National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants. [The Lancet, Volume 377, Issue 9765, Pages 568 – 577, 12 February 2011.]

Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP).

We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative.

In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7—129·4) in men and 124·4 mm Hg (123·0—125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (−0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (−0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3—4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8—1·6 mm Hg per decade in men (posterior probabilities 0·72—0·91) and 1·0—2·7 mm Hg per decade for women (posterior probabilities 0·75—0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions.

On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO.

(Fuente: The Lancet.)

El Candesartán puede ser perjudicial en algunos pacientes

El Candesartán puede ser perjudicial en algunos pacientes ya que no es beneficioso tras ictus agudo y pacientes con hipertensión arterial.

De las conclusiones de un trabajo presentado en la Conferencia Internacional de Ictus, en Los Ángeles, y que se publicó en la edición electrónica de The Lancet, se desprende que el empleo del fármaco candesartán en pacientes con presión arterial alta en fase aguda de ictus no ofrece ningún beneficio e, incluso, podría ser perjudicial.
Además, este tratamiento antihipertensivo empeora el pronóstico de los pacientes en comparación con el placebo.

(Fuente: Diario Médico)

Investigadores españoles descubrieron una proteína que es clave en el funcionamiento del sistema cardiovascular.

La hipertensión es una de las enfermedades cardiovasculares más comunes.
Los científicos del Consejo Superior de Investigaciones Científicas (CSIC) de España descubrieron que la ausencia de esta proteína provoca hipertensión.

El descubrimiento, publicado en la revista Nature Medicine podría conducir a la mejora en el diagnóstico de pacientes que sufren presión arterial alta.

Tal como dijo a BBC Mundo el doctor Xosé Bustelo, quien dirigió la investigación en el CSIC, “la aplicación más interesante de este hallazgo será el desarrollo de nuevos fármacos para el tratamiento de la condición”.

La presión sanguínea está determinada por la cantidad de sangre bombeada por el corazón y por el tamaño y condición de las arterias.

La hipertensión es un trastorno caracterizado por presión sanguínea crónicamente alta y si no se le controla puede conducir a derrames cerebrales o a insuficiencia cardiaca e infartos.

Fumar es una de las principales causas de enfermedades cardiovasculares.
Los investigadores españoles esperan que su hallazgo permita tener un conocimiento más profundo de las diferentes etapas del desarrollo de la hipertensión.

Según explicó Xosé Bustelo, el descubrimiento fue hecho durante un experimento realizado con ratones genéticamente modificados a los que habían eliminado esa proteína, llamada Vav3.

“Cuando estudiamos a los animales descubrimos que tenían una enfermedad cardiovascular muy similar a la que se desarrolla en pacientes con alta presión arterial”, explica el investigador.

Según Xosé Bustelo “existen muy pocos ejemplos de enfermedades cardiovasculares que se desarrollen como consecuencia de una alteración de un único gen”.

Pero el estudio del CSIC indica que la Vav3 juega un papel muy importante en la regulación del sistema cardiovascular.

La familia de proteínas Vav no sólo está implicada en la regulación del sistema cardiovascular.

También están implicadas en el desarrollo del cáncer y pueden inducir una serie de alteraciones que provocan la proliferación de las células tumorales y la metástasis.

“Estamos descubriendo que toda esta familia de proteínas tiene implicaciones tanto en el individuo con cáncer como en el individuo sano”, señala el investigador.

“Son proteínas que controlan procesos claves biológicos que son esenciales tanto para funciones normales del organismo como para patologías como hipertensión o cáncer”, agrega.

El estudio, dice Bustelo, permite a los investigadores tener un mejor conocimiento de los pasos progresivos del desarrollo de la hipertensión.

“Nos ofrece además información más concreta sobre los órganos que funcionan defectuosamente cuando esta proteína está ausente”, indica el científico.

Las enfermedades cardiovasculares y accidentes cerebrales se han convertido en una de las principales causas de muerte en el mundo.

Según la Organización Mundial de la Salud, unas 17 millones de personas, un 30% de la población mundial, mueren cada año por algún tipo de enfermedad cardiovascular.

(Fuente: BBC Mundo)

Using a generic blood pressure and heart drug could save the UK $324 million in 2011.

Paper accompanied by UK and US editorials

Using a generic drug to treat hypertension and heart failure, instead of branded medicines from the same class, could save the UK National Health Service (NHS) at least £200 million in 2011 without any real reduction in clinical benefits.

That is the key finding of a systematic review, statistical meta-analysis and cost-effectiveness analysis just published online by IJCP, the International Journal of Clinical Practice.

Researchers from University College London Hospitals NHS Foundation Trust looked at 14 hypertension and heart studies published between 1998 and 2009 on 16,179 patients. Just over two-thirds of the patients were male (68 per cent), with an average age of 60 years.

They set out to compare the clinical benefits and cost-effectiveness of using the market leader candesartan instead of generic losartan, which is now considerably cheaper.

“When drugs are first launched they are protected by patents and relatively expensive as the pharmaceutical companies need to recover their research and development costs” explains lead author Dr Anthony Grosso.

“Once these patents have expired, the manufacturer loses market exclusivity and generic drugs can be produced, which ultimately drives down the price. This offers significant opportunities for cost savings, but only if the clinical evidence supports the use of the less expensive generic drugs.”

The NHS currently spends more than £250 million a year on angiotensin-II receptor blockers (ARB) for high blood pressure and heart failure, with candesartan – which is still under patent and marketed under a number of brand names – currently dominating the market.

“Our comparative research showed that candesartan reduced blood pressure slightly more than losartan, with diastolic readings averaging 2mmHg lower and systolic readings 3mmHg lower” says Dr Grosso. “However, this difference is unlikely to be cost effective, particularly when it is prescribed in combination with other drugs.

“When we took all the factors into account, based on the evidence we reviewed, it was clear that losartan was likely to be the most cost-effective ARB to treat high blood pressure or heart failure.”

The authors estimate that using generic losartan as the angiotensin-II receptor blocker of choice could save the NHS approximately £200 million in 2011. “This figure is based on 2009 prescribing figures for primary care alone, so the actual savings could be even higher” says Dr Grosso.

In an accompanying editorial, Dr Rubin Minhas, Clinical Director & Editor-in-Chief of the BMJ Evidence Centre, stresses the need for the NHS to achieve clinically effective cost savings against a background of stringent public sector cuts and proposed NHS reforms.

He points out that the findings by Grosso et al come hard on the heels of the report by the York Health Economics Consortium in November 2010. This found that £300 million worth of medicine was discarded for various reasons in primary and community care rather than being taken by patients.

“NHS prescribing is a complex issue and it is vital that the proposed changes to the NHS ensure that doctors are making high-quality clinical decisions that are also cost-effective” says Dr Minhas. “It is a delicate balancing act between what doctors think are best for their patients and making the best use of hard-pressed budgets. That is why reviews like this are so important.”

A further editorial by US commentators Dr Bertram Pitt and Dr Stevo Julius, from the University of Michigan School of Medicine, has welcomed the findings but stressed the need for further research.

They say it is particularly important to see further data on comparable cardiovascular benefits in patients with hypertension and/or heart failure before switching patients from candesartan to losartan. This will ensure that clinicians are not trading short-term savings for a long-term, more expensive increase in cardiovascular risks.

(Fuente: www.eurekalert.org)

Accelerated bone growth may be an indicator of hypertension in children

Children whose bones are “older” than their chronological age may be at an increased risk of hypertension, according to a study reported today (19 October) in Hypertension: Journal of the American Heart Association.(1) As a result, the investigators suggest that markers of biological maturity should be evaluated in hypertensive children, and that physical activity and diet may deter the accelerated development of biological maturity.

Behind the study lies the hypothesis that the origins of hypertension are associated with abnormalities of growth and maturation in childhood. This study compared bone age as a marker of biological maturation in hypertensive children with healthy controls closely matched for body mass index (BMI), age and sex, to assess the association between skeletal maturation and hypertension.

The investigators X-rayed the left-hand wrists of 54 untreated hypertensive Polish children (average age 14.2 years) and compared them to X-ray images of 54 children with optimal blood pressure. Both groups were compared with reference images and rates of maturity were defined as physiological, accelerated and delayed.

Results showed that the healthy controls had a mean bone age of 14.7 (±2.3 years), which was not significantly different from their mean chronological age. However, in the group with primary hypertension mean bone age was found to be 16.0 (±2.0) years, reflecting an accelerated rate almost two years more than their chronological age of 14.1 years. The rate of bone age was the strongest predictor of blood pressure status. The investigators proposed that that some lifestyle modifications, such as increased physical activity and diet, might influence both metabolic abnormalities and the tempo of biological maturity.

Commenting on the study on behalf of the European Society of Cardiology, Professor Giuseppe Mancia from the University of Milan-Bicocca in Italy says: “In the last few years there has been much attention given to the traits which may in children and adolescents predict what will happen to their cardiovascular system in later life. We now know, for example, that higher blood pressure values in children predict hypertension in adulthood – and this is also the case with other factors, such as excess body weight (even in neonates) and increased heart rate. So early phenotypes must be considered with great attention, and it is interesting in the present study that this includes bone maturation – that is, something apparently unrelated to cardiovascular and metabolic variables.

“The problem behind the findings on hypertension is when to start intervention, since it is now apparent that associated body changes are already present to some degree at an early stage of life. It is also clear that treatment in adult patients cannot normalise the risk, potentially because hypertension-related changes have already become, at least in part, irreversible. So there are grounds for earlier intervention, and serious implementation of lifestyle changes, such as weight control and exercise, appears justified.”

(Fuente: www.eurekalert.org)