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VIDEO: HbA1c focus of diabetes education program
LAS VEGAS – In its fourth year, the Blood Sugar Basics program, which is the American College of Endocrinology and Merck’s diabetes education program, is turning its attention to hemoglobin A1c, because many patients with diabetes fail to achieve an HbA1c of 6.5% or less, the program’s leaders said.
This year’s campaign was unveiled at the annual meeting of the American Association of Clinical Endocrinologists.
With the goal of increasing the number of patients who achieve their HbA1c goal, the program has established three missions for patients: Talk to your physician; set goals and commit to a plan; and revisit and reassess.
The program’s website (bloodsugarbasics.com), which has had a facelift, provides forms and easy-to-follow guidelines for patients. The association is also distributing printed information about the program to AACE members, and this year, it is reaching out to primary care physicians, because there simply aren’t enough endocrinologists, said Dr. Etie Moghissi, who has helped develop the program since its inception in 2010.
Blood Sugar Basics is among a handful of credible diabetes education programs online, including the National Diabetes Education Program.
In a video interview, Dr. Moghissi of the department of medicine at the University of California, Los Angeles, explains the program’s goals, and why physicians should consider it as an educational source for their patients.
On Twitter @naseemsmiller
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – In its fourth year, the Blood Sugar Basics program, which is the American College of Endocrinology and Merck’s diabetes education program, is turning its attention to hemoglobin A1c, because many patients with diabetes fail to achieve an HbA1c of 6.5% or less, the program’s leaders said.
This year’s campaign was unveiled at the annual meeting of the American Association of Clinical Endocrinologists.
With the goal of increasing the number of patients who achieve their HbA1c goal, the program has established three missions for patients: Talk to your physician; set goals and commit to a plan; and revisit and reassess.
The program’s website (bloodsugarbasics.com), which has had a facelift, provides forms and easy-to-follow guidelines for patients. The association is also distributing printed information about the program to AACE members, and this year, it is reaching out to primary care physicians, because there simply aren’t enough endocrinologists, said Dr. Etie Moghissi, who has helped develop the program since its inception in 2010.
Blood Sugar Basics is among a handful of credible diabetes education programs online, including the National Diabetes Education Program.
In a video interview, Dr. Moghissi of the department of medicine at the University of California, Los Angeles, explains the program’s goals, and why physicians should consider it as an educational source for their patients.
On Twitter @naseemsmiller
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – In its fourth year, the Blood Sugar Basics program, which is the American College of Endocrinology and Merck’s diabetes education program, is turning its attention to hemoglobin A1c, because many patients with diabetes fail to achieve an HbA1c of 6.5% or less, the program’s leaders said.
This year’s campaign was unveiled at the annual meeting of the American Association of Clinical Endocrinologists.
With the goal of increasing the number of patients who achieve their HbA1c goal, the program has established three missions for patients: Talk to your physician; set goals and commit to a plan; and revisit and reassess.
The program’s website (bloodsugarbasics.com), which has had a facelift, provides forms and easy-to-follow guidelines for patients. The association is also distributing printed information about the program to AACE members, and this year, it is reaching out to primary care physicians, because there simply aren’t enough endocrinologists, said Dr. Etie Moghissi, who has helped develop the program since its inception in 2010.
Blood Sugar Basics is among a handful of credible diabetes education programs online, including the National Diabetes Education Program.
In a video interview, Dr. Moghissi of the department of medicine at the University of California, Los Angeles, explains the program’s goals, and why physicians should consider it as an educational source for their patients.
On Twitter @naseemsmiller
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT AACE 2014
Empagliflozin improves glycemia, blood pressure in type 2 diabetes study
Treatment with empagliflozin, an investigational sodium-glucose cotransporter 2 (SGLT2) inhibitor, was associated with benefits for blood pressure as well as glycemic control in a 3-month study of more than 800 patients with type 2 diabetes and hypertension.
The study results were released May 15 at the annual meeting of the American Association of Clinical Endocrinologists, held in Las Vegas, by Dr. Afshin Salsali, an endocrinologist and executive director, diabetes and metabolism, at Boehringer Ingelheim Pharmaceuticals, the manufacturer of the drug.
Since hypertension is common among patients with type 2 diabetes and is associated with diabetes-related complications, a treatment approach that includes control of blood pressure and hyperglycemia might reduce the risk of cardiovascular complications and mortality in these patients, Dr. Salsali said in an interview before the meeting.
In the phase III randomized, controlled study, 823 patients were treated with either 10 mg of empagliflozin (276 patients), 25 mg of empagliflozin (276), or placebo (271), once a day for 12 weeks. At baseline, the patients’ mean seated systolic and diastolic blood pressures were 130-159 mm Hg and 80-99 mm Hg, respectively; their mean age was 60 years; and their mean body mass index was about 33 kg/m2, in the obese category.
The two primary endpoints were changes from baseline in hemoglobin A1c and mean 24-hour systolic blood pressure as measured by ambulatory blood pressure monitoring, at week 12.
At 12 weeks, the mean reductions in HbA1c from baseline over placebo were 0.62% for those on the 10-mg dose and 0.65% among those on the 25-mg dose, both significant differences. The reductions in mean 24-hour systolic blood pressure were also significant, compared with placebo: They were 3.44 mm Hg with the 10-mg dose and 4.16 mm Hg with the 25-mg dose, according to Dr. Salsali.
In addition, the mean reductions from baseline in 24-hour diastolic blood pressure were significant at week 12, compared with placebo, a secondary endpoint. Those reductions were 1.36 mm Hg for patients on the 10-mg dose and 1.72 mm Hg for those on the 25-mg dose.
About half of the patients in each group reported adverse events. "Events consistent with volume depletion" were reported in one patient on the 10-mg dose of empagliflozin and one in the placebo group.
This study is unique because it utilized the gold standard for monitoring blood pressure to evaluate the effects of the drug on blood pressure, Dr. Salsali said.
Currently, empagliflozin is approved only in Australia, and it is under review in the United States and Europe. In March, Boehringer Ingelheim and Eli Lilly announced that the Food and Drug Administration had issued a complete response letter stating that deficiencies at a site where empagliflozin would be manufactured needed to be resolved before approval. But the FDA has not requested that any new clinical trials be completed for approval, according to the statement issued by Boehringer Ingelheim.
In March, the drug was recommended for approval by the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency for treating adults with type 2 diabetes.
In January, the FDA approved the SGLT2 inhibitor dapagliflozin for the treatment of type 2 diabetes. The first drug in this class to be approved in the United States was canagliflozin (Invokana), approved in March 2013. These agents, taken orally, work by inhibiting SGLT2 that is expressed in the kidney, reducing renal glucose reabsorption, increasing urinary excretion of glucose, and reducing plasma glucose levels.
The study was sponsored by Boehringer Ingelheim; Eli Lilly was a collaborator. Dr. Salsali is an employee of Boehringer Ingelheim USA. Other authors of the study included employees of Boehringer Ingelheim, including Boehringer Ingelheim Finland.
Treatment with empagliflozin, an investigational sodium-glucose cotransporter 2 (SGLT2) inhibitor, was associated with benefits for blood pressure as well as glycemic control in a 3-month study of more than 800 patients with type 2 diabetes and hypertension.
The study results were released May 15 at the annual meeting of the American Association of Clinical Endocrinologists, held in Las Vegas, by Dr. Afshin Salsali, an endocrinologist and executive director, diabetes and metabolism, at Boehringer Ingelheim Pharmaceuticals, the manufacturer of the drug.
Since hypertension is common among patients with type 2 diabetes and is associated with diabetes-related complications, a treatment approach that includes control of blood pressure and hyperglycemia might reduce the risk of cardiovascular complications and mortality in these patients, Dr. Salsali said in an interview before the meeting.
In the phase III randomized, controlled study, 823 patients were treated with either 10 mg of empagliflozin (276 patients), 25 mg of empagliflozin (276), or placebo (271), once a day for 12 weeks. At baseline, the patients’ mean seated systolic and diastolic blood pressures were 130-159 mm Hg and 80-99 mm Hg, respectively; their mean age was 60 years; and their mean body mass index was about 33 kg/m2, in the obese category.
The two primary endpoints were changes from baseline in hemoglobin A1c and mean 24-hour systolic blood pressure as measured by ambulatory blood pressure monitoring, at week 12.
At 12 weeks, the mean reductions in HbA1c from baseline over placebo were 0.62% for those on the 10-mg dose and 0.65% among those on the 25-mg dose, both significant differences. The reductions in mean 24-hour systolic blood pressure were also significant, compared with placebo: They were 3.44 mm Hg with the 10-mg dose and 4.16 mm Hg with the 25-mg dose, according to Dr. Salsali.
In addition, the mean reductions from baseline in 24-hour diastolic blood pressure were significant at week 12, compared with placebo, a secondary endpoint. Those reductions were 1.36 mm Hg for patients on the 10-mg dose and 1.72 mm Hg for those on the 25-mg dose.
About half of the patients in each group reported adverse events. "Events consistent with volume depletion" were reported in one patient on the 10-mg dose of empagliflozin and one in the placebo group.
This study is unique because it utilized the gold standard for monitoring blood pressure to evaluate the effects of the drug on blood pressure, Dr. Salsali said.
Currently, empagliflozin is approved only in Australia, and it is under review in the United States and Europe. In March, Boehringer Ingelheim and Eli Lilly announced that the Food and Drug Administration had issued a complete response letter stating that deficiencies at a site where empagliflozin would be manufactured needed to be resolved before approval. But the FDA has not requested that any new clinical trials be completed for approval, according to the statement issued by Boehringer Ingelheim.
In March, the drug was recommended for approval by the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency for treating adults with type 2 diabetes.
In January, the FDA approved the SGLT2 inhibitor dapagliflozin for the treatment of type 2 diabetes. The first drug in this class to be approved in the United States was canagliflozin (Invokana), approved in March 2013. These agents, taken orally, work by inhibiting SGLT2 that is expressed in the kidney, reducing renal glucose reabsorption, increasing urinary excretion of glucose, and reducing plasma glucose levels.
The study was sponsored by Boehringer Ingelheim; Eli Lilly was a collaborator. Dr. Salsali is an employee of Boehringer Ingelheim USA. Other authors of the study included employees of Boehringer Ingelheim, including Boehringer Ingelheim Finland.
Treatment with empagliflozin, an investigational sodium-glucose cotransporter 2 (SGLT2) inhibitor, was associated with benefits for blood pressure as well as glycemic control in a 3-month study of more than 800 patients with type 2 diabetes and hypertension.
The study results were released May 15 at the annual meeting of the American Association of Clinical Endocrinologists, held in Las Vegas, by Dr. Afshin Salsali, an endocrinologist and executive director, diabetes and metabolism, at Boehringer Ingelheim Pharmaceuticals, the manufacturer of the drug.
Since hypertension is common among patients with type 2 diabetes and is associated with diabetes-related complications, a treatment approach that includes control of blood pressure and hyperglycemia might reduce the risk of cardiovascular complications and mortality in these patients, Dr. Salsali said in an interview before the meeting.
In the phase III randomized, controlled study, 823 patients were treated with either 10 mg of empagliflozin (276 patients), 25 mg of empagliflozin (276), or placebo (271), once a day for 12 weeks. At baseline, the patients’ mean seated systolic and diastolic blood pressures were 130-159 mm Hg and 80-99 mm Hg, respectively; their mean age was 60 years; and their mean body mass index was about 33 kg/m2, in the obese category.
The two primary endpoints were changes from baseline in hemoglobin A1c and mean 24-hour systolic blood pressure as measured by ambulatory blood pressure monitoring, at week 12.
At 12 weeks, the mean reductions in HbA1c from baseline over placebo were 0.62% for those on the 10-mg dose and 0.65% among those on the 25-mg dose, both significant differences. The reductions in mean 24-hour systolic blood pressure were also significant, compared with placebo: They were 3.44 mm Hg with the 10-mg dose and 4.16 mm Hg with the 25-mg dose, according to Dr. Salsali.
In addition, the mean reductions from baseline in 24-hour diastolic blood pressure were significant at week 12, compared with placebo, a secondary endpoint. Those reductions were 1.36 mm Hg for patients on the 10-mg dose and 1.72 mm Hg for those on the 25-mg dose.
About half of the patients in each group reported adverse events. "Events consistent with volume depletion" were reported in one patient on the 10-mg dose of empagliflozin and one in the placebo group.
This study is unique because it utilized the gold standard for monitoring blood pressure to evaluate the effects of the drug on blood pressure, Dr. Salsali said.
Currently, empagliflozin is approved only in Australia, and it is under review in the United States and Europe. In March, Boehringer Ingelheim and Eli Lilly announced that the Food and Drug Administration had issued a complete response letter stating that deficiencies at a site where empagliflozin would be manufactured needed to be resolved before approval. But the FDA has not requested that any new clinical trials be completed for approval, according to the statement issued by Boehringer Ingelheim.
In March, the drug was recommended for approval by the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency for treating adults with type 2 diabetes.
In January, the FDA approved the SGLT2 inhibitor dapagliflozin for the treatment of type 2 diabetes. The first drug in this class to be approved in the United States was canagliflozin (Invokana), approved in March 2013. These agents, taken orally, work by inhibiting SGLT2 that is expressed in the kidney, reducing renal glucose reabsorption, increasing urinary excretion of glucose, and reducing plasma glucose levels.
The study was sponsored by Boehringer Ingelheim; Eli Lilly was a collaborator. Dr. Salsali is an employee of Boehringer Ingelheim USA. Other authors of the study included employees of Boehringer Ingelheim, including Boehringer Ingelheim Finland.
FROM AACE 2014
Key clinical point: A treatment approach that includes control of blood pressure and hyperglycemia might reduce the risk of cardiovascular complications and mortality in patients with diabetes and hypertension.
Major finding: After 12 weeks of treatment, patients treated with empagliflozin had significantly greater improvements in HbA1c (mean reductions of 0.62%-0.65% over placebo) and in systolic and diastolic blood pressure.
Data source: A phase III randomized, double-blind study of 823 adults with type 2 diabetes and hypertension.
Disclosures: The study was sponsored by Boehringer Ingelheim; Eli Lilly was a collaborator. Dr. Salsali is an employee of Boehringer Ingelheim USA. Other authors of the study included employees of Boehringer Ingelheim, including Boehringer Ingelheim Finland.
VIDEO: Motivational interviewing by primary care providers promotes weight loss
VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.
Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.
VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.
Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.
VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.
Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.
AT THE PAS ANNUAL MEETING
One in four patients with hypertension nonadherent to therapy
Urine testing of patients with hypertension revealed that 25% were partially or totally nonadherent to treatment, researchers reported online April 3 in the journal Heart.
Furthermore, nonadherence was linearly related to increased systolic and diastolic blood pressures during clinic visits and 24-hour mean daytime diastolic blood pressure (P < .006 for all), reported Dr. Maciej Tomaszewski of the University of Leicester, England, and his associates.
Using a urine test available to commercial labs, the investigators tested 208 patients for 40 of the most common antihypertensive medications and their metabolites by performing high-performance liquid chromatography–tandem mass spectrometry of spot urine samples. Patients were either newly referred (n = 125), followed up for inadequately controlled blood pressure (66), or referred for renal denervation (17), the investigators reported (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
Nonadherence was particularly common among patients whose hypertension was inadequately controlled (28.8%) or who were referred for renal denervation (23.5%), the investigators said. Without routine urine screening, nonadherent patients might receive or undergo unnecessary tests, procedures, or treatments for perceived nonresponse to treatment, said Dr. Tomaszewski, who is also with the National Institute for Health Research (NIHR) Leicester Biomedical Research Unit in Cardiovascular Disease, and his colleagues.
Larger, multicenter studies should directly estimate biochemical nonadherence in other populations and assess the cost-effectiveness of screening for nonadherence compared with the overall cost of managing resistant hypertension, the investigators said.
Dr. Tomaszewski and five of his associates reported receiving research and other support from the British Heart Foundation and the NIHR.
"A contentious question has been whether resistant hypertension is a pathogenetic subset of hypertension, justifying a search for ‘stratified medicines’; or is it an imaginary condition caused by doctors in white coats and patients who do not take their tablets?" commented Dr. Morris J. Brown.
"On the one hand, there is abundant evidence that primary aldosteronism causes 20%-25% of true treatment resistance," he added. But Tomaszewski et al. show that nonadherent patients "account for an almost identical, high proportion of supposed resistant hypertension. Furthermore, the authors answer not only the question ‘Is my patient taking his/her tablets,’ but also ‘How can I simply and cheaply find out?’ "
The authors "deftly side-stepped" questions related to the ethics of the test and what to do about the findings, said Dr. Brown. "Neither completion nor assent to urine testing could be compulsory," he emphasized. "But then, nor is progression to expensive tests for benign, curable causes of resistant hypertension – without resistance to treatment being first demonstrated."
Dr. Brown is a professor of clinical pharmacology at the University of Cambridge, England. He reported that he had no conflicts of interest. These remarks were taken from his editorial accompanying Dr. Tomaszewski’s report (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
"A contentious question has been whether resistant hypertension is a pathogenetic subset of hypertension, justifying a search for ‘stratified medicines’; or is it an imaginary condition caused by doctors in white coats and patients who do not take their tablets?" commented Dr. Morris J. Brown.
"On the one hand, there is abundant evidence that primary aldosteronism causes 20%-25% of true treatment resistance," he added. But Tomaszewski et al. show that nonadherent patients "account for an almost identical, high proportion of supposed resistant hypertension. Furthermore, the authors answer not only the question ‘Is my patient taking his/her tablets,’ but also ‘How can I simply and cheaply find out?’ "
The authors "deftly side-stepped" questions related to the ethics of the test and what to do about the findings, said Dr. Brown. "Neither completion nor assent to urine testing could be compulsory," he emphasized. "But then, nor is progression to expensive tests for benign, curable causes of resistant hypertension – without resistance to treatment being first demonstrated."
Dr. Brown is a professor of clinical pharmacology at the University of Cambridge, England. He reported that he had no conflicts of interest. These remarks were taken from his editorial accompanying Dr. Tomaszewski’s report (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
"A contentious question has been whether resistant hypertension is a pathogenetic subset of hypertension, justifying a search for ‘stratified medicines’; or is it an imaginary condition caused by doctors in white coats and patients who do not take their tablets?" commented Dr. Morris J. Brown.
"On the one hand, there is abundant evidence that primary aldosteronism causes 20%-25% of true treatment resistance," he added. But Tomaszewski et al. show that nonadherent patients "account for an almost identical, high proportion of supposed resistant hypertension. Furthermore, the authors answer not only the question ‘Is my patient taking his/her tablets,’ but also ‘How can I simply and cheaply find out?’ "
The authors "deftly side-stepped" questions related to the ethics of the test and what to do about the findings, said Dr. Brown. "Neither completion nor assent to urine testing could be compulsory," he emphasized. "But then, nor is progression to expensive tests for benign, curable causes of resistant hypertension – without resistance to treatment being first demonstrated."
Dr. Brown is a professor of clinical pharmacology at the University of Cambridge, England. He reported that he had no conflicts of interest. These remarks were taken from his editorial accompanying Dr. Tomaszewski’s report (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
Urine testing of patients with hypertension revealed that 25% were partially or totally nonadherent to treatment, researchers reported online April 3 in the journal Heart.
Furthermore, nonadherence was linearly related to increased systolic and diastolic blood pressures during clinic visits and 24-hour mean daytime diastolic blood pressure (P < .006 for all), reported Dr. Maciej Tomaszewski of the University of Leicester, England, and his associates.
Using a urine test available to commercial labs, the investigators tested 208 patients for 40 of the most common antihypertensive medications and their metabolites by performing high-performance liquid chromatography–tandem mass spectrometry of spot urine samples. Patients were either newly referred (n = 125), followed up for inadequately controlled blood pressure (66), or referred for renal denervation (17), the investigators reported (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
Nonadherence was particularly common among patients whose hypertension was inadequately controlled (28.8%) or who were referred for renal denervation (23.5%), the investigators said. Without routine urine screening, nonadherent patients might receive or undergo unnecessary tests, procedures, or treatments for perceived nonresponse to treatment, said Dr. Tomaszewski, who is also with the National Institute for Health Research (NIHR) Leicester Biomedical Research Unit in Cardiovascular Disease, and his colleagues.
Larger, multicenter studies should directly estimate biochemical nonadherence in other populations and assess the cost-effectiveness of screening for nonadherence compared with the overall cost of managing resistant hypertension, the investigators said.
Dr. Tomaszewski and five of his associates reported receiving research and other support from the British Heart Foundation and the NIHR.
Urine testing of patients with hypertension revealed that 25% were partially or totally nonadherent to treatment, researchers reported online April 3 in the journal Heart.
Furthermore, nonadherence was linearly related to increased systolic and diastolic blood pressures during clinic visits and 24-hour mean daytime diastolic blood pressure (P < .006 for all), reported Dr. Maciej Tomaszewski of the University of Leicester, England, and his associates.
Using a urine test available to commercial labs, the investigators tested 208 patients for 40 of the most common antihypertensive medications and their metabolites by performing high-performance liquid chromatography–tandem mass spectrometry of spot urine samples. Patients were either newly referred (n = 125), followed up for inadequately controlled blood pressure (66), or referred for renal denervation (17), the investigators reported (Heart 2014 April 3 [doi: 10.1136/heartjnl-2013-305063]).
Nonadherence was particularly common among patients whose hypertension was inadequately controlled (28.8%) or who were referred for renal denervation (23.5%), the investigators said. Without routine urine screening, nonadherent patients might receive or undergo unnecessary tests, procedures, or treatments for perceived nonresponse to treatment, said Dr. Tomaszewski, who is also with the National Institute for Health Research (NIHR) Leicester Biomedical Research Unit in Cardiovascular Disease, and his colleagues.
Larger, multicenter studies should directly estimate biochemical nonadherence in other populations and assess the cost-effectiveness of screening for nonadherence compared with the overall cost of managing resistant hypertension, the investigators said.
Dr. Tomaszewski and five of his associates reported receiving research and other support from the British Heart Foundation and the NIHR.
FROM HEART
Major finding: A urine test available to commercial labs showed that 25% of patients were totally (10.1%) or partially (14.9%) nonadherent to treatment. Nonadherence was linearly associated with increased clinic systolic blood pressure, clinic diastolic blood pressure, and 24-hour mean daytime diastolic blood pressure (P < .006 for all).
Data source: High-performance liquid chromatography–tandem mass spectrometry urine screening and blood pressure measurements in 208 patients with hypertension.
Disclosures: The authors reported receiving research and other support from the British Heart Foundation and the National Institute for Health Research.
Former JNC 8 hypertension panel issues minority report
The controversial hypertension-management guidelines released by the former JNC 8 panel in December was not the group’s last word. There was a minority report, too, published almost a month later in mid-January.
Five of the 17 members of the group originally assembled in 2008 by the National Heart, Lung, and Blood Institute (NHLBI) to research and write the eighth edition of the official U.S. hypertension guidelines not only disagreed with their 12 colleagues about resetting the systolic blood pressure target to 150 mm Hg from the prior target of 140 mm Hg for people aged 60-79 without diabetes or chronic kidney disease, but also felt strongly enough to write an article about it.
A published minority report is not how most medical guideline writing panels usually work.
The history of the Eighth Joint National Committee (JNC 8) already featured some unusual twists. After many months of unexpected delays leading up to the report’s release, the NHLBI announced last June that it would hand off the JNC 8 process to an appropriate medical group. A few weeks later, the institute announced that JNC 8 would get published under the auspices of the American Heart Association and American College of Cardiology. Then came word that the arrangement had fallen through, leaving what became the former JNC 8 panel to release its data analysis and recommendations without endorsement from a medical association.
The fact that the 150–mm Hg systolic target for treating 60- to 79-year-olds was controversial among the panel members themselves was no surprise. The former JNC 8 panel’s majority report in December acknowledged their lack of consensus on this issue. What had been previously unknown was exactly how the panel split, and the minority view that led to the disagreement.
The five dissenters were Dr. Jackson T. Wright Jr., Case Medical Center, Cleveland; Dr. Lawrence J. Fine, NHLBI, Bethesda, Md.; Daniel T. Lackland, Ph.D., Medical University of South Carolina, Charleston; Dr. Gbenga Ogedegbe, New York University; and Cheryl R. Dennison Himmelfarb, Ph.D., Johns Hopkins University, Baltimore.
Summarizing their view in their report, the five said they "believed that evidence was insufficient to increase the SBP goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for CVD and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years. Because of the overall evidence, including the RCT data reviewed by the panel, and the decrease in CVD mortality, we concluded that the evidence for increasing a blood pressure target in high-risk populations should be at least as strong as the evidence required to decrease the recommended blood pressure target. In addition, one target would simplify implementation for clinicians."
The unusual circumstances that surrounded release of the former JNC 8 panel’s report and the controversial systolic target they set initially raised questions about the impact the recommendations would have on U.S. practice. The minority report puts an asterisk on the majority report and dilutes its influence even more.
On Twitter @mitchelzoler
The controversial hypertension-management guidelines released by the former JNC 8 panel in December was not the group’s last word. There was a minority report, too, published almost a month later in mid-January.
Five of the 17 members of the group originally assembled in 2008 by the National Heart, Lung, and Blood Institute (NHLBI) to research and write the eighth edition of the official U.S. hypertension guidelines not only disagreed with their 12 colleagues about resetting the systolic blood pressure target to 150 mm Hg from the prior target of 140 mm Hg for people aged 60-79 without diabetes or chronic kidney disease, but also felt strongly enough to write an article about it.
A published minority report is not how most medical guideline writing panels usually work.
The history of the Eighth Joint National Committee (JNC 8) already featured some unusual twists. After many months of unexpected delays leading up to the report’s release, the NHLBI announced last June that it would hand off the JNC 8 process to an appropriate medical group. A few weeks later, the institute announced that JNC 8 would get published under the auspices of the American Heart Association and American College of Cardiology. Then came word that the arrangement had fallen through, leaving what became the former JNC 8 panel to release its data analysis and recommendations without endorsement from a medical association.
The fact that the 150–mm Hg systolic target for treating 60- to 79-year-olds was controversial among the panel members themselves was no surprise. The former JNC 8 panel’s majority report in December acknowledged their lack of consensus on this issue. What had been previously unknown was exactly how the panel split, and the minority view that led to the disagreement.
The five dissenters were Dr. Jackson T. Wright Jr., Case Medical Center, Cleveland; Dr. Lawrence J. Fine, NHLBI, Bethesda, Md.; Daniel T. Lackland, Ph.D., Medical University of South Carolina, Charleston; Dr. Gbenga Ogedegbe, New York University; and Cheryl R. Dennison Himmelfarb, Ph.D., Johns Hopkins University, Baltimore.
Summarizing their view in their report, the five said they "believed that evidence was insufficient to increase the SBP goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for CVD and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years. Because of the overall evidence, including the RCT data reviewed by the panel, and the decrease in CVD mortality, we concluded that the evidence for increasing a blood pressure target in high-risk populations should be at least as strong as the evidence required to decrease the recommended blood pressure target. In addition, one target would simplify implementation for clinicians."
The unusual circumstances that surrounded release of the former JNC 8 panel’s report and the controversial systolic target they set initially raised questions about the impact the recommendations would have on U.S. practice. The minority report puts an asterisk on the majority report and dilutes its influence even more.
On Twitter @mitchelzoler
The controversial hypertension-management guidelines released by the former JNC 8 panel in December was not the group’s last word. There was a minority report, too, published almost a month later in mid-January.
Five of the 17 members of the group originally assembled in 2008 by the National Heart, Lung, and Blood Institute (NHLBI) to research and write the eighth edition of the official U.S. hypertension guidelines not only disagreed with their 12 colleagues about resetting the systolic blood pressure target to 150 mm Hg from the prior target of 140 mm Hg for people aged 60-79 without diabetes or chronic kidney disease, but also felt strongly enough to write an article about it.
A published minority report is not how most medical guideline writing panels usually work.
The history of the Eighth Joint National Committee (JNC 8) already featured some unusual twists. After many months of unexpected delays leading up to the report’s release, the NHLBI announced last June that it would hand off the JNC 8 process to an appropriate medical group. A few weeks later, the institute announced that JNC 8 would get published under the auspices of the American Heart Association and American College of Cardiology. Then came word that the arrangement had fallen through, leaving what became the former JNC 8 panel to release its data analysis and recommendations without endorsement from a medical association.
The fact that the 150–mm Hg systolic target for treating 60- to 79-year-olds was controversial among the panel members themselves was no surprise. The former JNC 8 panel’s majority report in December acknowledged their lack of consensus on this issue. What had been previously unknown was exactly how the panel split, and the minority view that led to the disagreement.
The five dissenters were Dr. Jackson T. Wright Jr., Case Medical Center, Cleveland; Dr. Lawrence J. Fine, NHLBI, Bethesda, Md.; Daniel T. Lackland, Ph.D., Medical University of South Carolina, Charleston; Dr. Gbenga Ogedegbe, New York University; and Cheryl R. Dennison Himmelfarb, Ph.D., Johns Hopkins University, Baltimore.
Summarizing their view in their report, the five said they "believed that evidence was insufficient to increase the SBP goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for CVD and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years. Because of the overall evidence, including the RCT data reviewed by the panel, and the decrease in CVD mortality, we concluded that the evidence for increasing a blood pressure target in high-risk populations should be at least as strong as the evidence required to decrease the recommended blood pressure target. In addition, one target would simplify implementation for clinicians."
The unusual circumstances that surrounded release of the former JNC 8 panel’s report and the controversial systolic target they set initially raised questions about the impact the recommendations would have on U.S. practice. The minority report puts an asterisk on the majority report and dilutes its influence even more.
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