Long-Term Mortality in Hypertensive Patients With CAD (p 1110)
The dyad of hypertension and coronary artery disease is the most prevalent chronic disease dyad among adults; however, data on the optimal systolic blood pressure and long-term mortality in this high-risk population are lacking. The former members of the Eighth Joint National Committee Panel recommended a target therapeutic goal <150 mm Hg for adults aged ≥60 years and <140 mm Hg in those aged <60 years. These recommendations are inconsistent with the different society guidelines that recommended a therapeutic target <140 mm Hg. Using the extended follow-up (mean 11.6 years) data from the US cohort of INVEST (International Verapamil [SR]/Trandolapril Study) (n=17 131), subjects were categorized by age at enrollment (50 to <60 years and ≥60 years). Cox proportional adjusted hazard ratios were constructed for time to all-cause mortality according to achieved mean systolic blood pressure. In subjects aged 50 to <60 years, achieving a systolic blood pressure of <140 mm Hg was associated with a lower all-cause mortality. In those aged ≥60 years, achieving a systolic blood pressure of 130 to <140 mm Hg was associated with the lowest risk for all-cause mortality (Figure). In summary, our findings suggest that in hypertensive patients with coronary artery disease, achieving a systolic blood pressure of 130 to <140 mm Hg in the initial 2 to 3 years of treatment is associated with reduced all-cause mortality after ≈11.6 years of follow-up.
Sleepiness and Hypertension in OSA Patients (p 1264)
Excessive daytime sleepiness (EDS) is a key feature of obstructive sleep apnea (OSA), which exacerbates many consequences of OSA, including hypertension. In clinical practice, one of the cost-effective methods to assess EDS is self-reported questionnaires, such as Epworth Sleepiness Scale. However, it has been found that there is significant mismatch between subjective and objective EDS in OSA. The role of objective EDS on evaluating the risk of consequences in OSA is largely unknown. In this large-scale study on clinical sample, we used the Multiple Sleep Latency Test as a measure of objective EDS and confirmed the association of objective EDS with hypertension. Several clinical implications in the current study should be highlighted. First, it is strongly recommended that the Multiple Sleep Latency Test, in addition to other parameters of sleep apnea and subjective measure of EDS, should be used to evaluate the severity of OSA. Second, the Multiple Sleep Latency Test should be prioritized in some OSA patients because subgroup analyses showed that objective EDS had stronger associations with hypertension in women, patients aged below 55 years, and obese patients. Third, subjective measures of daytime sleepiness, such as the Epworth Sleepiness Scale, may not adequately evaluate EDS in patients with OSA because objective daytime sleepiness was also associated with hypertension even in those with low Epworth Sleepiness Scale scores.
Pharmacists Impact in Narrowing Socioeconomic Gaps (p 1314)
Race, ethnicity, and socioeconomic status are major predictors of healthcare disparities related to blood pressure (BP) control. Healthcare disparities lead to greater risks for heart disease, stroke, and mortality. As noted by the working group from the National Heart Lung and Blood Institute in another paper in this issue of Hypertension, gaps remain in BP control in African Americans. Team-based care using nurses or pharmacists has been shown to significantly improve BP in numerous studies. However, there is insufficient evidence that team-based care can reduce the gap in BP in those with healthcare disparities when compared with patients without disparities. We evaluated whether a pharmacist intervention could reduce the gap in BP management in patients at high risk for healthcare disparities. The analyses included 539 patients; 345 received the intervention and 194 were in the control group. Mean systolic BP was 7.3 mm Hg lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Intervention subjects in minority groups achieved greater BP reduction than nonminority subjects in the control group and nearly as great of a reduction as the nonminority subjects who received the intervention. Similar findings occurred in patients with less education, with lower incomes, receiving Medicaid, or without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of BP.
- © 2016 American Heart Association, Inc.