M. Alexander Otto

When working up patients with allergic contact dermatitis (ACD), the patch test used may depend on how frequently testing is performed in the practice, and the type of allergies that are being evaluated, according to Joseph Fowler Jr., MD, of the department of dermatology at the University of Louisville (Ky).

T.R.U.E. TEST is more convenient than standard patch testing is but misses allergic contact dermatitis up to 40% of the time, he pointed out. The benefit of the T.R.U.E. TEST is that it’s easy to use, allergens come preapplied to a gel-based tape so there’s very little prep time, and they are well standardized with the same quantity on each patch every time.

[email protected]

When working up patients with allergic contact dermatitis (ACD), the patch test used may depend on how frequently testing is performed in the practice, and the type of allergies that are being evaluated, according to Joseph Fowler Jr., MD, of the department of dermatology at the University of Louisville (Ky).

T.R.U.E. TEST is more convenient than standard patch testing is but misses allergic contact dermatitis up to 40% of the time, he pointed out. The benefit of the T.R.U.E. TEST is that it’s easy to use, allergens come preapplied to a gel-based tape so there’s very little prep time, and they are well standardized with the same quantity on each patch every time.

[email protected]

When working up patients with allergic contact dermatitis (ACD), the patch test used may depend on how frequently testing is performed in the practice, and the type of allergies that are being evaluated, according to Joseph Fowler Jr., MD, of the department of dermatology at the University of Louisville (Ky).

T.R.U.E. TEST is more convenient than standard patch testing is but misses allergic contact dermatitis up to 40% of the time, he pointed out. The benefit of the T.R.U.E. TEST is that it’s easy to use, allergens come preapplied to a gel-based tape so there’s very little prep time, and they are well standardized with the same quantity on each patch every time.

[email protected]

SAN FRANCISCO – The benefit of lowering blood pressure exceeded the potential for harm, even among the most frail elderly, in SPRINT, but it’s important to remember who was excluded from the trial when using the findings in the clinic, according to Mark Supiano, MD.

SPRINT (Systolic Blood Pressure Intervention Trial) excluded people with histories of stroke, diabetes, heart failure, and chronic kidney disease with a markedly reduced glomerular filtration rate. People living in nursing homes, assisted living centers, and those with prevalent dementia were also excluded, as were individuals with a standing systolic pressure below 110 mm Hg (N Engl J Med. 2015 Nov 26;373:2103-16).

Even with those exclusions, however, the 2,636 patients in SPRINT who were 75 years and older “were not a super healthy group of older people,” Dr. Supiano said at the joint scientific sessions of the American Heart Association Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

They were at high risk for cardiovascular disease (CVD), with a median 10-year Framingham risk score of almost 25%. More than a quarter had gait speeds below 0.8 m/sec, and almost a third were classified as frail. Many had mild cognitive impairment at baseline.

In the United States, Dr. Supiano and his colleagues estimate that there are almost 6 million similar people 75 years or older with hypertension who would likely achieve the same benefits from hypertension control as elderly subjects in the trial. “As a geriatrician, there are very few things that I can offer patients 75 years and older that will have a profound improvement in their overall mortality.” Blood pressure control is one of them, said Dr. Supiano, chief of geriatrics at the University of Utah, Salt Lake City, and a SPRINT investigator.

In SPRINT, intensive treatment to systolic pressure below 120 mm Hg showed greater benefit for patients 75 years and older than it did for younger patients, even among the frail, with a 34% reduction in fatal and nonfatal CVD events versus patients treated to below 140 mm Hg, and a 33% lower rate of death from any cause.

It should be no surprise that older patients had greater benefit from tighter control, because elderly patients have “a greater CVD risk. There’s more bang for the buck” with blood pressure lowering in an older population. “Overall, benefits exceed the potential for harm, even among the frailest older patients,” Dr. Supiano said.

“A systemic target of less than 140 mm Hg is, I believe, appropriate for most healthy people age 60 and older. A benefit-based systemic target of less than 120 mm Hg may be appropriate for those at higher CVD risk.” Among patients 60-75 years old, that would include those with a Framingham score above 15%. Among patients older than age 75 with an elevated CVD risk, treatment to below 120 mm Hg makes sense if it aligns with patient’s goals of care, Dr. Supiano said.

The 120–mm Hg target in SPRINT was associated with a greater incidence of some transient side effects in the elderly, including hypotension, syncope, acute kidney injury, and electrolyte imbalance, but not a higher risk of serious adverse events or injurious falls.

There were concerns raised at the joint sessions about the effect of blood pressure lowering on the cognitive function of older people. Dr. Supiano noted that the cognitive outcomes in SPRINT, as well as outcomes in patients with chronic kidney disease, have not yet been released, but are expected soon.

Dr. Supiano had no relevant disclosures.

[email protected]

SAN FRANCISCO – The benefit of lowering blood pressure exceeded the potential for harm, even among the most frail elderly, in SPRINT, but it’s important to remember who was excluded from the trial when using the findings in the clinic, according to Mark Supiano, MD.

SPRINT (Systolic Blood Pressure Intervention Trial) excluded people with histories of stroke, diabetes, heart failure, and chronic kidney disease with a markedly reduced glomerular filtration rate. People living in nursing homes, assisted living centers, and those with prevalent dementia were also excluded, as were individuals with a standing systolic pressure below 110 mm Hg (N Engl J Med. 2015 Nov 26;373:2103-16).

Even with those exclusions, however, the 2,636 patients in SPRINT who were 75 years and older “were not a super healthy group of older people,” Dr. Supiano said at the joint scientific sessions of the American Heart Association Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

They were at high risk for cardiovascular disease (CVD), with a median 10-year Framingham risk score of almost 25%. More than a quarter had gait speeds below 0.8 m/sec, and almost a third were classified as frail. Many had mild cognitive impairment at baseline.

In the United States, Dr. Supiano and his colleagues estimate that there are almost 6 million similar people 75 years or older with hypertension who would likely achieve the same benefits from hypertension control as elderly subjects in the trial. “As a geriatrician, there are very few things that I can offer patients 75 years and older that will have a profound improvement in their overall mortality.” Blood pressure control is one of them, said Dr. Supiano, chief of geriatrics at the University of Utah, Salt Lake City, and a SPRINT investigator.

In SPRINT, intensive treatment to systolic pressure below 120 mm Hg showed greater benefit for patients 75 years and older than it did for younger patients, even among the frail, with a 34% reduction in fatal and nonfatal CVD events versus patients treated to below 140 mm Hg, and a 33% lower rate of death from any cause.

It should be no surprise that older patients had greater benefit from tighter control, because elderly patients have “a greater CVD risk. There’s more bang for the buck” with blood pressure lowering in an older population. “Overall, benefits exceed the potential for harm, even among the frailest older patients,” Dr. Supiano said.

“A systemic target of less than 140 mm Hg is, I believe, appropriate for most healthy people age 60 and older. A benefit-based systemic target of less than 120 mm Hg may be appropriate for those at higher CVD risk.” Among patients 60-75 years old, that would include those with a Framingham score above 15%. Among patients older than age 75 with an elevated CVD risk, treatment to below 120 mm Hg makes sense if it aligns with patient’s goals of care, Dr. Supiano said.

The 120–mm Hg target in SPRINT was associated with a greater incidence of some transient side effects in the elderly, including hypotension, syncope, acute kidney injury, and electrolyte imbalance, but not a higher risk of serious adverse events or injurious falls.

There were concerns raised at the joint sessions about the effect of blood pressure lowering on the cognitive function of older people. Dr. Supiano noted that the cognitive outcomes in SPRINT, as well as outcomes in patients with chronic kidney disease, have not yet been released, but are expected soon.

Dr. Supiano had no relevant disclosures.

[email protected]

SAN FRANCISCO – The benefit of lowering blood pressure exceeded the potential for harm, even among the most frail elderly, in SPRINT, but it’s important to remember who was excluded from the trial when using the findings in the clinic, according to Mark Supiano, MD.

SPRINT (Systolic Blood Pressure Intervention Trial) excluded people with histories of stroke, diabetes, heart failure, and chronic kidney disease with a markedly reduced glomerular filtration rate. People living in nursing homes, assisted living centers, and those with prevalent dementia were also excluded, as were individuals with a standing systolic pressure below 110 mm Hg (N Engl J Med. 2015 Nov 26;373:2103-16).

Even with those exclusions, however, the 2,636 patients in SPRINT who were 75 years and older “were not a super healthy group of older people,” Dr. Supiano said at the joint scientific sessions of the American Heart Association Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

They were at high risk for cardiovascular disease (CVD), with a median 10-year Framingham risk score of almost 25%. More than a quarter had gait speeds below 0.8 m/sec, and almost a third were classified as frail. Many had mild cognitive impairment at baseline.

In the United States, Dr. Supiano and his colleagues estimate that there are almost 6 million similar people 75 years or older with hypertension who would likely achieve the same benefits from hypertension control as elderly subjects in the trial. “As a geriatrician, there are very few things that I can offer patients 75 years and older that will have a profound improvement in their overall mortality.” Blood pressure control is one of them, said Dr. Supiano, chief of geriatrics at the University of Utah, Salt Lake City, and a SPRINT investigator.

In SPRINT, intensive treatment to systolic pressure below 120 mm Hg showed greater benefit for patients 75 years and older than it did for younger patients, even among the frail, with a 34% reduction in fatal and nonfatal CVD events versus patients treated to below 140 mm Hg, and a 33% lower rate of death from any cause.

It should be no surprise that older patients had greater benefit from tighter control, because elderly patients have “a greater CVD risk. There’s more bang for the buck” with blood pressure lowering in an older population. “Overall, benefits exceed the potential for harm, even among the frailest older patients,” Dr. Supiano said.

“A systemic target of less than 140 mm Hg is, I believe, appropriate for most healthy people age 60 and older. A benefit-based systemic target of less than 120 mm Hg may be appropriate for those at higher CVD risk.” Among patients 60-75 years old, that would include those with a Framingham score above 15%. Among patients older than age 75 with an elevated CVD risk, treatment to below 120 mm Hg makes sense if it aligns with patient’s goals of care, Dr. Supiano said.

The 120–mm Hg target in SPRINT was associated with a greater incidence of some transient side effects in the elderly, including hypotension, syncope, acute kidney injury, and electrolyte imbalance, but not a higher risk of serious adverse events or injurious falls.

There were concerns raised at the joint sessions about the effect of blood pressure lowering on the cognitive function of older people. Dr. Supiano noted that the cognitive outcomes in SPRINT, as well as outcomes in patients with chronic kidney disease, have not yet been released, but are expected soon.

Dr. Supiano had no relevant disclosures.

[email protected]

The overall response rate to immune checkpoint inhibitors was 45% among cancer patients who had more than three variants of unknown significance in their circulating tumor DNA; among those with three or fewer, the response rate was 15%, according to a University of California, San Diego, investigation with 69 subjects.

Higher mutation burdens in circulating tumor DNA (ctDNA) also correlated with improved progression-free and overall survival across 20 cancer types, the investigators reported (Clin Cancer Res. 2017 Oct. 1. doi: 10.1158/1078-0432.CCR-17-1439).

Tumor mutation burdens can predict response to checkpoint inhibitors, but they are usually assessed by tissue biopsy, which is costly and invasive. The findings suggest that blood tests could replace tissue biopsies to green-light immune checkpoint inhibitor treatment.

“Our current results may be clinically exploitable. ... Liquid biopsies that assess blood-derived ctDNA are noninvasive, easily acquired, and inexpensive. The ctDNA derived from blood may also represent shed DNA from multiple metastatic sites, whereas tissue genomics reflects only the piece of tissue removed,” said investigators led by Yulian Khagi, MD, a hematology-oncology fellow at the university.

In a press statement, Dr. Khagi said “If verified by further studies, clinicians will be able to utilize the ... results of this simple blood test to make determinations about whether to use checkpoint inhibitor–based immune therapy in a variety of tumor types.”

The 69 patients were a median of 56 years old, and 43 (62.3%) were men. Melanoma, lung cancer, and head and neck cancer were the most common malignancies. The majority of patients had anti–PD-1 or PD-L1 monotherapy.

For most patients, blood samples were drawn a month or 2 before treatment. Next-generation sequencing (Guardant360) was done on ctDNA to detect alterations in cancer genes. Of the 69 patients, 20 (29%) had more than three variants of unknown significance (VUS); the rest had three or fewer.

The median overall survival was 15.3 months from the start of immunotherapy. For patients with three or fewer VUS, median overall survival was 10.72 months; for patients with more, median overall survival could not be calculated because more than half were alive at the study’s conclusion.

Median progression-fee survival was 2.07 months with three or fewer VUS, versus 3.84 months with more. The findings were statistically significant.

Similar results were found when all genomic alterations, not just VUS, were examined and dichotomized as six or more versus fewer than six.

“The number of genes assayed in our ctDNA analysis was only between 54 and 70. Unlike targeted NGS [next-generation sequencing] of tumor tissue, which often tests for hundreds of genes and allows a relatively accurate estimate of total mutational burden, targeted NGS of plasma ctDNA provides only a limited snapshot of the cancer genome. More extensive ctDNA gene panels merit investigation to determine if they increase the correlative value of our findings,” the investigators said.

The work was funded by the Joan and Irwin Jacobs Fund and the National Cancer Institute. Dr. Khagi had no industry disclosures. Three authors reported financial ties to a number of companies, including Boehringer, Merck, Guardant, and Pfizer. The senior author has ownership interests in CureMatch.

[email protected]

The overall response rate to immune checkpoint inhibitors was 45% among cancer patients who had more than three variants of unknown significance in their circulating tumor DNA; among those with three or fewer, the response rate was 15%, according to a University of California, San Diego, investigation with 69 subjects.

Higher mutation burdens in circulating tumor DNA (ctDNA) also correlated with improved progression-free and overall survival across 20 cancer types, the investigators reported (Clin Cancer Res. 2017 Oct. 1. doi: 10.1158/1078-0432.CCR-17-1439).

Tumor mutation burdens can predict response to checkpoint inhibitors, but they are usually assessed by tissue biopsy, which is costly and invasive. The findings suggest that blood tests could replace tissue biopsies to green-light immune checkpoint inhibitor treatment.

“Our current results may be clinically exploitable. ... Liquid biopsies that assess blood-derived ctDNA are noninvasive, easily acquired, and inexpensive. The ctDNA derived from blood may also represent shed DNA from multiple metastatic sites, whereas tissue genomics reflects only the piece of tissue removed,” said investigators led by Yulian Khagi, MD, a hematology-oncology fellow at the university.

In a press statement, Dr. Khagi said “If verified by further studies, clinicians will be able to utilize the ... results of this simple blood test to make determinations about whether to use checkpoint inhibitor–based immune therapy in a variety of tumor types.”

The 69 patients were a median of 56 years old, and 43 (62.3%) were men. Melanoma, lung cancer, and head and neck cancer were the most common malignancies. The majority of patients had anti–PD-1 or PD-L1 monotherapy.

For most patients, blood samples were drawn a month or 2 before treatment. Next-generation sequencing (Guardant360) was done on ctDNA to detect alterations in cancer genes. Of the 69 patients, 20 (29%) had more than three variants of unknown significance (VUS); the rest had three or fewer.

The median overall survival was 15.3 months from the start of immunotherapy. For patients with three or fewer VUS, median overall survival was 10.72 months; for patients with more, median overall survival could not be calculated because more than half were alive at the study’s conclusion.

Median progression-fee survival was 2.07 months with three or fewer VUS, versus 3.84 months with more. The findings were statistically significant.

Similar results were found when all genomic alterations, not just VUS, were examined and dichotomized as six or more versus fewer than six.

“The number of genes assayed in our ctDNA analysis was only between 54 and 70. Unlike targeted NGS [next-generation sequencing] of tumor tissue, which often tests for hundreds of genes and allows a relatively accurate estimate of total mutational burden, targeted NGS of plasma ctDNA provides only a limited snapshot of the cancer genome. More extensive ctDNA gene panels merit investigation to determine if they increase the correlative value of our findings,” the investigators said.

The work was funded by the Joan and Irwin Jacobs Fund and the National Cancer Institute. Dr. Khagi had no industry disclosures. Three authors reported financial ties to a number of companies, including Boehringer, Merck, Guardant, and Pfizer. The senior author has ownership interests in CureMatch.

[email protected]

The overall response rate to immune checkpoint inhibitors was 45% among cancer patients who had more than three variants of unknown significance in their circulating tumor DNA; among those with three or fewer, the response rate was 15%, according to a University of California, San Diego, investigation with 69 subjects.

Higher mutation burdens in circulating tumor DNA (ctDNA) also correlated with improved progression-free and overall survival across 20 cancer types, the investigators reported (Clin Cancer Res. 2017 Oct. 1. doi: 10.1158/1078-0432.CCR-17-1439).

Tumor mutation burdens can predict response to checkpoint inhibitors, but they are usually assessed by tissue biopsy, which is costly and invasive. The findings suggest that blood tests could replace tissue biopsies to green-light immune checkpoint inhibitor treatment.

“Our current results may be clinically exploitable. ... Liquid biopsies that assess blood-derived ctDNA are noninvasive, easily acquired, and inexpensive. The ctDNA derived from blood may also represent shed DNA from multiple metastatic sites, whereas tissue genomics reflects only the piece of tissue removed,” said investigators led by Yulian Khagi, MD, a hematology-oncology fellow at the university.

In a press statement, Dr. Khagi said “If verified by further studies, clinicians will be able to utilize the ... results of this simple blood test to make determinations about whether to use checkpoint inhibitor–based immune therapy in a variety of tumor types.”

The 69 patients were a median of 56 years old, and 43 (62.3%) were men. Melanoma, lung cancer, and head and neck cancer were the most common malignancies. The majority of patients had anti–PD-1 or PD-L1 monotherapy.

For most patients, blood samples were drawn a month or 2 before treatment. Next-generation sequencing (Guardant360) was done on ctDNA to detect alterations in cancer genes. Of the 69 patients, 20 (29%) had more than three variants of unknown significance (VUS); the rest had three or fewer.

The median overall survival was 15.3 months from the start of immunotherapy. For patients with three or fewer VUS, median overall survival was 10.72 months; for patients with more, median overall survival could not be calculated because more than half were alive at the study’s conclusion.

Median progression-fee survival was 2.07 months with three or fewer VUS, versus 3.84 months with more. The findings were statistically significant.

Similar results were found when all genomic alterations, not just VUS, were examined and dichotomized as six or more versus fewer than six.

“The number of genes assayed in our ctDNA analysis was only between 54 and 70. Unlike targeted NGS [next-generation sequencing] of tumor tissue, which often tests for hundreds of genes and allows a relatively accurate estimate of total mutational burden, targeted NGS of plasma ctDNA provides only a limited snapshot of the cancer genome. More extensive ctDNA gene panels merit investigation to determine if they increase the correlative value of our findings,” the investigators said.

The work was funded by the Joan and Irwin Jacobs Fund and the National Cancer Institute. Dr. Khagi had no industry disclosures. Three authors reported financial ties to a number of companies, including Boehringer, Merck, Guardant, and Pfizer. The senior author has ownership interests in CureMatch.

[email protected]

SAN FRANCISCO – Nocturia is a sign of uncontrolled hypertension and also is associated with diuretic use in middle-aged black men, according to a study conducted at 53 barbershops in and around Los Angeles.

In the study, investigators averaged the last three of five automated blood pressure readings in 1,748 black men aged 35-49 years old and asked them about symptoms of nocturia – defined in the study as getting up two or more times per night to urinate – and about what blood pressure medications they were taking, if any.

Men with untreated hypertension – defined as at or above 135/85 mm Hg – were 34% more likely to report nocturia than were men who were normotensive.

However, “what really grabbed our attention was the treated group,” lead investigator Ronald Victor, MD said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The highest risk of nocturia, more than three times the risk of normotensive men, was among men treated with a diuretic who still had elevated blood pressure readings in the barbershop. Their risk was about 2.5 times greater in men who were treated but uncontrolled and were not on a diuretic, said Dr. Victor, director of the hypertension center at Cedars-Sinai Medical Center, Los Angeles.

Among men treated and controlled down to a systolic blood pressure of almost 120 mm Hg, those with a diuretic included in their regimen had about twice the risk of nocturia as did normotensive men; those controlled without a diuretic had no elevated risk of nocturia. The results were statistically significant and were adjusted for nocturia confounders, including diabetes, body mass index, sleep apnea, and an enlarged prostate.

“Nocturia is far more likely when hypertension is inadequately treated,” especially with a diuretic, than when untreated, Dr. Victor said. “The data suggest that nocturia may be a side effect of blood pressure drugs unless strict blood pressure control is achieved. Appropriate treatment of blood pressure without a diuretic may be really beneficial in terms of reducing nocturia.”

Not all the data on the specific medications the men in the study were taking were available, but the most common antihypertensive prescribed for them was short-acting, low-dose hydrochlorothiazide, he noted.

It has been shown that hydrochlorothiazide wears off in the evening when dosed in the morning, so blood pressure might appear to be well-controlled in the daytime, but patients become hypertensive at night, leading to pressure natriuresis and nocturia. “This might [help] explain our data,” Dr. Victor said, noting that longer-acting, more potent diuretics, such as chlorthalidone, might reduce the risk.

The team plans further work to see if tighter nighttime blood pressure control reduces nocturia and improves sleep. Maybe, he noted, “if you take your blood pressure meds correctly, you sleep better. That would be a fantastic public health message; we’ll see.”

Middle-aged black men are underrepresented in hypertension research, in part because of a mistrust of doctors and medical institutions. Enrolling black men in barbershops seemed a good way to address the problem; barbers are trusted and respected members of the community, and the shops themselves are warm and relaxed, which is why hypertension was defined in the study a bit lower than the usual 140/90 mm Hg, Dr. Victor commented.

A total of 45% of the men were hypertensive; only 16% were controlled on medication. Nocturia prevalence was higher than expected in the general population, at about 29% overall, and ranged from 24% in normotensive men to 50% in men whose hypertension was treated but uncontrolled.

Average blood pressures were 120/71 mm Hg in the normotensive men; 143/87 mm Hg in untreated hypertensive men; and 148/91 mm Hg in treated but uncontrolled men. The mean age in the study was 43 years. “We capped it at 49 because after that, nocturia is so prevalent, and dominated by prostate disease,” Dr. Victor said.

The investigators had no disclosures. The National Institutes of Health funded the work.

[email protected]

SAN FRANCISCO – Nocturia is a sign of uncontrolled hypertension and also is associated with diuretic use in middle-aged black men, according to a study conducted at 53 barbershops in and around Los Angeles.

In the study, investigators averaged the last three of five automated blood pressure readings in 1,748 black men aged 35-49 years old and asked them about symptoms of nocturia – defined in the study as getting up two or more times per night to urinate – and about what blood pressure medications they were taking, if any.

Men with untreated hypertension – defined as at or above 135/85 mm Hg – were 34% more likely to report nocturia than were men who were normotensive.

However, “what really grabbed our attention was the treated group,” lead investigator Ronald Victor, MD said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The highest risk of nocturia, more than three times the risk of normotensive men, was among men treated with a diuretic who still had elevated blood pressure readings in the barbershop. Their risk was about 2.5 times greater in men who were treated but uncontrolled and were not on a diuretic, said Dr. Victor, director of the hypertension center at Cedars-Sinai Medical Center, Los Angeles.

Among men treated and controlled down to a systolic blood pressure of almost 120 mm Hg, those with a diuretic included in their regimen had about twice the risk of nocturia as did normotensive men; those controlled without a diuretic had no elevated risk of nocturia. The results were statistically significant and were adjusted for nocturia confounders, including diabetes, body mass index, sleep apnea, and an enlarged prostate.

“Nocturia is far more likely when hypertension is inadequately treated,” especially with a diuretic, than when untreated, Dr. Victor said. “The data suggest that nocturia may be a side effect of blood pressure drugs unless strict blood pressure control is achieved. Appropriate treatment of blood pressure without a diuretic may be really beneficial in terms of reducing nocturia.”

Not all the data on the specific medications the men in the study were taking were available, but the most common antihypertensive prescribed for them was short-acting, low-dose hydrochlorothiazide, he noted.

It has been shown that hydrochlorothiazide wears off in the evening when dosed in the morning, so blood pressure might appear to be well-controlled in the daytime, but patients become hypertensive at night, leading to pressure natriuresis and nocturia. “This might [help] explain our data,” Dr. Victor said, noting that longer-acting, more potent diuretics, such as chlorthalidone, might reduce the risk.

The team plans further work to see if tighter nighttime blood pressure control reduces nocturia and improves sleep. Maybe, he noted, “if you take your blood pressure meds correctly, you sleep better. That would be a fantastic public health message; we’ll see.”

Middle-aged black men are underrepresented in hypertension research, in part because of a mistrust of doctors and medical institutions. Enrolling black men in barbershops seemed a good way to address the problem; barbers are trusted and respected members of the community, and the shops themselves are warm and relaxed, which is why hypertension was defined in the study a bit lower than the usual 140/90 mm Hg, Dr. Victor commented.

A total of 45% of the men were hypertensive; only 16% were controlled on medication. Nocturia prevalence was higher than expected in the general population, at about 29% overall, and ranged from 24% in normotensive men to 50% in men whose hypertension was treated but uncontrolled.

Average blood pressures were 120/71 mm Hg in the normotensive men; 143/87 mm Hg in untreated hypertensive men; and 148/91 mm Hg in treated but uncontrolled men. The mean age in the study was 43 years. “We capped it at 49 because after that, nocturia is so prevalent, and dominated by prostate disease,” Dr. Victor said.

The investigators had no disclosures. The National Institutes of Health funded the work.

[email protected]

SAN FRANCISCO – Nocturia is a sign of uncontrolled hypertension and also is associated with diuretic use in middle-aged black men, according to a study conducted at 53 barbershops in and around Los Angeles.

In the study, investigators averaged the last three of five automated blood pressure readings in 1,748 black men aged 35-49 years old and asked them about symptoms of nocturia – defined in the study as getting up two or more times per night to urinate – and about what blood pressure medications they were taking, if any.

Men with untreated hypertension – defined as at or above 135/85 mm Hg – were 34% more likely to report nocturia than were men who were normotensive.

However, “what really grabbed our attention was the treated group,” lead investigator Ronald Victor, MD said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The highest risk of nocturia, more than three times the risk of normotensive men, was among men treated with a diuretic who still had elevated blood pressure readings in the barbershop. Their risk was about 2.5 times greater in men who were treated but uncontrolled and were not on a diuretic, said Dr. Victor, director of the hypertension center at Cedars-Sinai Medical Center, Los Angeles.

Among men treated and controlled down to a systolic blood pressure of almost 120 mm Hg, those with a diuretic included in their regimen had about twice the risk of nocturia as did normotensive men; those controlled without a diuretic had no elevated risk of nocturia. The results were statistically significant and were adjusted for nocturia confounders, including diabetes, body mass index, sleep apnea, and an enlarged prostate.

“Nocturia is far more likely when hypertension is inadequately treated,” especially with a diuretic, than when untreated, Dr. Victor said. “The data suggest that nocturia may be a side effect of blood pressure drugs unless strict blood pressure control is achieved. Appropriate treatment of blood pressure without a diuretic may be really beneficial in terms of reducing nocturia.”

Not all the data on the specific medications the men in the study were taking were available, but the most common antihypertensive prescribed for them was short-acting, low-dose hydrochlorothiazide, he noted.

It has been shown that hydrochlorothiazide wears off in the evening when dosed in the morning, so blood pressure might appear to be well-controlled in the daytime, but patients become hypertensive at night, leading to pressure natriuresis and nocturia. “This might [help] explain our data,” Dr. Victor said, noting that longer-acting, more potent diuretics, such as chlorthalidone, might reduce the risk.

The team plans further work to see if tighter nighttime blood pressure control reduces nocturia and improves sleep. Maybe, he noted, “if you take your blood pressure meds correctly, you sleep better. That would be a fantastic public health message; we’ll see.”

Middle-aged black men are underrepresented in hypertension research, in part because of a mistrust of doctors and medical institutions. Enrolling black men in barbershops seemed a good way to address the problem; barbers are trusted and respected members of the community, and the shops themselves are warm and relaxed, which is why hypertension was defined in the study a bit lower than the usual 140/90 mm Hg, Dr. Victor commented.

A total of 45% of the men were hypertensive; only 16% were controlled on medication. Nocturia prevalence was higher than expected in the general population, at about 29% overall, and ranged from 24% in normotensive men to 50% in men whose hypertension was treated but uncontrolled.

Average blood pressures were 120/71 mm Hg in the normotensive men; 143/87 mm Hg in untreated hypertensive men; and 148/91 mm Hg in treated but uncontrolled men. The mean age in the study was 43 years. “We capped it at 49 because after that, nocturia is so prevalent, and dominated by prostate disease,” Dr. Victor said.

The investigators had no disclosures. The National Institutes of Health funded the work.

[email protected]

SAN FRANCISCO – The best way to make sure that patients are taking their blood pressure medications is to screen their urine for the drugs and metabolites, according to Robert Carey, MD, professor of medicine and dean emeritus of the University of Virginia, Charlottesville.

Dr. Carey shared his thoughts on the matter during his presentation on treatment resistant hypertension, at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

In up to about half the cases of apparent resistant hypertension, people simply aren’t taking their medications. Urine screening, “I believe, is the most accurate and best method of verifying adherence,” far more reliable than asking patients, or counting prescription refills, he said.

“I’m sort of a mad dog on documenting adherence because I think if we don’t document it and treat it, we will be stuck with a lot of inertia, and things won’t get better,” Dr. Carey said. He recommended speaking with patients, getting their permission to check urine levels, and reporting back results. It won’t make a difference in every case, but sometimes it will, especially if there’s an intervention to improve adherence, he noted.

Urine screening is available in most teaching hospitals and in commercial labs. “I think we will be seeing more and more availability. It has been demonstrated to be cost effective,” he said.

If adherence isn’t a problem, obesity, high sodium intake, and other lifestyle issues should be addressed, as well as the use of drugs that can raise blood pressure, especially NSAIDS, contraceptives, and hormone replacement therapies.

A workup for secondary causes also is in order. About 20% of patients will have primary aldosteronism, so all patients should be screened. Renal parenchymal disease and renal vascular disease also are common. Renal artery stenosis usually can be managed medically and rarely requires stenting. “One might take the tack of nonscreening until there’s a reduction in renal function or blood pressure goes way out of control,” Dr. Carey said.

Pheochromocytoma and Cushing’s syndrome are rare causes. Obstructive sleep apnea also is on the list “but I’m not sure it should be there. For one thing, CPAP [continuous positive airway pressure] only lowers blood pressure 1 or 2 mm. Secondly, CPAP does not prevent cardiovascular disease events in patients with moderate to severe sleep apnea and established cardiovascular risk,” he said.

If there’s no secondary cause that can be addressed, “the first thing to do is check the diuretic, and substitute in a long-acting, thiazide-like diuretic, either chlorthalidone or indapamide.” They lower blood pressure more effectively than do the thiazide diuretics, such as chlorothiazide and hydrochlorothiazide. They also provide better protection against cardiovascular events. “Once you make that substitution, you need to add a mineralocorticoid receptor antagonist, spironolactone or eplerenone. We have excellent data for both [classes of] diuretics to be added,” Dr. Carey said.

“Once we get beyond that point, we have to search the literature, and generally, we’ll come up with a goose egg in terms of randomized clinical trials. Another step is to add a beta-blocker or a vasodilating beta-blocker, [but] you would need to know precisely the mechanism of vasodilation,” he noted. After that, “you could add hydralazine or minoxidil,” a more potent vasodilator, but they have to be given with a beta-blocker and diuretic. If those approaches fail, “consider referring to a hypertension specialist,” he said.

Dr. Carey did not report any industry ties.

[email protected]

SAN FRANCISCO – The best way to make sure that patients are taking their blood pressure medications is to screen their urine for the drugs and metabolites, according to Robert Carey, MD, professor of medicine and dean emeritus of the University of Virginia, Charlottesville.

Dr. Carey shared his thoughts on the matter during his presentation on treatment resistant hypertension, at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

In up to about half the cases of apparent resistant hypertension, people simply aren’t taking their medications. Urine screening, “I believe, is the most accurate and best method of verifying adherence,” far more reliable than asking patients, or counting prescription refills, he said.

“I’m sort of a mad dog on documenting adherence because I think if we don’t document it and treat it, we will be stuck with a lot of inertia, and things won’t get better,” Dr. Carey said. He recommended speaking with patients, getting their permission to check urine levels, and reporting back results. It won’t make a difference in every case, but sometimes it will, especially if there’s an intervention to improve adherence, he noted.

Urine screening is available in most teaching hospitals and in commercial labs. “I think we will be seeing more and more availability. It has been demonstrated to be cost effective,” he said.

If adherence isn’t a problem, obesity, high sodium intake, and other lifestyle issues should be addressed, as well as the use of drugs that can raise blood pressure, especially NSAIDS, contraceptives, and hormone replacement therapies.

A workup for secondary causes also is in order. About 20% of patients will have primary aldosteronism, so all patients should be screened. Renal parenchymal disease and renal vascular disease also are common. Renal artery stenosis usually can be managed medically and rarely requires stenting. “One might take the tack of nonscreening until there’s a reduction in renal function or blood pressure goes way out of control,” Dr. Carey said.

Pheochromocytoma and Cushing’s syndrome are rare causes. Obstructive sleep apnea also is on the list “but I’m not sure it should be there. For one thing, CPAP [continuous positive airway pressure] only lowers blood pressure 1 or 2 mm. Secondly, CPAP does not prevent cardiovascular disease events in patients with moderate to severe sleep apnea and established cardiovascular risk,” he said.

If there’s no secondary cause that can be addressed, “the first thing to do is check the diuretic, and substitute in a long-acting, thiazide-like diuretic, either chlorthalidone or indapamide.” They lower blood pressure more effectively than do the thiazide diuretics, such as chlorothiazide and hydrochlorothiazide. They also provide better protection against cardiovascular events. “Once you make that substitution, you need to add a mineralocorticoid receptor antagonist, spironolactone or eplerenone. We have excellent data for both [classes of] diuretics to be added,” Dr. Carey said.

“Once we get beyond that point, we have to search the literature, and generally, we’ll come up with a goose egg in terms of randomized clinical trials. Another step is to add a beta-blocker or a vasodilating beta-blocker, [but] you would need to know precisely the mechanism of vasodilation,” he noted. After that, “you could add hydralazine or minoxidil,” a more potent vasodilator, but they have to be given with a beta-blocker and diuretic. If those approaches fail, “consider referring to a hypertension specialist,” he said.

Dr. Carey did not report any industry ties.

[email protected]

SAN FRANCISCO – The best way to make sure that patients are taking their blood pressure medications is to screen their urine for the drugs and metabolites, according to Robert Carey, MD, professor of medicine and dean emeritus of the University of Virginia, Charlottesville.

Dr. Carey shared his thoughts on the matter during his presentation on treatment resistant hypertension, at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

In up to about half the cases of apparent resistant hypertension, people simply aren’t taking their medications. Urine screening, “I believe, is the most accurate and best method of verifying adherence,” far more reliable than asking patients, or counting prescription refills, he said.

“I’m sort of a mad dog on documenting adherence because I think if we don’t document it and treat it, we will be stuck with a lot of inertia, and things won’t get better,” Dr. Carey said. He recommended speaking with patients, getting their permission to check urine levels, and reporting back results. It won’t make a difference in every case, but sometimes it will, especially if there’s an intervention to improve adherence, he noted.

Urine screening is available in most teaching hospitals and in commercial labs. “I think we will be seeing more and more availability. It has been demonstrated to be cost effective,” he said.

If adherence isn’t a problem, obesity, high sodium intake, and other lifestyle issues should be addressed, as well as the use of drugs that can raise blood pressure, especially NSAIDS, contraceptives, and hormone replacement therapies.

A workup for secondary causes also is in order. About 20% of patients will have primary aldosteronism, so all patients should be screened. Renal parenchymal disease and renal vascular disease also are common. Renal artery stenosis usually can be managed medically and rarely requires stenting. “One might take the tack of nonscreening until there’s a reduction in renal function or blood pressure goes way out of control,” Dr. Carey said.

Pheochromocytoma and Cushing’s syndrome are rare causes. Obstructive sleep apnea also is on the list “but I’m not sure it should be there. For one thing, CPAP [continuous positive airway pressure] only lowers blood pressure 1 or 2 mm. Secondly, CPAP does not prevent cardiovascular disease events in patients with moderate to severe sleep apnea and established cardiovascular risk,” he said.

If there’s no secondary cause that can be addressed, “the first thing to do is check the diuretic, and substitute in a long-acting, thiazide-like diuretic, either chlorthalidone or indapamide.” They lower blood pressure more effectively than do the thiazide diuretics, such as chlorothiazide and hydrochlorothiazide. They also provide better protection against cardiovascular events. “Once you make that substitution, you need to add a mineralocorticoid receptor antagonist, spironolactone or eplerenone. We have excellent data for both [classes of] diuretics to be added,” Dr. Carey said.

“Once we get beyond that point, we have to search the literature, and generally, we’ll come up with a goose egg in terms of randomized clinical trials. Another step is to add a beta-blocker or a vasodilating beta-blocker, [but] you would need to know precisely the mechanism of vasodilation,” he noted. After that, “you could add hydralazine or minoxidil,” a more potent vasodilator, but they have to be given with a beta-blocker and diuretic. If those approaches fail, “consider referring to a hypertension specialist,” he said.

Dr. Carey did not report any industry ties.

[email protected]

SAN FRANCISCO – Pediatric ambulatory blood pressure monitoring (ABPM) is not stable over time and should be repeated before hypertension is diagnosed, according to an investigation of 102 children at Seattle Children’s Hospital.

Most of the children in the study had two 24-hour ABPM sessions at least 6 months apart (median, 1.5 years apart); a few children had three or four sessions. The children were aged 14.6 years, on average, at the first session, and had lifestyle counseling during the study period, but were not on blood pressure medications. Children were considered hypertensive if their average 24-hour readings were above the 95th percentile for sex and height until age 17 years, when they were considered hypertensive with readings of 140/85 mm Hg awake and 120/70 mm Hg asleep. Children with secondary causes of hypertension were excluded from the study.

Half of the children had a change in their ABPM classification from their first to their last session. Among 19 children with an initially normal reading, five progressed to prehypertension, and five to overt hypertension. Among 37 children initially classified as prehypertensive, 10 reverted to normal, and 9 progressed to hypertension. Among 46 children who were hypertensive on the first ABPM, 4 reverted to normal, and 17 improved to prehypertension. Among the 20 children with initially blunted nocturnal dipping, 9 normalized and 1 progressed to reverse dipping.

“These findings support greater use of repeat ABPM. It is possible that children with initially normal ABP may progress to hypertension or prehypertension, or that those with initial prehypertension or hypertension may be normal on repeat,” lead investigator Coral Hanevold, MD, said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

ABPM “is a great tool, but I think we have to realize it has some limitations,” she added. One limitation is that the patterns may not be that stable, and “before we go in and label people, it’s a good idea not to rely on just one session of monitoring,” added Dr. Hanevold, a clinical professor of pediatrics and director of the hypertension program at Seattle Children’s Hospital.

“Kids could be having a bad day the first time and get labeled hypertensive when maybe they’re not. Maybe they will improve,” she said.

The investigators plan to combine their data with a similar dataset from the Children’s Hospital of Pittsburgh. The goal is to be able to predict when white coat and prehypertension will progress to hypertension. Part of the work will involve putting a finer tooth on the broad ABPM categories of normal, prehypertensive, and hypertensive. It’s possible, for instance, that prehypertensive children who are initially closer to the threshold of hypertension will be more likely than other prehypertensive children to actually develop it.

“Our question is what’s going to happen long term. The telling thing is what’s the kid going to be like in 5 years, 10 years,” data that are not available, Dr. Hanevold said.

There was no external funding for the work, and the investigators had no disclosures.

[email protected]

SAN FRANCISCO – Pediatric ambulatory blood pressure monitoring (ABPM) is not stable over time and should be repeated before hypertension is diagnosed, according to an investigation of 102 children at Seattle Children’s Hospital.

Most of the children in the study had two 24-hour ABPM sessions at least 6 months apart (median, 1.5 years apart); a few children had three or four sessions. The children were aged 14.6 years, on average, at the first session, and had lifestyle counseling during the study period, but were not on blood pressure medications. Children were considered hypertensive if their average 24-hour readings were above the 95th percentile for sex and height until age 17 years, when they were considered hypertensive with readings of 140/85 mm Hg awake and 120/70 mm Hg asleep. Children with secondary causes of hypertension were excluded from the study.

Half of the children had a change in their ABPM classification from their first to their last session. Among 19 children with an initially normal reading, five progressed to prehypertension, and five to overt hypertension. Among 37 children initially classified as prehypertensive, 10 reverted to normal, and 9 progressed to hypertension. Among 46 children who were hypertensive on the first ABPM, 4 reverted to normal, and 17 improved to prehypertension. Among the 20 children with initially blunted nocturnal dipping, 9 normalized and 1 progressed to reverse dipping.

“These findings support greater use of repeat ABPM. It is possible that children with initially normal ABP may progress to hypertension or prehypertension, or that those with initial prehypertension or hypertension may be normal on repeat,” lead investigator Coral Hanevold, MD, said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

ABPM “is a great tool, but I think we have to realize it has some limitations,” she added. One limitation is that the patterns may not be that stable, and “before we go in and label people, it’s a good idea not to rely on just one session of monitoring,” added Dr. Hanevold, a clinical professor of pediatrics and director of the hypertension program at Seattle Children’s Hospital.

“Kids could be having a bad day the first time and get labeled hypertensive when maybe they’re not. Maybe they will improve,” she said.

The investigators plan to combine their data with a similar dataset from the Children’s Hospital of Pittsburgh. The goal is to be able to predict when white coat and prehypertension will progress to hypertension. Part of the work will involve putting a finer tooth on the broad ABPM categories of normal, prehypertensive, and hypertensive. It’s possible, for instance, that prehypertensive children who are initially closer to the threshold of hypertension will be more likely than other prehypertensive children to actually develop it.

“Our question is what’s going to happen long term. The telling thing is what’s the kid going to be like in 5 years, 10 years,” data that are not available, Dr. Hanevold said.

There was no external funding for the work, and the investigators had no disclosures.

[email protected]

SAN FRANCISCO – Pediatric ambulatory blood pressure monitoring (ABPM) is not stable over time and should be repeated before hypertension is diagnosed, according to an investigation of 102 children at Seattle Children’s Hospital.

Most of the children in the study had two 24-hour ABPM sessions at least 6 months apart (median, 1.5 years apart); a few children had three or four sessions. The children were aged 14.6 years, on average, at the first session, and had lifestyle counseling during the study period, but were not on blood pressure medications. Children were considered hypertensive if their average 24-hour readings were above the 95th percentile for sex and height until age 17 years, when they were considered hypertensive with readings of 140/85 mm Hg awake and 120/70 mm Hg asleep. Children with secondary causes of hypertension were excluded from the study.

Half of the children had a change in their ABPM classification from their first to their last session. Among 19 children with an initially normal reading, five progressed to prehypertension, and five to overt hypertension. Among 37 children initially classified as prehypertensive, 10 reverted to normal, and 9 progressed to hypertension. Among 46 children who were hypertensive on the first ABPM, 4 reverted to normal, and 17 improved to prehypertension. Among the 20 children with initially blunted nocturnal dipping, 9 normalized and 1 progressed to reverse dipping.

“These findings support greater use of repeat ABPM. It is possible that children with initially normal ABP may progress to hypertension or prehypertension, or that those with initial prehypertension or hypertension may be normal on repeat,” lead investigator Coral Hanevold, MD, said at the joint scientific sessions of the AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

ABPM “is a great tool, but I think we have to realize it has some limitations,” she added. One limitation is that the patterns may not be that stable, and “before we go in and label people, it’s a good idea not to rely on just one session of monitoring,” added Dr. Hanevold, a clinical professor of pediatrics and director of the hypertension program at Seattle Children’s Hospital.

“Kids could be having a bad day the first time and get labeled hypertensive when maybe they’re not. Maybe they will improve,” she said.

The investigators plan to combine their data with a similar dataset from the Children’s Hospital of Pittsburgh. The goal is to be able to predict when white coat and prehypertension will progress to hypertension. Part of the work will involve putting a finer tooth on the broad ABPM categories of normal, prehypertensive, and hypertensive. It’s possible, for instance, that prehypertensive children who are initially closer to the threshold of hypertension will be more likely than other prehypertensive children to actually develop it.

“Our question is what’s going to happen long term. The telling thing is what’s the kid going to be like in 5 years, 10 years,” data that are not available, Dr. Hanevold said.

There was no external funding for the work, and the investigators had no disclosures.

[email protected]

A single-arm study is being conducted at the Ohio State University Comprehensive Cancer Center, Columbus, to assess transoral robotic surgery (TORS) for oral and laryngopharyngeal benign and malignant lesions using the da Vinci Robotic Surgical System.

The study started in 2007, and the estimated completion date is December 2020. Investigators hope to enroll 360 adults.

[email protected]

A single-arm study is being conducted at the Ohio State University Comprehensive Cancer Center, Columbus, to assess transoral robotic surgery (TORS) for oral and laryngopharyngeal benign and malignant lesions using the da Vinci Robotic Surgical System.

The study started in 2007, and the estimated completion date is December 2020. Investigators hope to enroll 360 adults.

[email protected]

A single-arm study is being conducted at the Ohio State University Comprehensive Cancer Center, Columbus, to assess transoral robotic surgery (TORS) for oral and laryngopharyngeal benign and malignant lesions using the da Vinci Robotic Surgical System.

The study started in 2007, and the estimated completion date is December 2020. Investigators hope to enroll 360 adults.

[email protected]

SAN FRANCISCO – In just 6 months, a commonsense quality improvement program increased the rate of blood pressure control from 66% to 75% among 21,035 hypertensive patients at 16 primary care clinics in northwestern South Carolina.

The American Medical Association collaborated with the Care Coordination Institute in Greenville, S.C., to develop the program, dubbed “MAP,” which stands for measuring blood pressure accurately; acting rapidly to manage uncontrolled blood pressure; and partnering with patients to promote blood pressure self-management.

[email protected]

SAN FRANCISCO – In just 6 months, a commonsense quality improvement program increased the rate of blood pressure control from 66% to 75% among 21,035 hypertensive patients at 16 primary care clinics in northwestern South Carolina.

The American Medical Association collaborated with the Care Coordination Institute in Greenville, S.C., to develop the program, dubbed “MAP,” which stands for measuring blood pressure accurately; acting rapidly to manage uncontrolled blood pressure; and partnering with patients to promote blood pressure self-management.

[email protected]

SAN FRANCISCO – In just 6 months, a commonsense quality improvement program increased the rate of blood pressure control from 66% to 75% among 21,035 hypertensive patients at 16 primary care clinics in northwestern South Carolina.

The American Medical Association collaborated with the Care Coordination Institute in Greenville, S.C., to develop the program, dubbed “MAP,” which stands for measuring blood pressure accurately; acting rapidly to manage uncontrolled blood pressure; and partnering with patients to promote blood pressure self-management.

[email protected]

SAN FRANCISCO – Lowering blood pressure below 140/90 mm Hg might not be a good idea in the very elderly, especially if they have cognitive impairment, according to Philip Gorelick, MD.

“Lower blood pressure” in those patients “may be associated with worse cognitive outcomes,” he said at the joint scientific sessions of AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The problem is that higher pressures may be needed to maintain cerebral perfusion. It’s possible the very elderly have impaired cerebral autoregulation, especially if there’s a history of hypertension. A little extra pressure is needed to overcome increased cerebral vascular resistance.

“Cautious blood pressure–lowering with a target of about 150 mm Hg systolic, may be prudent,” said Dr. Gorelick, professor of translational science and molecular medicine at Michigan State University in Grand Rapids. Meanwhile, “for those without cognitive impairment and who have intact cerebral autoregulation, lower blood pressure targets may be beneficial to preserve cognition.

[email protected]

SAN FRANCISCO – Lowering blood pressure below 140/90 mm Hg might not be a good idea in the very elderly, especially if they have cognitive impairment, according to Philip Gorelick, MD.

“Lower blood pressure” in those patients “may be associated with worse cognitive outcomes,” he said at the joint scientific sessions of AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The problem is that higher pressures may be needed to maintain cerebral perfusion. It’s possible the very elderly have impaired cerebral autoregulation, especially if there’s a history of hypertension. A little extra pressure is needed to overcome increased cerebral vascular resistance.

“Cautious blood pressure–lowering with a target of about 150 mm Hg systolic, may be prudent,” said Dr. Gorelick, professor of translational science and molecular medicine at Michigan State University in Grand Rapids. Meanwhile, “for those without cognitive impairment and who have intact cerebral autoregulation, lower blood pressure targets may be beneficial to preserve cognition.

[email protected]

SAN FRANCISCO – Lowering blood pressure below 140/90 mm Hg might not be a good idea in the very elderly, especially if they have cognitive impairment, according to Philip Gorelick, MD.

“Lower blood pressure” in those patients “may be associated with worse cognitive outcomes,” he said at the joint scientific sessions of AHA Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, and American Society of Hypertension.

The problem is that higher pressures may be needed to maintain cerebral perfusion. It’s possible the very elderly have impaired cerebral autoregulation, especially if there’s a history of hypertension. A little extra pressure is needed to overcome increased cerebral vascular resistance.

“Cautious blood pressure–lowering with a target of about 150 mm Hg systolic, may be prudent,” said Dr. Gorelick, professor of translational science and molecular medicine at Michigan State University in Grand Rapids. Meanwhile, “for those without cognitive impairment and who have intact cerebral autoregulation, lower blood pressure targets may be beneficial to preserve cognition.

[email protected]

SAN FRANCISCO – Hypertensive patients averaged about a 10-mm Hg drop in 24-hour ambulatory systolic blood pressure and about a 12-mm Hg drop in office systolic blood pressure, 2 years after treatment with Medtronic’s new Symplicity Spyral renal artery denervation catheter, according to a review of the company’s renal artery denervation registry.

No major safety issues were reported, but there was no reduction from baseline in the number of antihypertensive drugs that patients were prescribed, which averaged more than four.

[email protected]

SAN FRANCISCO – Hypertensive patients averaged about a 10-mm Hg drop in 24-hour ambulatory systolic blood pressure and about a 12-mm Hg drop in office systolic blood pressure, 2 years after treatment with Medtronic’s new Symplicity Spyral renal artery denervation catheter, according to a review of the company’s renal artery denervation registry.

No major safety issues were reported, but there was no reduction from baseline in the number of antihypertensive drugs that patients were prescribed, which averaged more than four.

[email protected]

SAN FRANCISCO – Hypertensive patients averaged about a 10-mm Hg drop in 24-hour ambulatory systolic blood pressure and about a 12-mm Hg drop in office systolic blood pressure, 2 years after treatment with Medtronic’s new Symplicity Spyral renal artery denervation catheter, according to a review of the company’s renal artery denervation registry.

No major safety issues were reported, but there was no reduction from baseline in the number of antihypertensive drugs that patients were prescribed, which averaged more than four.

[email protected]