CME: Systolic Hypertension & Cardiovascular Mortality

CME: Systolic Hypertension & Cardiovascular Mortality
Author Information (click to view)

Donald M. Lloyd-Jones, MD, ScM

Eileen M. Foell Professor of Heart Research
Chairperson, Department of Preventive Medicine
Senior Associate Dean for Clinical and Translational Research
Northwestern University Feinberg School of Medicine

Donald M. Lloyd-Jones, MD, ScM, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the findings—and their implications—of a study that assessed the risk for cardiovascular disease among patients with isolated systolic hypertension who were aged 18 to 49, did not have diagnosed coronary heart disease, and were not taking antihypertensive therapy at baseline.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJuly02.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Christopher Cole – Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Donald M. Lloyd-Jones, MD, ScM
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Donald M. Lloyd-Jones, MD, ScM (click to view)

Donald M. Lloyd-Jones, MD, ScM

Eileen M. Foell Professor of Heart Research
Chairperson, Department of Preventive Medicine
Senior Associate Dean for Clinical and Translational Research
Northwestern University Feinberg School of Medicine

Donald M. Lloyd-Jones, MD, ScM, has indicated to Physician’s Weekly that he has no financial interests to disclose.

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A study has found that younger and middle-aged adults with isolated systolic hypertension have higher risks of death from heart disease than those with optimal blood pressure levels.
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Studies have shown that isolated systolic hypertension (ISH)—defined as having a systolic blood pressure (BP) of 140 mm Hg or higher with a diastolic BP less than 90 mm Hg—is associated with elevated risks for cardiovascular disease (CVD) in older adults. “There has been a sense among clinicians that ISH is a benign condition in younger people,” explains Donald M. Lloyd-Jones, MD, ScM. “This had led some experts to label ISH as pseudo-hypertension, but the data to support this belief are limited.”

 

A Look at Younger Patients

Few studies have looked at ISH in younger patients, despite research suggesting that its prevalence has increased in younger and middle-aged adults in recent years. For a study published in the Journal of the American College of Cardiology, Dr. Lloyd-Jones and colleagues assessed the risk for CVD in 27,000 patients aged 18 to 49 who did not have diagnosed coronary heart disease and were not taking antihypertensive therapy when they were assessed at baseline. Participants in the study were classified into one of the following groups:

  • Optimal-normal BP (systolic BP <130 mm Hg, diastolic BP <85 mm Hg).
  • High-normal BP (systolic BP 130 to 139, diastolic BP 85 to 89 mm Hg).
  • ISH.
  • Isolated diastolic hypertension (systolic BP <140 mm Hg, diastolic BP ≥90 mm Hg).
  • Systolic and diastolic hypertension (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg).

With access to the Chicago Heart Association Study database and linkage to the National Death Index, the study team was able to assess follow-up data on the cause of death among participants as well as 35-year outcomes, with an average follow-up of about 31 years. “It is necessary to follow younger patients for the long term because they don’t typically have many cardiovascular events in the near term,” says Dr. Lloyd-Jones.

 

Important Results

The most important finding from the study, according to Dr. Lloyd-Jones, was that the pattern of ISH in younger patients was associated with a higher risk for cardiovascular mortality, and for coronary mortality in particular. “When compared with younger men who had normal BP levels, those with ISH were at about 15% higher risk for cardiovascular mortality over the next 30 years,” he explains. “For younger women with ISH, the risk was even more pronounced. Overall, patients with ISH had a 1.5- to 2.0-fold higher risk for 30-year cardiovascular mortality than those with normal BPs. Our findings suggest that it is increasingly important to detect ISH in younger individuals. Clinicians need to become aware of this correlation.”

The highest risks for CVD mortality among the various BP patterns studied were seen among participants with elevations in both systolic and diastolic BP (Figure). However, ISH was clearly associated with higher risk when compared with normal BP, explains Dr. Lloyd-Jones. “Our study is the first to show this observation in a large dataset of younger individuals,” he adds.

Even after adjusting for comorbid conditions like diabetes, smoking, or elevated BMI, patients with ISH had significantly higher rates of death from CVD, coronary heart disease, and stroke when compared with those with normal BPs. “There seems to be an independent association of ISH with higher mortality risks,” says Dr. Lloyd-Jones.

 

Incorporating the Findings

When ISH is observed in younger patients, the first step should be to confirm the finding with a repeat BP measurement in the near future, according to Dr. Lloyd-Jones. “If the repeat measurement confirms that the patient has ISH, intensive lifestyle modifications—including losing weight, increasing physical activity, and reducing sodium in the diet— should be considered,” he says. “Whereas physicians might be reluctant to prescribe a medication immediately, research has shown that lifestyle modifications can effectively lower BP. Failure to address these modifications will likely lead to negative implications over the long term, particularly for women.”

If attempts at lifestyle changes do not result in improvements in systolic BP, Dr. Lloyd-Jones says it may be reasonable to have a conversation with patients about whether or not medical therapy should be considered. “It’s important to note, however, that few clinical trials have shown that medications in young adults effectively prevent future cardiovascular events,” he adds. “It is paramount that clinicians are aware of the risks associated with ISH and discount the notion that it may just be pseudo-hypertension.”

Readings & Resources (click to view)

Yano Y, Stamler J, Garside D, et al. Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry Study. J AM Coll Cardiol. 2015;65:327-335. Available at http://content.onlinejacc.org/article.aspx?articleID=2091726.

Mancia G, Giannattasio C. Diagnostic and therapeutic problems of isolated systolic hypertension. J Hypertension. 2015;33:33-43.

Ewen S, Ukena C, Linz D, et al. Reduced effect of percutaneous renal denervation on blood pressure in patients with isolated systolic hypertension. Hypertension. 2015;65:193-199.

Mancusi C, Gerdts E, De Simone G, et al. Impact of isolated systolic hypertension on normalization of left ventricular structure during antihypertensive treatment (the LIFE study). Blood Press. 2014;23:206-212.

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