Tag: hypertension

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Hypertension at Night Raises Cardiovascular Disease Risk

On By ModernMedia

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

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Algorithm-driven Treatment Lowers LDL-c, Blood Pressure

On By ModernMedia

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

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A Bad Rap? Statins Have “Nocebo” Effect

On By ModernMedia

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.