UK Scientists have developed a new urine test which may help doctors predict pre-eclampsia, a serious and often life-threatening complication in pregnant women.

According to a study published in Journal of Clinical Endocrinology and Metabolism, the composition of five proteins in the urine at around 18 weeks' gestation can predict pre-eclampsia with high accuracy. 

University of Leicester researchers believe the new test can help physicians detect woman at-risk of developing the life-threatening high blood pressure condition in early stages and manage the disorder better and with less complications. 

Pre-eclampsia affects approximately 5% of pregnancies and is a condition which can pose serious health concerns, including kidney, liver and neurological problems, to both mother and fetus. 

The condition is characterized by a dramatic rise in the blood pressure and the presence of excessive protein in the urine usually after the 20th week of pregnancy. 

Warning symptoms for the condition includes headache, abdominal pain, visual problems such as blurred vision, shortness of breath, nausea and vomiting, confusion and anxiety. 

Although there is no cure for pre-eclampsia, at risk mothers may be treated with preventive measures, including the use of medications to lower blood pressure, corticosteroids (for severe cases), anticonvulsives such as magnesium (severe cases), or bed rest. 

“Early identification will allow focused monitoring of those women and timely delivery of their babies, as well as reassurance for women at low risk,” said lead researcher Matt Hall. 

Overweight children show signs of future heart disease by 15 or 16

Children who are overweight are already showing signs of future heart disease when they hit 15 or 16, according to the first study of its kind.  Being overweight or obese aged nine to 12 leads to a higher chance of displaying risk factors - including high blood pressure and high cholesterol - at age 15 or 16.

The study, of more than 5,000 children, investigated blood pressure, glucose and insulin levels, and cholesterol.  At the start of the study, when the youngsters were aged nine to 12, 19% of the sample were overweight and another 5% were obese.

Researchers, led by a University of Bristol team, found that those children who were still overweight when they reached 15 or 16 were more likely to have high blood pressure, high cholesterol and high insulin levels - all risk factors for heart disease.

At this age, 29% had high systolic blood pressure (pressure exerted when the heart beats) and 3% had high diastolic blood pressure (pressure between heart beats). But those youngsters who lost weight before they reached 15 or 16 had less risk, particularly if they were girls.

"Girls who favourably alter their overweight status between childhood and adolescence have cardiovascular risk profiles broadly similar to those who were normal weight at both time points," the experts said.

"But boys who change from overweight to normal show risk factor profiles intermediate between the normal at both ages and overweight at both ages."

The research, published in the British Medical Journal (BMJ), is the first of its kind to investigate the link between body mass index (BMI) at ages 9 to 12 and then heart disease risk factors aged 15 to 16.

The experts found a large waist circumference and high body fat mass were also correlated to increased risk, regardless of BMI.

Source: Press Association

Up to eight percent of Canadian children have a blood pressure which is cause for concern

Up to eight per cent of Canadian children have elevated blood pressure that could be cause for concern, researchers say.  For 15 years, researchers have focused on obesity and nutrition to fight high blood pressure, a risk factor for heart disease in general.

Professor Terrance Wade, Canada Research Chair in Youth and Wellness at Brock University in St. Catharines, Ont., is trying something different.

Wade's five-year study focuses on why children might not be getting enough physical activity and developing elevated blood pressure.  Many of the findings about elevated blood pressure in kids have been observed in adults.  "So, it's completely predictable, but it's also worrisome," Wade said Wednesday.

Using repeated measurements from automated blood pressure cuffs, the researchers found 1.5 per cent to four cent of the children participating in the study would be classified as having serious hypertension because they fell in the 95th percentile for high blood pressure.  Another 6.5 per cent to eight per cent of children studied had elevated blood pressure that could be a cause for concern.

The research team of sociologists, cardiologists and exercise physiologists have developed an intervention that aims to help children and youth deal with stress and reduce blood pressure.

The four-step program includes:

      Focusing on children's strengths and making them aware of these.

      Teaching children to focus on positive emotions and adopting a glass half-full perspective.

      Thinking about how children spend their free time.

      Learning coping skills to manage stress.

      The program includes a one-week youth leadership camp for children in grades six to eight. Participants go on to pass on what they have learned to their peers at school

The researchers hope to have results on whether the intervention at five schools in St. Catharines worked by the end of the summer.

The five-year study is funded by the Heart and Stroke Foundation of Ontario.

Source CBC / Read more: http://www.cbc.ca/health/story/2010/11/24/blood-pressure-children-stress.html#ixzz16I6BIXIt

Experts in Blood Pressure - new e-shop launch

Experts in Healthcare has launched a new e-shop to support people looking to buy clinically validated blood pressure monitors.  The new e-shop will not only be selling high quality, validated blood pressure monitors, but will also be offering news and information about high blood pressure as well as video reviews and podcasts.  Experts in Blood Pressure Monitors is one of a number of new sites that will be launched over the next year with plans to expand into allergy products, child health and diabetes.

http://www.expertsinbloodpressure.co.uk/

A short blast of radio waves to the kidneys can help control high blood pressure in patients who do not respond to medication, a study shows.

The pioneering work, described in The Lancet medical journal, selectively severs nerves to the kidney that play a key role in regulating blood pressure.  Although still in the testing phase, experts say the procedure could one day help hundreds of thousands of patients.

Half of patients fail to achieve good blood pressure control with drugs.  This is partly because it can be difficult to remember to take medication every day. But for up to a fifth of patients it is because the drugs simply have no effect.

High blood pressure is an exceedingly common condition, affecting around one in three adults in England.  Experts believe the new procedure could help many of these better control their condition, thereby lowering their risk of future strokes and heart attacks.  Doctors led by Professor Murray Esler at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, have been testing the safety and effectiveness of the therapy.

To get to the kidneys, the doctors use a long, thin piece of tubing called a catheter that is threaded into an artery in the groin and guided up to the kidney.  Once in place, the catheter is connected to a machine that generates radio waves, known as radiofrequency energy.

In this way, a short burst from the machine can knock out a number of tiny nerves that run in the lining of the arteries of the kidney.  By stopping these nerves from sending signals the treatment lowers blood pressure.  The Australian team, working with 24 centres across the globe, have tested the treatment in trials involving more than 100 patients.  They found the therapy lowered blood pressure by about 10mmHg or more - which although is not enough to return blood pressure to a 'normal' level is enough to reduce some of the associated health risks of very high blood pressure.  And, importantly, there were few side effects if any.

The first patient in the UK received the innovative procedure at Barts and The London NHS Trust a year ago.  Commenting on the findings, Professor Jeremy Pearson of the British Heart Foundation said: "This trial opens up a potentially exciting new avenue for the treatment of patients with high blood pressure who do not respond well to current medicines.

"Further studies are needed to see if this invasive procedure will be acceptable to patients and produce long-lasting effects that are safe and reduce future cardiovascular events."

Source: BBC News

Garlic extract can reduce blood pressure say Australian researchers

Australian doctors enrolled 50 patients in a trial to see if garlic supplements could help those whose blood pressure was high, despite medication.  Those given four capsules of garlic extract a day had lower blood pressure than those on placebo, they report in a scientific journal.  Garlic supplements have previously been shown to lower cholesterol and reduce high blood pressure in those with untreated hypertension.

In the latest study, researchers from the University of Adelaide, Australia, looked at the effects of four capsules a day of a supplement known as aged garlic for 12 weeks.  They found systolic blood pressure was around 10mmHg lower in the group given garlic compared with those given a placebo.  Researcher Karin Ried said: "Garlic supplements have been associated with a blood pressure lowering effect of clinical significance in patients with untreated hypertension.

"Our trial, however, is the first to assess the effect, tolerability and acceptability of aged garlic extract as an additional treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension."

Experts say garlic supplements should only be used after seeking medical advice, as garlic can thin the blood or interact with some medicines.

Ellen Mason, senior cardiac nurse at the British Heart Foundation, said using garlic for medicinal purposes dates back thousands of years, but it is essential that scientific research proves that garlic can help conditions such as raised blood pressure.  She said: "This study demonstrated a slight blood pressure reduction after using aged garlic supplements but it's not significant enough or in a large enough group of people to currently recommend it instead of medication.

"It's a concern that so many people in the UK have poorly controlled blood pressure, with an increased risk of stroke and heart disease as a consequence. So enjoy garlic as part of your diet but don't stop taking your blood pressure medication."

The study is reported in the journal Maturitas.

Source: BBC News

Teens warned to cut down salt if they wish to avoid high blood pressure

A teenager who consumes recommended quantities of salt each day has a considerably lower risk of developing hypertension (high blood pressure), stroke, heart disease, and dying prematurely later on in life during adulthood, researchers from the University of California, San Francisco, explained at the American Heart Association's Scientific Sessions 2010, Chicago. They added that processed foods contribute significantly to the high salt intake that currently affects many teens and their families. They also suggest that food manufacturers should do more to reduce the levels of salt in their produce.

Kirsten Bibbins-Domingo, Ph.D., M.D. and team used an advanced computer modeling analysis system to work out the long-term health benefits if salt levels in processed foods were reduced by 3-grams per day nationwide. They focused on produce consumed most commonly by male and female teenagers.

The team explain that teenagers consume more salt than any other age group in America - over 9 grams daily, equivalent to over 3,800 milligrams of sodium. The daily recommended amount stands at 1,500 milligrams of sodium daily, according to the American Heart Association.

They worked out that a 3 gram drop in daily salt intake among teenagers would result in a 380,000 to 550,000 reduction in the eventual number of young adults or late teenagers with hypertension (high blood pressure) - a decrease of between 44% to 63%.

This same reduction in daily salt intake during teen years would eventually result in between 2.7 million to 3.9 million fewer adults aged 35 to 50 with hypertension.

Bibbins-Domingo, Ph.D., M.D. said:

"Reducing the amount of salt that is already added to the food that we eat could mean that teenagers live many more years free of hypertension. The additional benefit of lowering salt consumption early is that we can hopefully change the expectations of how food should taste, ideally to something slightly less salty.

A one-gram-per-day reduction in salt consumption results in a small drop of systolic blood pressure of 0.8 mm Hg. Reducing the salt in the teenage diet from an average of 9 grams to 6 grams would get teenage boys and girls to appropriate levels of salt intake."

Highlighted below are some projections the team made if teenagers reduced their daily salt intake. By the time the teenagers were 50 years old:

• There would be 120,000 to 210,000 fewer cases of coronary heart disease, a drop of 7% to 12%
• There would be 36,000 to 64,000 fewer heart attacks, a fall of 8% to 14%
• There would be 16,000 to 28,000 fewer strokes, a reduction of 5% to 8%
• There would be 69,000 to 120,000 fewer deaths from any cause

According to the researchers, approximately 80% of a typical teenager's salt intake comes from processed foods, just over a third comes from breads, pastries and cereals.

Bibbins-Domingo, Ph.D., M.D. said:

"The hidden places of salt in our diet are in breads and cereals, canned foods and condiments, and of course fast foods," said Bibbins-Domingo, also co-director of the UCSF Center for Vulnerable Populations. "Most of the salt that we eat is not from our salt shaker, but salt that is already added in food that we eat."

According to the National Center for Health Statistics, the most salt-laden processed food regularly eaten by teenagers is pizza.

The team welcomes the efforts made by some food manufacturers to reduce salt content in their produce, such as joining the National Sodium Reduction initiative. However, these efforts should be widened to all manufacturers, who should work with state and federal authorities.

Source: American Heart Association's Scientific Sessions 2010

Written by Christian Nrodqvist 
Copyright: Medical News Today 

Solar powered BP monitor could be breakthrough for low-income nations health

A solar-powered blood-pressure measuring device that's reliable and affordable could help reduce rapidly rising rates of cardiovascular disease in low-income nations, according to a new study.

Field tests at three medical centers in Africa -- two in Uganda and one in Zambia -- showed that the $32 automated device is 94 percent in agreement with the standard blood-pressure testing method for systolic blood pressure, which is the top number in a blood-pressure reading and represents the maximum pressure when the heart contracts.

It was less accurate for diastolic blood pressure (the lower number that shows pressure when the heart is relaxed), but that is something that should be easy to fix, the researchers said. They also noted that systolic blood pressure is the major contributor to cardiovascular events and tends to be the more important reading.

The research is reported Nov. 8 in the journal Hypertension.

It took about 15 minutes to train medical center staff to use the device. The staff then used the new device and a standard device to take blood pressure readings on about 716 patients. They repeated this one month later. Medical staff and patients said they preferred the solar device over the standard device.

"Solar energy eliminates the need for expensive rechargeable batteries in remote areas where electricity and the availability of batteries might be scarce, but sunlight is plentiful. It can be run on batteries, but it can also be left in the sunlight to charge, making it ideal for rural areas and use out in the bush," lead author Dr. Eoin O'Brien, a professor at Conway Institute of Biomolecular and Biomedical Research of the University College Dublin, Ireland, said in an American Heart Association news release.

He noted that the incidence of hypertension, or high blood pressure, has risen dramatically in low-income nations, many of which lack trained medical personnel.

"Hypertension leads to stroke and heart attack as the major cause of death around the world. It is greater than malnutrition, cancer and AIDS," O'Brien said.

"We have been able to provide an accurate, robust and inexpensive device to diagnose high blood pressure," O'Brien added. "It's a start. If we can't measure blood pressure, we certainly can't begin to treat hypertension."

SOURCE: American Heart Association, news release, Nov. 8, 2010 / HealthDay.

Researchers discover important link between adrenal gland hormone and brain in hypertension

PRESS RELEASE ALERT!

A hormone already responsible for increasing blood pressure by prompting the kidneys to retain salt appears to moonlight as a major stimulator of the brain centers that control the vascular system and blood pressure.

Researchers at UT Southwestern Medical Center studied patients who overproduce aldosterone to see whether the hormone had any effect on sympathetic nerve activity responsible for blood pressure increases.  "Between 10 percent and 20 percent of patients with high blood pressure who are resistant to treatment have elevated aldosterone hormones," said Dr. Wanpen Vongpatanasin, associate professor of internal medicine at UT Southwestern and senior author of the study in the October issue of the Journal of Clinical Endocrinology & Metabolism. "Previous studies in animals showed that this hormone can affect many parts of the brain that control the cardiovascular system. We wanted to understand whether aldosterone also increases the nerve activity that causes constriction of blood vessels, which elevates blood pressure in humans.  "Since aldosterone can cause high blood pressure by affecting multiple systems and not just the kidneys, this study sheds light on why blood pressure is so difficult to control in patients with high aldosterone levels."


Aldosterone is an essential hormone that regulates electrolytes in the body. Created by the adrenal glands, it is responsible for re-absorption of sodium and water into the bloodstream and for regulating potassium. High levels of aldosterone can cause high blood pressure, muscle cramps and weakness.
Dr. Vongpatanasin and her team studied 14 hypertensive patients who overproduced aldosterone, a condition known as primary aldosteronism, and compared them with 20 hypertensive patients and 18 patients with normal blood pressure.


The data showed that in humans, aldosterone does increase activity in a part of the nervous system that raises blood pressure. Such activity contributes to the onset of hypertension. Furthermore, when the nerve activity was measured in patients who had adrenal surgery to remove tumors that produced this hormone, both nerve activity and blood pressure decreased substantially.  "Our study also suggested that treatment of hypertension in these patients not only requires targeting the kidneys but also the sympathetic nervous system that controls blood pressure," Dr. Vongpatanasin said. "Since our study shows that patients with high aldosterone levels have high nerve activity, future studies are needed to determine how we could prevent effects of aldosterone on the brain."


The research was supported by the National Institutes of Health, the Donald W. Reynolds Foundation, the George M. O'Brien Kidney Research Center, the Lincy Foundation and the Burroughs Wellcome Fund.
Other UT Southwestern researchers who contributed to the study included senior author Dr. Andrew Kontak, postdoctoral researcher in internal medicine; Dr. Zhongyun Wang, research associate in internal medicine; Debbie Arbique, advance practice nurse in internal medicine; Beverley Adams-Huet, assistant professor of clinical sciences; Dr. Richard Auchus, professor of internal medicine; and Dr. Shawna Nesbitt, associate professor of internal medicine. Other researchers included Dr. Ronald Victor of Cedars-Sinai Medical Center.

This news release is available on: http://www.utsouthwestern.edu/home/news/index.html

What is pre-hypertension? WSJ Blog

While a third of Americans suffer from full-blown high blood pressure, at least that many — and possibly up to 37% of the population — are in a borderline zone called prehypertension. And that “precondition” carries its own risks of heart disease, stroke, and progression to full hypertension, today’s Informed Patient column reports.

As high blood pressure is increasingly identified as a risk factor for health problems including stroke, heart disease, kidney disease and even dementia, researchers are trying to find out more about prehypertension and how to address it. But the new medical designation has also sparked some contentious debates, which are expected to play out in February at the first international conference on prehypertension. One planned session is called “Is it Justified to Merge Normal and High Normal Blood Pressure into Prehypertension?” and there will also be a debate, “Prehypertension – Is it a Disease or Disease Invention?”

That kind of question has been swirling since 2003, when a federal panel, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, designated prehypertension as a new classification covering a range long considered “normal to high normal”: blood pressure between 120 and 139 millimeters of mercury systolic (the pressure at the moment the heart beats) or between 80 and 89 mm Hg diastolic (when the heart is at rest).

The committee did not suggest drug treatment for prehypertension, recommending only lifestyle modifications, such as weight loss and exercise. But after a 2006 study showed that blood-pressure drugs can reduce the progression to hypertension in prehypertensive patients, more physicians have been calling for pharmaceutical solutions.

In August of this year, an article in the British Medical Journal noted that in the wake of the new classification, prehypertension is emerging as a potential goldmine for drug companies, and pointed out that many physicians who were members of the committee have disclosed financial relationships to industry.

One of the committee members named in the article is George Bakris, director of the Hypertension Center at the University of Chicago, who has disclosed consulting arrangements with several drug companies. Bakris, for his part, tells the Health Blog that the committee’s decision had nothing to do with drug-company interests, and was meant to educate and empower patients.

At the time the committee was finalizing its recommendations, he says, new studies were showing that cardiovascular risk starts climbing at blood-pressure readings of 115/75, not 140/90. And starting at 115/75, the risk doubles for each 20 mm Hg increase in systolic pressure and each 10 mm Hg increase in diastolic pressure.

“Everyone wants to beat up on the term prehypertension, like saying it is pre-death, when we are all pre-death,” Bakris says. “But we know if we intervene in blood pressure we can buy back some lost lifetime for the patient, if we can get it under control.” After 55, there is a 90% chance that most people will become hypertensive if they aren’t already, he notes. “I tell patients the analogy is that if you know there is a fire in one room of your house, if you don’t do something about it, the house is going to burn down.”

By Laura Landro / WSJ

Children with hypertension more likely to have ADHD

Children who have hypertension are much more likely to have learning disabilities than children with normal blood pressure, according to a new University of Rochester Medical Center (URMC) study published today in the journal, Pediatrics.  In fact, when variables such as socio-economic levels are evened out, children with hypertension were four times more likely to have cognitive problems.

“This study also found that children with hypertension are more likely to have ADHD (attention deficit hyperactivity disorder),” said Heather R. Adams, Ph.D., an assistant professor of Neurology andPediatrics at URMC, and an author of the study. “Although retrospective, this work adds to the growing evidence of an association between hypertension and cognitive function. With 4 percent of children now estimated to have hypertension, the need to understand this potential connection is incredibly important.”

Among the study’s 201 patients, all of whom had been referred to a pediatric hypertension clinic at URMC’s Golisano Children’s Hospital, 101 actually had hypertension, or sustained high blood pressure, determined by 24-hour ambulatory monitoring or monitoring by a school nurse or at home. Overall, 18 percent of the children had learning disabilities, well above the general population’s rate of 5 percent. But the percentage among those without hypertension was closer to 9 percent, and among those with hypertension, the rate jumped to 28 percent. All of the children were between 10- and 18-years-old, and the children’s learning disability and ADHD diagnoses were reported by parents.

This study is part of a series of hypertension studies by Golisano Children’s Hospital researchers, led by Principal Investigator Marc Lande, M.D., a pediatric nephrologist, but it was the first that included children with ADHD. Previous studies excluded them because ADHD medications can increase blood pressure. Researchers included them this time because, although it is possible that some of the children’s hypertension was caused by medications, it is also possible that the higher rate of ADHD among children with hypertension is a reflection of neurocognitive problems caused by hypertension. Twenty percent of the children with hypertension had ADHD whereas only 7 percent of those without hypertension had ADHD among the study participants. And even when ADHD was factored out of the analyses, there was still a higher rate of learning disabilities in the hypertensive, compared to the nonhypertensive group of children.

“With each study, we’re getting closer to understanding the relationship between hypertension and cognitive function in children,” Lande said. “And this study underscores the need for us to continue to tease out the potential risk children with hypertension have for learning difficulties at a time when learning is so important. It may be too early to definitively link hypertension and learning disabilities, but it isn’t too early for us, as clinicians, to ensure our pediatric patients with hypertension are getting properly screened for cognitive issues.”

The study was funded by a grant from the National Institutes of Health. The authors have no conflicts to disclose.

Source: http://www.healthcanal.com/child-health/12248-Children-with-High-Blood-Pressure-More-Likely-Have-Learning-Disabilities.html

People with hyperuricemia are at an increased risk for high blood pressure

People with hyperuricemia are at an increased risk for high blood pressure, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Hyperuricemia is an abnormally high level of uric acid in the blood that can lead to gout – a painful and potentially disabling form of arthritis that has been recognized since ancient times.

It has long been known that people with high levels of uric acid in the blood can also have high blood pressure. However, it is unknown if these two conditions simply tend to occur together or if one condition actually precedes the other. Researchers recently set out to establish whether excessive uric acid increases the risk for future development of hypertension. They reviewed all previously published studies related to this topic and combined the outcomes of those studies into one overall analysis.

To do this, they searched major electronic databases using specific medical terms associated with hyperuricema and high blood pressure and evaluated hypertension studies that measured the impact of serum uric acid levels. They conducted an analysis of 18 studies that included at least 100 participants of all ages who were studied for at least one year and who did not have high blood pressure at the beginning of the study in which they participated.

According to Peter Grayson MD, a rheumatologist at the Boston Medical Center and lead investigator in the study, most of the studies his team reviewed accounted for factors that are traditionally known to increase the likelihood of developing high blood pressure – such as age, family history, weight and tobacco use. By doing this, Dr. Grayson and his team were able to determine if uric acid independently increases the risk for hypertension.

Among the 18 studies analyzed, there was data from 55,607 participants, including 13,025 participants with high blood pressure. The researchers noted that participants with hyperuricemia were more than 40 percent more likely to later develop high blood pressure than participants without hyperuricemia. Women with the highest uric acid levels and people who develop high levels of uric acid at a relatively young age are especially at risk for developing high blood pressure.

Additionally, race may play an important role, and the researchers noted that black people with hyperuricemia may also be at particularly increased risk.

“The results of this study show that people with elevated uric acid levels are at an increased risk for the future development of hypertension, but this does not mean that uric acid directly causes elevated blood pressure. More studies are needed to clarify that question,” explains Dr. Grayson. “Medications that lower uric acid levels in the blood may potentially be useful in the prevention or treatment of hypertension. Randomized trial data, with particular attention paid to gender, age, and racial subgroups, would be valuable to address this issue.”

Statutory limits on salt content of processed food could be more effective than voluntary restrictions

Imposing statutory limits on the salt content of processed foods could be 20 times more effective than voluntary restrictions in terms of the impact on cardiovascular health, a new study in Australia has found [1].  In their paper published online November 1, 2010 in Heart, Dr Linda J Cobiac (University of Queensland, Herston, Australia) and colleagues note that many countries, including Australia, the UK, Canada, France, Finland, and New Zealand have implemented salt-reduction programs, but that most of these rely on voluntary changes by food manufacturers and informed choice by consumers. "It is argued that legislative enforcement of salt limits in food processing is needed to achieve meaningful changes in population salt levels," they observe.

In their study, they assessed the public-health benefits and cost-effectiveness of three strategies for reducing dietary sodium content, including the current Australian "Tick" program. This entails food manufacturers being able to buy an endorsed logo for use on packaging to try to achieve higher sales in return for voluntarily reducing the salt content of the endorsed products. They also examined the impact of two other possible interventions: mandatory reductions in sodium content and professional advice to cut dietary salt for those at increased and high risk of cardiovascular disease.

They calculated the cost-effectiveness ratios in Aus$ (for the year 2003) per disability-adjusted life-years (DALYs) for the strategies—adding in various other variables, such as government/food industry costs and costs of unrelated healthcare in added years of life—and compared the results with what would happen if none of these strategies were in place.  Interventions that came out as "dominant" led to more health and less cost than if no intervention to reduce salt was in place: they found that providing dietary advice to reduce salt intake was not cost-effective, even if directed toward those with the highest blood pressure who are most at risk of cardiovascular disease.

Voluntary industry restrictions on the salt content of processed foods under the current Australian incentive scheme were cost-effective, however, and would cut ill health from cardiovascular disease by almost 1%, which is substantial at the population level, they point out.  But in order to achieve significant improvements in population health, government legislation to reduce sodium should be enacted in Australia, which could generate an 18% reduction in morbidity from cardiovascular disease, they calculate.  "Food manufacturers have a responsibility to make money for their shareholders, but they also have a responsibility to society. If corporate responsibility fails, maybe there is an ethical justification for government to step in and legislate," they conclude.

Source: http://www.theheart.org/article/1143681.do

Renin testing to be encouraged by BHS according to Pulse Article

Exclusive: Hypertension guidance is set to encourage GPs to use renin testing to guide treatment for patients with resistant hypertension, prompting warnings that the test is only available in around a dozen centres across the UK.

Pulse has learned new draft guidance by the British Hypertension Society, due to be published in March, will recommend renin measurement in patients whose blood pressure remains uncontrolled even though they are on three different treatments.

Professor Morris Brown, former president of the BHS and professor of clinical pharmacology at the University of Cambridge, said he believed ‘the time has arrived for more routine measurement of plasma renin’ by GPs.

‘It’s the BHS’ view people who are not at target despite being on three drugs should be tested. People with hypertension on lots of drugs who still have low renin need bigger doses of diuretic.’

Professor Brown is leading the PATHWAY trial to try to establish if use of treatment directed by plasma renin testing helps patients reach target more quickly.

Testing measures the renin-aldosterone ratio and can identify possible primary hyperaldosteronism in hypertensives. But it is not available in most pathology labs and GPs are unfamiliar with it.

Dr Terry McCormack, a GP in Whitby, Yorkshire, and a hypertension researcher, said: ‘If you recognise renin deficiency you should use diuretics differently. But I don’t think it’s available to the average GP. We need evidence about whether it’s value for money.’

Dr Stuart Smellie, director of clinical practice at the Association of Clinical Biochemists, said: ‘Few local labs do this, it’s pretty well the exclusive reserve of specialist labs, but local labs can organise testing through regional centres. GPs should check with labs as samples may need prompt separating.’

Dr Mark Davis, a GP in Garforth, Leeds said: 'It depends on where this research leads. When you get to that stage you could use renin testing - depending on renin levels you could go for a drug that works on the renin system or if renin is low use a diuretic. Theoretically it sounds like a good idea but it would have to be proven in a trial before we could use it in a widespread way.'

Department of Health criticised for failing to tackle high blood pressure inequalities

The Department of Health has known since 1997 that low-cost drug treatments could have a major effect in deprived areas, but they have still not been adopted on the scale required, say MPs in a damning new report.  It is “unacceptable” that the Department took until 2006 – nine years after it announced the importance of tackling health inequalities – to establish this as an NHS priority, adds the House of Commons Committee of Public Accounts, in a report published this morning.

The Committee, which is chaired by Labour MP Margaret Hodge, points out that inequalities in health outcomes between the most affluent and disadvantaged members of society are longstanding, deep-seated and have proved difficult to change.  In 1997, the government put tackling the problem at the heart of its health agenda, published a number of policy documents and related targets, and in 2004 it set the Department the target of reducing the gap in life expectancy between 70 “spearhead” local authorities with high deprivation and the population as a whole by 10% by 2010.

However, “the Department has not met this target and has been exceptionally slow to tackle health inequalities,” says the report.   In 2002, it notes, three cost-effective health interventions that were known to improve life expectancy were emphasised by a Treasury-led review of health inequalities. They were: - the prescription of drugs to control blood pressure; - the prescription of drugs to reduce cholesterol; - and smoking cessation services.

“Yet it took the Department until 2007 to develop an evidence-based tool to help Primary Care Trusts (PCTs) implement these treatments and to start to monitor how to use them,” say the Committee members, who add that they have also been told by the Department that these three key interventions have not yet been adopted “to the scale necessary to close the inequalities gap.”

Criticising the Department’s slowness to develop an evidence base for cost-effective interventions, the MPs say it has also failed to put in place mechanisms to hold providers and commissioners to account over whether they apply these interventions. “Even now, implementation of the three most cost-effective treatments is inconsistent, with considerable variation by location,” they say, and in their recommendations they call on the Department and the NHS Commissioning Board to “identify and implement the action needs to stimulate the wider adoption of the treatments, so that GPs in all areas comply with accepted good practice.”

After the Department established the objective of tackling the “complex and intractable problem” of the continually-widening gap between people in deprived areas and the general population, it did not then “set about its task with sufficient urgency or focus,” they say. Moreover, it “did not deploy its own resources effectively or coherently, was too slow in making health inequalities an NHS priority and set a performance measure that proved too blunt an instrument to target those most in need effectively.”

The Department has also failed to address adequately GP shortages in the areas of highest need, and its officials are not clear why some areas are performing better than others, or of the extent of the NHS’ contribution in tackling health inequalities, says the report, which also notes that two-thirds of PCTs in areas with the highest deprivation still do not receive the money due to them under the Department’s funding formula.

 During the transition period in which the change set out in the government’s White Paper on the future of the NHS is managed, it is important that tackling health inequalities does not slip down the Department’s agenda, say the MPs. “The Department will need to set a clear framework of accountability at all levels of the health service if it is to be successful in addressing health inequalities in future,” they conclude.

Source: Lynne Taylor, Pharma Times Online

Can you engineer blood pressure? A new experimental implanted device may offer some help to those who are drug resistant

An implantable device that triggers the body’s own blood pressure control system could provide treatment for those suffering high blood pressure but unable to tolerate drugs.  Although there are many different kinds of drugs on the market, many people’s blood pressure is not adequately controlled by medication. Up to 30 per cent of people have to take three or more drugs and are considered resistant to therapy. 

Now, a new implantable device is being readied for commercialisation in Europe that could help these resistant patients. The Rheos System, developed by Minneapolis-based CVRx, is a pacemaker-like device designed to reduce high blood pressure and address heart failure by electrically activating specific target areas at the carotid arteries in the neck.

The system comprises three components; a small device implanted beneath the collar bone, two thin lead wires that are implanted in contact with the left and right carotid arteries, plus an external unit to monitor the system’s functional characteristics and to program it via telemetry.

The carotid arteries on either side of the neck contain a specific location called the carotid sinus. Embedded in the walls of the arteries at that location are specialised receptors called baroreceptors, which are the body’s natural blood flow monitors.

They sense the pressure of blood flowing through the vessels, which causes them to send electrical impulses to the brain to let the brain know what the blood pressure is.

Engineers hope to develop a system where a physician could program in a patient’s required blood pressure

The implanted device works by electrically stimulating baroreceptors on the carotid arteries. This causes the baroreceptors to send signals to the brain that are interpreted as a rise in blood pressure that needs to be corrected. The brain acts to lower the blood pressure by reducing the workload of the heart in a chain of events that ultimately reduces risk of stroke, heart attack, heart failure and kidney disease.

According to Dr Robert Kieval, founder and chief technology officer of CVRx, three key parameters are used by the pulse generator to non-invasively regulate the activation energy from the device to the leads, and hence control the amount of stimulation delivered to a patient.

These parameters are the amplitude of the voltage of the pulses, their frequency and width. They are controlled by the external system via a telemetry communications link that allows a physician to program the microprocessor inside the device. This allows the physician to provide a therapy that is specific to each patient.

Since the device has primarily been used in clinical trials, key parameters are varied systematically by the external computer system used by a doctor in the presence of a CVRx representative until the most effective dose response; or optimal setting of the parameters; is found.

Then, in a series of regular check-ups, the dose response is checked again to ensure that a patient remains responsive. If not, the parameters can be modified to increase effectiveness.

’Clinical studies of the device have taken place across Europe and the US. A number of patients have been implanted with the device for more than four years and have experienced a significant and sustained drop in systolic blood pressure,’ said Kieval.

Eventually, the company’s engineers hope to develop a system where a physician would be able to program in the patient’s required blood pressure from a user interface and the embedded machine would then take appropriate action to stimulate the baroreceptors to do just that.

SoSource: The Engineer