High Blood Pressure Blog

Data presented at a recent meeting of the American Society of Hypertension suggests that aspirin might play a larger role in the control of high blood pressure than was previously thought.

While doctors have long known that a daily, low dose aspirin can help thin the blood and protect against heart attacks in at-risk patients, new data suggests that the same daily dose might help control pre-hypertension. The catch? It only works if taken right before bed.

The researchers tracked about 250 patients with early hypertension who were told to take the same dose of aspirin either before bed or right after waking up. In the group taking the night-time dose, blood pressure fell by a significant amount. In the daytime group, there was no decrease in pressure.

Further trials will be needed before aspirin becomes a standard part of hypertension therapy.

Keeping with a rising trend of using common technology in novel ways in order to improve health care, researchers at the Cincinnati Children's Hospital are using a tool familiar to many teenagers - text messaging.

Data has shown that teens and tweens typically do a poor job controlling chronic conditions like asthma, diabetes, and high blood pressure. A large contributor to this poor control is failure to adhere to sometimes complex medication dosing schedules. In an effort to improve this, investigators have started a pilot program that sends teens text messages to remind them that it is time to take their medicines.

Currently the study is limited to early teens with asthma, who receive a daily text message with quick reminders about which medicines should be taken that day. The time the message is sent is tailored to the individual patient schedule. The goal is to help prevent full blown asthma attacks and thus increase school attendance and decrease visits to the emergency room.

Data is scheduled to be published late this year and pilot studies are also planned for teens with diabetes and high blood pressure.

Data presented at a recent meeting of the American Geriatrics Society suggests that even small increases in prescription copayment costs have dramatic effects on the number of people who take their medications as prescribed.

Dr. Jalpa Doshi and colleagues from the University of Pennsylvania looked at data from the Veterans Affairs Medical Association (VA) covering prescription and office visit information since 2002, when the VA instituted a $5 increase in the required copayment rate for 30 day prescriptions. After discovering trends that seemed to suggest that fewer patients were taking their medicines as prescribed, the team focused their research on the 24 months prior to the rate increase and the 24 months immediately following the rate increase.

When compared to "category 1" veterans (who have no out of pocket fees for any medical services), all patients who experienced the increase had a declining rate in appropriate medication use after the $5 increase. Even more, the decrease was directly related to the increased cost, even though the actual cost was small. Overall, in the group of patients who had their copay rise by $5, the number of people taking their medications as prescribed fell by about 20%.

The researchers emphasize the importance of proper medication use and have used their study to urge government officials to more carefully consider the outcomes of price increases in the future.

Patients with existing diseases unrelated to high blood pressure may be less likely to receive intensive high blood pressure treatment, according to a new study published in the Annals of Internal Medicine.

Researchers from the University of Pennsylvania School of Medicine examined the case records of more than 15,000 patients from six independent outpatient care clinics in the greater Philadelphia area. They found that about 60% of the patients with high blood pressure also had at least two unrelated illnesses (illnesses not connected to or affecting blood pressure).

Unexpectedly, while analyzing the data investigators found that as the number of other, unrelated illnesses rose, the odds that patients would receive intensive high blood pressure treatment fell. Though no firm conclusions are suggested by the study, the authors speculate that the other illnesses may create a "shadow effect" where doctors are hesitant to be too aggressive with blood pressure treatment because of possible negative effects on the other illnesses.

The study, encouragingly, also found that those with diseases related to high blood pressure (diabetes, circulation problems, heart disease) were significantly more likely to receive intensive treatment for high blood pressure.

As the use of "connected technology" in health care continues to expand, a variety of new studies suggest that the advances it brings are improving the quality of care for heart patients.

Connected technology refers to a number of different systems designed to keep patients and health care professionals in contact via automated systems used to track vital signs, physical parameters (like temperature, urine output, and blood hormone levels), and changes in treatment. These systems automatically gather data from patients and transmit them back to the doctor's office for review.

Though they sound sophisticated, these systems are actually fairly inexpensive, and represent a repurposing of existing technology that is commonly used in everyday life.

Data from 11 research studies, presented at a recent telemedicine conference, suggests that heart patients around the nation are benefiting from the use of these technologies. One study, which tracked participants in the Connected Cardiac Care Program, found that patients who participated had improved overall health and lower rates of hospital admissions. The program collects vital signs and symptom reports on a daily basis and transmits them to a central location for review. Any potential problems can be evaluated quickly, without the need for more invasive measures.

One hundred percent of the patients participating in the program gave the system positive reviews and said it helped to improve their quality of life and health care satisfaction.

For those curious about whether or not health care professionals follow the same advice they give to patients, a series of research studies shows that, for the most part, they do.

A series of 11 survey based research studies covering a cross section of doctors and nurses around the country found that the healthy behaviors advocated by these health care providers are often a part of their own daily lives.

Of the nearly 2000 professionals surveyed:

• 82% eat a healthy, balanced diet
• 73% exercise regularly
• 72% ensure their intake of the the RDA of vitamins and minerals
• 90% don't smoke

The new data may help some patients feel a little better about the recommendations passed along by their doctors and nurses.

Stents - small tubes used to hold heart vessels open after angioplasty - are an important part of modern, minimally invasive treatment for heart disease. An important potential complication of stent use is the development of blood clots that can lead to heart attack or stroke. To combat this risk, modern stents are manufactured with anti-clotting drugs built in to the stent itself. After implantation, the stents "elute" the drug in the area around the implant site, theoretically lowering the risk of clot related complications.

Because of ongoing data reports showing some confusion about the use and benefits of drug-eluting stents the US Food and Drug Administration (FDA) has proposed a new set of guidelines that makers must follow when seeking FDA approval for new stents. These new guidelines take aim specifically at patient centered issues and at helping doctors better understand which stent to choose to improve patient care. Specifically, the guidelines say that makers must provide data on how effective the stents are at reducing patient deaths, how often patients develop blood clots, and how easy (or hard) it is to complete follow up treatment and care on patients who have the stents implanted.

The FDA has stated that new guidelines represent the agency's ongoing efforts to make data clear and appropriate for health care professionals who need to formulate effective treatment plans.

Research published in the Archives of Internal Medicine has again suggested that family history plays a large role in the development of high blood pressure. Namely, researchers found that the risk of hypertension is almost doubled in people who have two hypertensive parents.

The study, conducted by researchers from Johns Hopkins, tracked about 1000 male participants for an average of 54 years. Monitoring started in early adulthood, and lasted for the rest of the subjects' lives. Even after adjusting for things like activity level, smoking, and weight, investigators still found that those with one or two hypertensive parents were more likely to develop high blood pressure themselves.

The increase in risk was about 50% in men with hypertensive mothers, 80% in men with hypertensive fathers, and 150% for men with hypertensive mothers and fathers.

Though this data is interesting, and supports the ongoing task of classifying the genetics of high blood pressure, family history is an uncontrollable risk factor. Remember that being at risk of a disease does not mean you'll actually develop that disease. It does, however, mean that making smart choices becomes even more important. The best way to protect yourself from high blood pressure is still through health living - don't smoke, exercise, and control your body weight.

The Food and Drug Administration (FDA) is busy analyzing data from an ongoing study tracking the cardiovascular risks associated with two important HIV Drugs called Videx and Ziagen. The FDA is reviewing data from a large study known as the DAD study, which is thought to be the largest study of its kind ever undertaken. DAD tracks HIV patients on three continents - patients who are being treated with a variety of anti-HIV drugs.

Preliminary data review suggests that both Videx and Ziagen carry an increase in the risk of cardiovascular events - specifically, heart attack. That means that patients taking one of these two drugs may be more likely to have a heart attack compared to patients being treated with other anti-HIV drugs. Notably, the FDA review shows that the increase in risk appears to be sudden and reversible. That means that the risk rises as soon as one begins treatment, rises to an absolute and predictable level where it stays for the duration of treatment, and goes away when the drug is stopped.

The makers of both drugs, as well as the FDA, stress that all of the data has yet to be gathered, and that the review is still incomplete. Drug makers stress that while the increase in risk might be real, the actual overall risk is still very small. In other words, one must weigh the risks and benefits. If a drug is very effective at treating a disease, but increases the risk of heart attack from (for example) 1 in a million to 5 in a million, it's still a good drug. While it is technically correct to say that the drug raises the risk of heart attack by 500%, the actual risk of having a heart attack while on the drug is still small.

Data review is ongoing, and no official recommendations have been issued.

A study presented this week at the annual meeting of the American College of Cardiology revealed surprising data about the home monitoring of elderly patients with heart failure. Researchers examined health and treatment data from medicare patients who either had or had not been monitored at home with a sophisticated device that constantly transmits data about heart function, blood pressure, and cardiovascular status. When compared to people who received no monitoring - i.e., they received "only" standard care including regular follow up appointments - those on the home monitoring program had no improvements in the rate of hospitalization, "cardiac events" (like heart attack), or death.

This suggests that the home monitoring plan, which costs almost $18,000 per year compared to $13,000 per year for standard care, may not be an effective way to improve patients' health.

It is important to note that this study only examined a specific sub-type of patient; namely, those who would have gotten regular care anyway, but were supplimented with the additional at home monitoring. It remains to be seen what benefits home monitoring provides for patients who otherwise would not be getting regular follow up care for their heart problems.