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Effective hypertension screening by family physicians
Abstracts / Journal of the American Society of Hypertension 8(4S) (2014) e45–e64
P-66 Effect of acute moderate-intensity cycling on peripheral and central blood pressure at rest and during stress test Florian Milatz,1 Sascha Ketelhut,1 Reinhard G. Ketelhut.2 1Humboldt University of Berlin, Institute of Sports Science, Berlin, Germany; 2 Medical Center Berlin (MCB), Berlin, Germany Introduction: The favorable influence of acute as well as regular exercise on peripheral blood pressure (BP) regulation is widely known. In the present study we investigated the influence of acute endurance exercise on peripheral and moreover on central BP and during a cold pressor stress test. Methods: In 30 healthy men (33.2 7.2 years, BMI 24 2.4 kg / m2;) peripheral and central BP were measured non-invasively at rest and at the end of a 2 minute cold pressor test (CPT) using Mobil-O-Graph (PWA monitor, IEM Company). After a 60 minute endurance training on a bicycle ergometer (65% of the previously during cardiopulmonary exercise testing determined maximum heart rate) peripheral and central BP were controlled again after 60 minutes of recovery and thereafter during a CPT. Results were compared with those before the endurance exercise. Results: After 60 minutes of recovery peripheral systolic (p < 0.001) and diastolic (p ¼ 0.02) BP were still reduced (1299/837mmHg before to 1228/806mmHg post exercise). Both central systolic (p < 0.001) and diastolic (p ¼ 0.01) pressures were significantly reduced from 11810/ 857 to 1128/816 mmHg as well. In comparison to BP during CPT before exercise, BP during CPT after endurance exercise showed a significant reduction in peripheral (p ¼ 0.02) and central (p ¼ 0.02) systolic BP (14213 mmHg to 13712 mmHg; 12913 mmHg to 12512 mmHg). There were no significant reductions in diastolic BP, although reduced mean values were recorded (peripheral BP 9513 to 9311 mmHg; central BP 9713 to 9511 mmHg). Conclusions: The present study provides evidence that moderate acute endurance training results not only in a decrease of peripheral BP but more of central BP regulation even after 60 minutes of recovery. Furthermore, the peripheral as well as central BP response during a subsequent stress test was attenuated due to the previous exercise bout when compared with pre-exercise. Keywords: endurance exercise; cold pressor test; peripheral blood pressure; central blood pressure
P-67 Effective hypertension screening by family physicians Raveenie Rajasingham.1,.2 1Athabasca University, Athabasca, AB, Canada; 2 Athabasca University, Pickering, ON, Canada Background: Increased patient anxiety related to regular check-ups at a medical clinic can cause a temporary rise in blood pressure, causing inaccurate and uncharacteristic blood pressure measurements that do not reflect the average or typical daily patient blood pressure values. This phenomenon is known as White Coat Hypertension (WCH). Based on the 2013 Canadian Hypertension Education Program guideline, if at the initial office visit the patient’s systolic blood pressure (SBP) is > 140 mmHg and/or if the Diastolic Blood Pressure (DBP) > 90mmHg, this is considered hypertensive. Primary care physicians can misdiagnose their patients as hypertensive when they are not based on these criteria. Purpose: To review the current Canadian practices of screening for hypertensive patients during clinic visits and to recommend and reinforce to use effective screening tools for family physicians to accurately diagnose blood pressure changes. Finding: The three main tools (1) traditional office measurements, 2) in office BpTRU, home measurements and 3) Ambulatory Blood Pressure monitoring are recommended to be used appropriately. Conclusion: Review of studies indicates ABPM clearly provides complete report of the patient circadian pattern and the efficacy of antihypertensive therapy and fluctuations in BP. It is recommend that primary care
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physicians follow the Canadian Hypertension Education guideline as well as use ABPM in their practices as part of their screening process. Keywords: Blood Pressure Measurement; White Coat Hypertension; Screening; Ambulatory Blood Pressure Monitoring
P-68 Effects of celebrex vs. naproxen on blood pressure in pediatric subjects with juvenile idiopathic arthritis (JIA) 4 Bonita Falkner,y, Robert W. Nickeson,1 Lawrence Zemel,2 Dinu Iorga,3 Pritha Bhadra Brown,3 Manuela F. Berger.3 1All Children’s Hospital, St Petersburg, FL, United States; 2Connecticut Children’s Medical Center, Hartford, CT, United States; 3Pfizer Inc, New York, NY, United States; 4 Thomas Jefferson University, Philadelphia, PA, United States Introduction: This study was conducted to provide additional information about the impact of chronic NSAID therapy on blood pressure in a pediatric population ages 2 to 17 years old for the indication of treatment of JIA. Methods: 201 subjects were randomized in a 1:1 ratio in the two arms celecoxib and naproxen. Subjects were treated 6 weeks as follows: Celecoxib 50 mg or 100 mg BID and Naproxen 7.5 mg/Kg BID. The primary endpoint was the change from Baseline to Week 6 (End of Study) in Systolic Blood Pressure. The primary analysis was based on a 90% confidence interval (CI) for the difference across treatment groups (celecoxib - naproxen), in mean change from baseline in SBP. Results: The demographic characteristics were similar in the two treatment groups. The primary analysis was conducted using the Safety population. The mean (SD) SBP at baseline were 98.5 (9.49) and 98.1 (9.49) and at week 6/Final visit 98.9 (8.84) and 97.4 (10.33) for celecoxib and naproxen, respectively. The LS mean difference (celecoxib - naproxen) was 1.10 (1.004) with a 90% CI of (-0.56, 2.76). Therefore, it can be interpreted with 90% confidence that there was no difference in SBP changes from baseline to week 6/Final visit between the celecoxib and naproxen groups. The mean (SD) DBP at baseline were 62.2 (7.82) and 62.0 (7.61) and at week 6/Final visit 61.8 (6.78) and 61.5 (7.64) for celecoxib and naproxen, respectively. The LS mean difference (celecoxib - naproxen) was -0.179 (0.765) with a 95% CI of (-1.69, 1.33). Adverse Event (all causalities) occurring in at least 5% of the subjects: Headache, Nausea and Arthralgia. Treatment related AE, Nausea occurred in 7.1% of subjects in the naproxen group. Conclusions: The effects on blood pressure were minimal and similar between the two treatment groups for SBP and DBP changes at week 6/Final visit. The adverse event profile was comparable between the two treatment groups. Keywords: NSAIDs; JIA; hypertension; celecoxib
P-69 Effects of home blood pressure monitoring on recurrent stroke Gregory R. Franklin, Andrea Boan, Daniel Lackland. Medical University of South Carolina, Charleston, SC, United States Hypertension has long been known to be the primary risk factor for stroke, especially in preventing recurrent strokes in post-ischemic patients. Studies have shown that home blood pressure monitoring is an inexpensive way to provide a clear representation of patients’ hypertension and helps to overcome many of the limitations of clinic (in-office) blood pressure readings. The Heart 360 program, sponsored by the American Heart Association, gives patients the ability to record blood pressure readings onto an online database so that clinicians can better treat hypertension, thereby reducing the incidence of recurrent strokes. This study intends to show that home blood pressure monitoring is effective in reducing recurrent strokes in post-ischemic patients by: 1) making post-ischemic patients feel more comfortable about their health 2) giving clinicians more data to be more
P-66 Effect of acute moderate-intensity cycling on peripheral and central blood pressure at rest and during stress test Florian Milatz,1 Sascha Ketelhut,1 Reinhard G. Ketelhut.2 1Humboldt University of Berlin, Institute of Sports Science, Berlin, Germany; 2 Medical Center Berlin (MCB), Berlin, Germany Introduction: The favorable influence of acute as well as regular exercise on peripheral blood pressure (BP) regulation is widely known. In the present study we investigated the influence of acute endurance exercise on peripheral and moreover on central BP and during a cold pressor stress test. Methods: In 30 healthy men (33.2 7.2 years, BMI 24 2.4 kg / m2;) peripheral and central BP were measured non-invasively at rest and at the end of a 2 minute cold pressor test (CPT) using Mobil-O-Graph (PWA monitor, IEM Company). After a 60 minute endurance training on a bicycle ergometer (65% of the previously during cardiopulmonary exercise testing determined maximum heart rate) peripheral and central BP were controlled again after 60 minutes of recovery and thereafter during a CPT. Results were compared with those before the endurance exercise. Results: After 60 minutes of recovery peripheral systolic (p < 0.001) and diastolic (p ¼ 0.02) BP were still reduced (1299/837mmHg before to 1228/806mmHg post exercise). Both central systolic (p < 0.001) and diastolic (p ¼ 0.01) pressures were significantly reduced from 11810/ 857 to 1128/816 mmHg as well. In comparison to BP during CPT before exercise, BP during CPT after endurance exercise showed a significant reduction in peripheral (p ¼ 0.02) and central (p ¼ 0.02) systolic BP (14213 mmHg to 13712 mmHg; 12913 mmHg to 12512 mmHg). There were no significant reductions in diastolic BP, although reduced mean values were recorded (peripheral BP 9513 to 9311 mmHg; central BP 9713 to 9511 mmHg). Conclusions: The present study provides evidence that moderate acute endurance training results not only in a decrease of peripheral BP but more of central BP regulation even after 60 minutes of recovery. Furthermore, the peripheral as well as central BP response during a subsequent stress test was attenuated due to the previous exercise bout when compared with pre-exercise. Keywords: endurance exercise; cold pressor test; peripheral blood pressure; central blood pressure
P-67 Effective hypertension screening by family physicians Raveenie Rajasingham.1,.2 1Athabasca University, Athabasca, AB, Canada; 2 Athabasca University, Pickering, ON, Canada Background: Increased patient anxiety related to regular check-ups at a medical clinic can cause a temporary rise in blood pressure, causing inaccurate and uncharacteristic blood pressure measurements that do not reflect the average or typical daily patient blood pressure values. This phenomenon is known as White Coat Hypertension (WCH). Based on the 2013 Canadian Hypertension Education Program guideline, if at the initial office visit the patient’s systolic blood pressure (SBP) is > 140 mmHg and/or if the Diastolic Blood Pressure (DBP) > 90mmHg, this is considered hypertensive. Primary care physicians can misdiagnose their patients as hypertensive when they are not based on these criteria. Purpose: To review the current Canadian practices of screening for hypertensive patients during clinic visits and to recommend and reinforce to use effective screening tools for family physicians to accurately diagnose blood pressure changes. Finding: The three main tools (1) traditional office measurements, 2) in office BpTRU, home measurements and 3) Ambulatory Blood Pressure monitoring are recommended to be used appropriately. Conclusion: Review of studies indicates ABPM clearly provides complete report of the patient circadian pattern and the efficacy of antihypertensive therapy and fluctuations in BP. It is recommend that primary care
e53
physicians follow the Canadian Hypertension Education guideline as well as use ABPM in their practices as part of their screening process. Keywords: Blood Pressure Measurement; White Coat Hypertension; Screening; Ambulatory Blood Pressure Monitoring
P-68 Effects of celebrex vs. naproxen on blood pressure in pediatric subjects with juvenile idiopathic arthritis (JIA) 4 Bonita Falkner,y, Robert W. Nickeson,1 Lawrence Zemel,2 Dinu Iorga,3 Pritha Bhadra Brown,3 Manuela F. Berger.3 1All Children’s Hospital, St Petersburg, FL, United States; 2Connecticut Children’s Medical Center, Hartford, CT, United States; 3Pfizer Inc, New York, NY, United States; 4 Thomas Jefferson University, Philadelphia, PA, United States Introduction: This study was conducted to provide additional information about the impact of chronic NSAID therapy on blood pressure in a pediatric population ages 2 to 17 years old for the indication of treatment of JIA. Methods: 201 subjects were randomized in a 1:1 ratio in the two arms celecoxib and naproxen. Subjects were treated 6 weeks as follows: Celecoxib 50 mg or 100 mg BID and Naproxen 7.5 mg/Kg BID. The primary endpoint was the change from Baseline to Week 6 (End of Study) in Systolic Blood Pressure. The primary analysis was based on a 90% confidence interval (CI) for the difference across treatment groups (celecoxib - naproxen), in mean change from baseline in SBP. Results: The demographic characteristics were similar in the two treatment groups. The primary analysis was conducted using the Safety population. The mean (SD) SBP at baseline were 98.5 (9.49) and 98.1 (9.49) and at week 6/Final visit 98.9 (8.84) and 97.4 (10.33) for celecoxib and naproxen, respectively. The LS mean difference (celecoxib - naproxen) was 1.10 (1.004) with a 90% CI of (-0.56, 2.76). Therefore, it can be interpreted with 90% confidence that there was no difference in SBP changes from baseline to week 6/Final visit between the celecoxib and naproxen groups. The mean (SD) DBP at baseline were 62.2 (7.82) and 62.0 (7.61) and at week 6/Final visit 61.8 (6.78) and 61.5 (7.64) for celecoxib and naproxen, respectively. The LS mean difference (celecoxib - naproxen) was -0.179 (0.765) with a 95% CI of (-1.69, 1.33). Adverse Event (all causalities) occurring in at least 5% of the subjects: Headache, Nausea and Arthralgia. Treatment related AE, Nausea occurred in 7.1% of subjects in the naproxen group. Conclusions: The effects on blood pressure were minimal and similar between the two treatment groups for SBP and DBP changes at week 6/Final visit. The adverse event profile was comparable between the two treatment groups. Keywords: NSAIDs; JIA; hypertension; celecoxib
P-69 Effects of home blood pressure monitoring on recurrent stroke Gregory R. Franklin, Andrea Boan, Daniel Lackland. Medical University of South Carolina, Charleston, SC, United States Hypertension has long been known to be the primary risk factor for stroke, especially in preventing recurrent strokes in post-ischemic patients. Studies have shown that home blood pressure monitoring is an inexpensive way to provide a clear representation of patients’ hypertension and helps to overcome many of the limitations of clinic (in-office) blood pressure readings. The Heart 360 program, sponsored by the American Heart Association, gives patients the ability to record blood pressure readings onto an online database so that clinicians can better treat hypertension, thereby reducing the incidence of recurrent strokes. This study intends to show that home blood pressure monitoring is effective in reducing recurrent strokes in post-ischemic patients by: 1) making post-ischemic patients feel more comfortable about their health 2) giving clinicians more data to be more