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Dubai (20 April 2012): High normal blood pressure becomes less of a risk factor for incident cardiovascular disease (CVD) and coronary heart disease (CHD) with age, according to a new study presented today at the World Congress of Cardiology.

The study, carried out over 9.3 years, evaluated the risk of different blood pressure categories among 6,273 participants aged 30 years old and above. The results showed that the risk of developing incident CVD and CHD was significantly higher in people with high normal blood pressure during middle-age (between 30 and 60 years of age) than for people with the same high normal blood pressure aged 60 years and older. Incident CVD and CHD risk was, however, similarly high in people with diagnosed high blood pressure across all age-groups.

“These results reinforce the fact that high blood pressure is a serious risk for CVD in all age groups,” said Dr. F. Hadaegh, Prevention of Metabolic Disorders Research Center, Tehran, Iran. “However, the results also suggest that when looking to manage high normal blood pressure resources should be focused on those individuals that are in middle age.”

High blood pressure is defined as a repeatedly elevated systolic pressure of 140 mmHg or higher OR a diastolic pressure of 90 mmHg or higher. This study was carried out over 9.3 years and the study protocol established before new guidelines around high normal blood pressure were adapted. In 2003, the Joint National Committee 7(JNC7) from the United States introduced the concept of prehypertension into guidelines categorizing the individuals with systolic blood pressure between 120-139 mmHg or diastolic blood pressure between 80-89 as prehypertension groups.

Hypertension and CVD

Hypertension (high blood pressure) is one of the major preventable risk factors for premature death from CVD worldwide. High blood pressure contributes to around half of all CVD and the risk of developing CVD doubles for every 10-point increase in diastolic blood pressure.

High blood pressure that is left untreated can greatly increase a person’s risk of developing CVD. Treating raised blood pressure has been associated with a 35 per cent reduction in the risk of stroke and at least a 16 per cent reduction in the risk of myocardial infarction

Newswise — April 11 2012 – Although observational studies have suggested that losartan, a drug used primarily for the treatment of hypertension, may be associated with an increased risk of death among patients with heart failure compared with other medications in the same class of drugs (angiotensin II receptor blockers [ARBs]), an analysis that included nearly 6,500 patients found that overall, use of losartan was not associated with increased all-cause death or cardiovascular death compared with use of the ARB candesartan, according to a study in the April 11 issue of JAMA.

Henrik Svanstrom, M.Sc., of Statens Serum Institut, Copenhagen, Denmark, and colleagues conducted a study to assess whether use of losartan is associated with increased all-cause mortality in heart failure patients compared with candesartan. The study, which included data from a nationwide Danish registry, linked individual-level information on hospital contacts, filled prescriptions, and potential confounders (factors that can influence outcomes). Patients ages 45 years and older with first-time hospitalization for heart failure in 1998-2008 were identified from the registry. New users of losartan and candesartan were selected for inclusion in the study cohort. The final study group included 6,479 patients; 2,082 users of candesartan and 4,397 users of losartan.

During follow-up, there were 2,378 deaths in the study population. Among these, 330 occurred during ongoing candesartan use and 1,212 during ongoing losartan use. The researchers found no significantly increased risk of death associated with use of losartan as compared to candesartan. Also, use of losartan was not significantly associated with an increased risk of cardiovascular mortality compared with candesartan use.

The authors did find that use of low-dose losartan (12.5 mg) was associated with a more than 2-fold increased risk of mortality as compared with high doses of candesartan (16-32 mg). Treatment with 50 mg of losartan (medium dose) was also associated with a higher mortality risk. However, there was no increased risk associated with use of 100 mg of losartan (high-dose).

The authors write that compared with previous observational studies, “our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure.”

“This large, nationwide cohort study of patients with heart failure found no significantly increased risk of all-cause mortality associated with use of losartan as compared with candesartan. Whereas lower doses of losartan were associated with increased mortality risk as compared with higher doses of candesartan, there was a decreasing risk of mortality with increasing losartan dose; and no significantly increased mortality risk was observed when comparing the highest dose of losartan against the highest doses of candesartan. These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure,” the researchers conclude.

New York, NY, July 12, 2011 – A study published in the July issue of The American Journal of Medicine, reports that among hypertensive patients with coronary artery disease, chronic self-reported use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with an increased risk of adverse events during long-term follow-up. Long-term NSAIDs use is common for treatment of chronic pain.

Researchers from the Division of Cardiovascular Medicine, College of Medicine and the Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, found that after a mean of 2.7 years of follow-up, in hypertensive patients with coronary artery disease (average age of 65 years), chronic self-reported NSAID use was associated with a 47% increase in the occurrence of death, nonfatal myocardial infarction, or nonfatal stroke. This was due to a 90% increase in all-cause mortality (which persisted into extended follow-up of more than 5 years), a 126% increase in cardiovascular mortality, and a 66% increase in total myocardial infarctions. There was no significant difference in the occurrence of stroke.

“Among coronary artery disease patients with hypertension, chronic self-reported use of NSAIDs was associated with harmful outcomes, and this practice should be avoided where possible,” commented Anthony A. Bavry, MD, MPH, Assistant Professor, Division of Cardiovascular Medicine, College of Medicine at the University of Florida, Gainesville. “This association did not appear to be due to elevated blood pressure because chronic NSAID users actually had slightly lower on-treatment blood pressure over a mean of 2.7 years of follow-up. Until further data are available, alternative modes of pain relief should be considered for these patients.”

Currently, there is a paucity of data about possible harmful effects of chronic NSAIDs in patients with hypertension and coronary artery disease. This observational study was conducted within a large randomized trial that provided long-term blood pressure measures, target blood pressures, and standardized assessment of adverse cardiovascular outcomes.

Data were obtained from INVEST (The INternational VErapamil Trandolapril Study), a randomized trial conducted in 14 countries, originally designed to compared the effects of a calcium antagonist (verapamil SR)-based strategy with a beta-blocker (atenolol)-based strategy for hypertension among patients with stable coronary artery disease. In this study, there were 882 chronic NSAID users and 21,694 nonchronic NSAID users. Many of the previous analyses on this topic have been conducted from case-control studies.

Interestingly investigators did not find a difference in serious gastrointestinal bleeding events from chronic NSAID use, as might have been expected. While this was somewhat counterintuitive, chronic NSAID users likely started these medications before study enrollment, at which time major bleeding events could have occurred.

The article is “Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease” by Anthony A. Bavry, MD, MPH, Asma Khaliq, MD, Yan Gong, PhD, Eileen M. Handberg, PhD, Rhonda M. Cooper-DeHoff, PharmD, MS, and Carl J. Pepine, MD. It appears in The American Journal of Medicine, Volume 124, Issue 7 (July 2011) published by Elsevier.

WINSTON-SALEM, N.C. – Monday, March 21, 2011 – For a patient at high risk of cardiovascular disease (CVD), keeping up with what pills to take at different times of the day can be tedious. Window sills lined with prescription bottles – a pill for cholesterol, another for blood pressure, and an aspirin to keep blood thin and flowing – the list can get quite long and, as a result, many people, especially the elderly, often forget doses or take the wrong pill at the wrong time.

But what if there was a single pill that had all the benefits of multiple medications in one dose? Would people take it? Would doctors prescribe it? And would it be effective?

A new study done by researchers at Wake Forest Baptist Medical Center provides evidence that, in fact, such a pill may be a viable option for developing countries, where CVD is strongly emerging and the demand for cost-effective, low maintenance treatment is high.

“The idea behind the polypill is that it offers a simpler way to give medications to people so that they will have better adherence to their pills,” said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author on the study. “It’s not always easy for people to consistently take multiple pills, even if they are needed to treat a serious condition, like CVD. This is especially true in developing countries, where cost of CVD medications is another major challenge. This one pill has the potential to improve adherence while being less costly to the population in developing countries.”

To adopt the polypill approach in developing countries, a large scale clinical trial is needed, Soliman added. However, before conducting such a trial, research was needed to see if it was even possible to conduct a clinical trial in a developing country.

Going into this study, there were many perceived barriers to doing research in a developing country, Soliman said. Among them, would the country have investigators capable and willing to participate in a study and the necessary follow-up? Would patients sign up to participate? And if the pill was proven to work, would doctors even feel comfortable prescribing it?

So Soliman and colleagues brought the study to Sri Lanka, where they enrolled 216 participants without diagnosed CVD, in the hope of answering some of these questions. Half of the participants received “standard’ treatment for CVD risk prevention, and the other half received the polypill. Patients were recruited as planned. Two hundred three patients (94.0%) completed the treatment program and returned for their follow-up visits. No safety concerns were reported.

These findings suggest a high rate of patient acceptability, a finding that is bolstered by the fact that the majority of patients who completed the trial – 90 percent – indicated that they would take the polypill “for life” if proven to be effective in reducing CVD risk. Approximately 86 percent of the physicians surveyed agreed with and supported use of the polypill for primary prevention and 93 percent for secondary prevention of CVD. In terms of reduction in CVD risk, both the polypill and “standard treatment” resulted in marked reductions in systolic blood pressure, total cholesterol and 10-year estimated risk of CVD.

“Our trial has fulfilled its purposes,” Soliman said. “We wanted to check the feasibility of doing a large-scale clinical trial with a polypill in a developing country and to examine the acceptability of the polypill by patients and physicians, and we now know that it’s feasible and acceptable.”

He added that the “standard” treatment in this trial was administered by highly specialized physicians in tertiary-care centers, making it a tough competitor, yet the simple polypill held its own.

Although feasibility has been demonstrated, Soliman explained that there are other important questions about the polypill that still need answers, such as: Which patient population should a polypill target: those who have not yet been diagnosed with CVD (primary prevention) or those who have a CVD diagnosis in their medical history (secondary prevention)? Also, what components should make up the pill and in what doses will they be most effective?

“There are many questions, but a single trial will never answer all of them,” Soliman said. “At least now we know that it is possible to begin looking for the answers.”

The study, published recently in Trials, was funded by World Health Organization (WHO) headquarters in Geneva. Co-authors include Curt D. Furberg, M.D., Ph.D., of Wake Forest Baptist; Shanthi Mendis, M.D., of the WHO, Geneva; Wasantha P. Dissanayake, M.D., Noel P. Somasundaram, M.D., Padma S. Gunarantne, M.D., and I. Kumundini Jayasingne, M.D., of the Ministry of Health, Sri Lanka.