by PWeekly | Jul 15, 2016
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...
by PWeekly | May 13, 2015
“The topic of treatment-resistant HTN has gained attention in recent years,” says Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC. “The condition increases long-term risk for poor outcomes, regardless of whether or not HTN is controlled or uncontrolled. Unfortunately, we’re lacking important data on the long-term effects of treatment-resistant HTN.” Coronary artery disease (CAD) is among the leading causes of mortality, and treatment-resistant HTN is more common in patients with CAD than without CAD. Little is known, however, about the impact that treatment-resistant HTN has on cardiovascular outcomes in patients with CAD. Such data may inform clinicians on strategies to aggressively manage risk factors. Identifying Predictors & Impact In the Journal of Hypertension, Dr. Cooper-DeHoff and colleagues published a study that described the prevalence, predictors, and impact on adverse cardiovascular outcomes of resistant HTN among patients with CAD and HTN. More than 17,000 study participants were divided into three groups according to achieved BP: 1) controlled (BP<140/90 mm Hg on three or fewer drugs); 2) uncontrolled (BP≥140/90 mm Hg on two or fewer drugs); or 3) resistant (BP≥140/90 mm Hg on three drugs or any patient on at least four drugs). “We found that resistant HTN occurred in 38% of patients with CAD and HTN,” says Dr. Cooper-DeHoff. “Those with resistant HTN were at increased risk for having poorer outcomes.” Several characteristics were associated with an increased risk of resistant HTN, including a history of heart failure, diabetes, and renal insufficiency, among others (Figure 1). Overall, 13 independent predictors of resistant HTN were identified. Many of these characteristics can be obtained noninvasively and help clinicians recognize these patients in the clinic. “The prevalence...
