided significant mortality risk reduction," Papademetriou said in a statement.
One author of the study disclosed financial ties to Abbott and AstraZeneca.
In a retrospective study presented at the conference by Costas Tsioufis, M.D., of the VAMC in Washington, D.C., researchers evaluated over 6,000 men with a mean age of 68 years and most with hypertension, to assess left ventricular mass index (LVMI) at baseline, and kidney function and BP levels both at baseline and at the end of the study period.
The researchers found a strong association of LVMI for both body surface area and height on all of the studied renal outcome measures (doubling of serum creatinine, glomerular filtration rate less than 30 mL/min/1.73m2, and incident hemodialysis). There was an increase in the risk of all renal outcomes for each 42 g/m2 increase in LVMI, with a 45.7 percent increase for doubling of serum creatinine, a 51.9 percent increase for estimated glomerular filtration rate of less than 30 mL/min/1.73m2, and a 58.3 percent increase for hemodialysis. Patients with an LVMI of more than 125g/m2 demonstrated a significant decrease in renal function, compared to those with an LVMI below 110g/m2.
"In these patients, clinical practitioners should monitor and lower BP. At this point, it is best to treat high BP before the development of left ventricular hypertrophy to protect the heart and the kidneys," Tsioufis said.
ASH: Masked Hypertension Spotted in At-Risk Children
MONDAY, May 3 (HealthDay News) -- Children and adolescents whose parents have hypertension and larger waist and hip circumference are at increased risk of having masked hypertension, suggesting the need for ambulatory blood pressure monitoring outside the doctor's office, according to research presented at the American Society of Hypertension's 25th Annual Scientific Meeting and Exposition, held from May 1 to 4 in New York City.
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