Richard M. Kirkner

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – The rise of the medical home along with the publication of large clinical trials will likely influence updated Joint National Committee guidelines for the management of hypertension, according to several experts at the annual meeting of the American Society of Hypertension.

Updated guidelines may and should address home and ambulatory monitoring of blood pressure, greater reliance on global risk assessment, a revision of target blood pressures in high-risk groups, greater use of individualization in setting pressure targets, greater clarity on when to start drug therapy, earlier use of fixed-dose combination antihypertensive therapy, revocation of beta-blockers as frontline therapy, and specific recommendations on how to overcome therapeutic inertia, they said.

The panel of experts explored how hypertension management has evolved since the Seventh Report of the Joint National Committee (JNC 7) was published in 2003. According to the National Heart, Lung, and Blood Institute, JNC 8 is expected to be released next year. None of the panelists are members of the JNC guideline panel.

The so-called medical home – where a patient stays within a care system with a primary care physician coordinating care – is causing a "paradigm shift," according to Dr. Jan Basile, professor of medicine at the Medical University of South Carolina in Charleston. "We’ve always been paid for face-to-face interactions, and we really need to be paid for energy and effort," he said. "For example, why aren’t we incentivized to use novel means of tracking blood pressure at home through telemonitoring and other techniques?"

The reorganization of primary care and the publication of JNC 8 may create significant opportunities to get nonphysician members of the medical home team, such as nurses, pharmacists, and dieticians, more involved in controlling blood pressure, the panelists said. Dr. Angela Brown, assistant professor of medicine at Washington University, St. Louis, noted that hypertensive patients in her clinic already receive 6 months of dietician counseling. Dr. Leonard Fromer, a family physician and University of California, Los Angeles, faculty member, noted his network recently launched five care team pilot programs in large integrated networks.

Ambulatory monitoring may also play a more prominent role in the revised guidelines, according to Dr. George Bakris, president of the American Society of Hypertension and professor of medicine at the University of Chicago. "Ambulatory blood pressure is most likely going to be recommended for everyone who has documented nuanced hypertension, and the reasons for that include blood pressure variability, the dramatic increase in the appreciation of masked hypertension, and the dipping and nondipping phenomenon, all of which contribute to higher mortality," he said. Dr. Bakris was a member of the JNC 7 executive committee.

Personalized follow-up is also important to make sure patients get their medications and take them as directed, Dr. Basile said. "I or someone from my office staff often calls patients within 48 hours and asks them, ‘Have you filled your prescription? Are you taking the medications? Are you having any problems taking them?’ Someone in the medical home needs to do that."

Dr. Brown suggested that routine screening for albuminuria should become part of the global assessment for the hypertensive patient in the primary care setting. "It is very important from a risk assessment standpoint because it may guide our therapy," Dr. Brown said.

Dr. Basile wasn’t convinced. "I’m not sure we can afford to spend money on knowing how sick the patient is unless we can show that intervening in those we wouldn’t normally treat would make a difference," he said. Dr. Basile noted that the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that when systolic blood pressures reached 120 mm Hg, microalbuminuria "melted away."

With regard to blood pressure targets, Dr. Bakris said he expects JNC 8 to continue the target of 140/90 mm Hg or less for most patients, and actually to also recommend that as a target for patients with diabetes and chronic kidney disease (currently recommended at 130/80 mm Hg or less in JNC 7). "It’s going to be less than 140/90 mm Hg for most people except for those with advanced kidney disease who have proteinuria," he said. In patients aged 80 years and older, the target pressure may be less than 150/80 mm Hg, according to Dr. Basile.

Meanwhile, Dr. Basile noted that the latest American Diabetes Association guidelines set the target for diabetics at 130/80 mm Hg, and that treatment should be tailored to the individual. "Individualization is going to be a very important word because perhaps, as in ACCORD, if your patient has had a stroke or is stroke prone, you might want to drive the blood pressure lower," Dr. Basile said. "But if the patient is not [stroke prone], you may not want to be as aggressive."

JNC 7 recommends initial combination therapy when systolic blood pressure is more than 20 mm Hg above goal. Since then, two important clinical trials have strengthened the evidence favoring combination over monotherapy: Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) and the Systolic Blood Pressure Intervention Trial (SPRINT).

The moderator of the discussion, Dr. Michael Bloch of the University of Nevada, Reno, noted that JNC 7 includes beta-blockers as an initial therapy, but that the revised National Institute for Health and Clinical Excellence (NICE) guidelines in the United Kingdom, as well as other guidelines that have come out since JNC 7, do not. "I can only presume that JNC 8 will follow other guidelines," Dr. Brown said.

Dr. Bakris noted that, although some of the newer beta-blockers may be better tolerated and have other potential advantages over some older drugs in that class, recommending those drugs as firstline therapy will be more difficult in the absence of new end-point trials as the JNC 8 panel strives to make the guidelines more evidenced based. "So if you want to be hardcore evidence based, you can’t really argue that those particular drugs are rated better," he said.

The panelists disclosed they have relationships with a variety of pharmaceutical companies.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on a report presented at the annual meeting of the American Society of Hypertension.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

"Intensive control of systolic blood pressure did not result in an increased risk of falls," reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. "And fewer intensive than standard group patients developed nonspinal fractures."

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects’ average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients’ average body mass index was 32.5 kg/m².

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. "About 20% in the intensive group and 21% in the standard group fell," she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. "This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

"With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip," said Dr. Margolis. "Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78," she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. "One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that’s a very suggestive mechanism," she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average BMI. "I’m not sure that overweight people aren’t protected in some way against blood pressure–related falls," Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. "To some extent falls are not always due to just people getting possible hypotension; they’re related to amount of activity," he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Boosting patient awareness and use of a new equation for measuring glomerular filtration rate are showing early signs of being the cornerstones to the prevention of chronic kidney disease among people at risk for the disease, according to preliminary results from the National Kidney Foundation’s nationwide screening initiative.

The Kidney Early Evaluation Program (KEEP) has enrolled 150,000 people so far, making it the nation’s largest perpetual chronic kidney disease screening program, according to Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation and a faculty member at Mount Sinai School of Medicine, New York.

The point is to identify "individuals in the community with kidney disease along with the risk factors that go with it," said Dr. George Bakris of the University of Chicago Medical Center and a former KEEP principal investigator. All of the participants have some stage of kidney disease or hypertension and are referred to the registry by physicians. Enrollment is voluntary and participants complete a questionnaire and undergo a medical evaluation that includes standard panels plus testing for calcium, phosphorus, and parathyroid hormone. The program does not accept people who have had a kidney transplant or are on dialysis, he said.

Under the program, a new method for estimating glomerular filtration rate (eGFR), known as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, has been used. This equation is more accurate in determining kidney function than is the Modification of Diet in Renal Disease (MDRD) Study equation, said Dr. Lesley Stevens of Tufts Medical Center, Boston. "The use of the CKD-EPI equation more accurately reflects measured GFR and results in a lower prevalence of eGFR below 60 mL/min per 1.73 m²," said Dr. Stevens, a KEEP committee member. As a result, there are fewer false positives and "ultimately, fewer tests and lower costs," she said.

According to Dr. Stevens, the equation has been validated in two clinical studies (Am. J. Kidney Dis. 2010;55:648-59 and Am. J. Kidney Dis. 2010;55:660-70).

One of the goals of KEEP is to determine factors that help slow the slide into chronic kidney disease, as well as the loss of kidney function over time, Dr. Vassalotti said. "Multiple trials on systolic blood pressure show that untreated hypertension results in a loss of 10-12 mL/min per 1.73 m² eGFR a year," he said. "In individuals with blood pressure in the target range, the annual loss is approximately 2-3 mL/min per 1.73 m². By educating participants and fostering their engagement with local clinicians, KEEP can impact care."

Managing blood pressure early in kidney disease is critical because as eGFR declines, hypertension becomes more difficult to control, Dr. Vassalotti said. Thus, self-reported hypertension is one of the qualifiers for KEEP enrollment, he said. He cited early data from KEEP that showed prevalence, awareness and treatment of hypertension increased with stage of chronic kidney disease, but that didn’t necessarily translate to control with severe disease. Among those with stage 3 disease, only 82% were undergoing treatment, compared with 92% of those with stage 4 disease. However, 38% of the stage 3 group had systolic blood pressure below 140 mm Hg, while only 35% of the stage 4 group did (Am. J. Med. 2008; 121:332-40).

KEEP data have shown an uptick in overall blood pressure control, from 45% at the initial screening to 49% at rescreening, Dr. Vassalotti said, and even some improvement in control without medication. "But I wouldn’t overstate this."

The project involves merging data with the National Death Index and the United States Renal Data System to track survival and chronic kidney failure outcomes, respectively. Future goals include additional data links with Medicare Parts B and D to gain clarity on morbidity and medication use, Dr. Vassalotti said. "Preliminary longitudinal data show that community screening appears to influence hypertension despite progression of chronic kidney disease," he said.

Patient awareness is the cornerstone of hypertension management, noted Dr. Adam Whaley-Connell of the University of Missouri. "Awareness has a very important role in not only understanding blood pressure control, especially in the context of the early stages of kidney disease, but in improving kidney related patient outcomes," he said. However, he noted that awareness of kidney disease, particularly in its early stages, "is alarmingly low."

He noted that KEEP data on awareness reflect that of National Health and Nutrition Examination Survey and other CKD cohort studies: Only about 5% of those with stages 1-3 are aware of their disease. "Roughly 95% of individuals entering into the screening program are unaware they have chronic kidney disease," Dr. Whaley-Connell said.

KEEP enrollees with cardiovascular disease had a keener awareness of the risks of kidney disease, he said. "While awareness may be triggered by cardiovascular disease, those unaware in the earlier stages of kidney disease are particularly vulnerable to poor risk factor control and increased risk for mortality and progression to end-stage renal disease," Dr. Whaley-Connell said. "We advocate for targeted education and awareness at earlier stages of kidney disease to improve risk factor control."

"I think any general practitioner seeing patients needs to pay attention to eGFR," Dr. Bakris said. "If the patient has stage 2 disease and an eGFR of 60-80 mL/min per 1.73 m² now, especially with the CKD-EPI equation, the next question out of his mouth should be, ‘Do you have a family history of kidney disease?’"

However, he cited National Kidney Foundation data that showed only 31% of physicians considered family history an important factor. "If your patient has a family history of kidney disease and an eGFR of 50 mL/min per 1.73 m² ... you really do need to pay attention to that and do something about it."

KEEP is funded by Amgen, Abbott, Siemens, Astellas, Genzyme, Fresenius Medical Care, Pfizer, Nephroceuticals and the LifeScan unit of Johnson & Johnson. Panel participants disclosed affiliations with a variety of device and pharmaceutical companies.

NEW YORK – Boosting patient awareness and use of a new equation for measuring glomerular filtration rate are showing early signs of being the cornerstones to the prevention of chronic kidney disease among people at risk for the disease, according to preliminary results from the National Kidney Foundation’s nationwide screening initiative.

The Kidney Early Evaluation Program (KEEP) has enrolled 150,000 people so far, making it the nation’s largest perpetual chronic kidney disease screening program, according to Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation and a faculty member at Mount Sinai School of Medicine, New York.

The point is to identify "individuals in the community with kidney disease along with the risk factors that go with it," said Dr. George Bakris of the University of Chicago Medical Center and a former KEEP principal investigator. All of the participants have some stage of kidney disease or hypertension and are referred to the registry by physicians. Enrollment is voluntary and participants complete a questionnaire and undergo a medical evaluation that includes standard panels plus testing for calcium, phosphorus, and parathyroid hormone. The program does not accept people who have had a kidney transplant or are on dialysis, he said.

Under the program, a new method for estimating glomerular filtration rate (eGFR), known as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, has been used. This equation is more accurate in determining kidney function than is the Modification of Diet in Renal Disease (MDRD) Study equation, said Dr. Lesley Stevens of Tufts Medical Center, Boston. "The use of the CKD-EPI equation more accurately reflects measured GFR and results in a lower prevalence of eGFR below 60 mL/min per 1.73 m²," said Dr. Stevens, a KEEP committee member. As a result, there are fewer false positives and "ultimately, fewer tests and lower costs," she said.

According to Dr. Stevens, the equation has been validated in two clinical studies (Am. J. Kidney Dis. 2010;55:648-59 and Am. J. Kidney Dis. 2010;55:660-70).

One of the goals of KEEP is to determine factors that help slow the slide into chronic kidney disease, as well as the loss of kidney function over time, Dr. Vassalotti said. "Multiple trials on systolic blood pressure show that untreated hypertension results in a loss of 10-12 mL/min per 1.73 m² eGFR a year," he said. "In individuals with blood pressure in the target range, the annual loss is approximately 2-3 mL/min per 1.73 m². By educating participants and fostering their engagement with local clinicians, KEEP can impact care."

Managing blood pressure early in kidney disease is critical because as eGFR declines, hypertension becomes more difficult to control, Dr. Vassalotti said. Thus, self-reported hypertension is one of the qualifiers for KEEP enrollment, he said. He cited early data from KEEP that showed prevalence, awareness and treatment of hypertension increased with stage of chronic kidney disease, but that didn’t necessarily translate to control with severe disease. Among those with stage 3 disease, only 82% were undergoing treatment, compared with 92% of those with stage 4 disease. However, 38% of the stage 3 group had systolic blood pressure below 140 mm Hg, while only 35% of the stage 4 group did (Am. J. Med. 2008; 121:332-40).

KEEP data have shown an uptick in overall blood pressure control, from 45% at the initial screening to 49% at rescreening, Dr. Vassalotti said, and even some improvement in control without medication. "But I wouldn’t overstate this."

The project involves merging data with the National Death Index and the United States Renal Data System to track survival and chronic kidney failure outcomes, respectively. Future goals include additional data links with Medicare Parts B and D to gain clarity on morbidity and medication use, Dr. Vassalotti said. "Preliminary longitudinal data show that community screening appears to influence hypertension despite progression of chronic kidney disease," he said.

Patient awareness is the cornerstone of hypertension management, noted Dr. Adam Whaley-Connell of the University of Missouri. "Awareness has a very important role in not only understanding blood pressure control, especially in the context of the early stages of kidney disease, but in improving kidney related patient outcomes," he said. However, he noted that awareness of kidney disease, particularly in its early stages, "is alarmingly low."

He noted that KEEP data on awareness reflect that of National Health and Nutrition Examination Survey and other CKD cohort studies: Only about 5% of those with stages 1-3 are aware of their disease. "Roughly 95% of individuals entering into the screening program are unaware they have chronic kidney disease," Dr. Whaley-Connell said.

KEEP enrollees with cardiovascular disease had a keener awareness of the risks of kidney disease, he said. "While awareness may be triggered by cardiovascular disease, those unaware in the earlier stages of kidney disease are particularly vulnerable to poor risk factor control and increased risk for mortality and progression to end-stage renal disease," Dr. Whaley-Connell said. "We advocate for targeted education and awareness at earlier stages of kidney disease to improve risk factor control."

"I think any general practitioner seeing patients needs to pay attention to eGFR," Dr. Bakris said. "If the patient has stage 2 disease and an eGFR of 60-80 mL/min per 1.73 m² now, especially with the CKD-EPI equation, the next question out of his mouth should be, ‘Do you have a family history of kidney disease?’"

However, he cited National Kidney Foundation data that showed only 31% of physicians considered family history an important factor. "If your patient has a family history of kidney disease and an eGFR of 50 mL/min per 1.73 m² ... you really do need to pay attention to that and do something about it."

KEEP is funded by Amgen, Abbott, Siemens, Astellas, Genzyme, Fresenius Medical Care, Pfizer, Nephroceuticals and the LifeScan unit of Johnson & Johnson. Panel participants disclosed affiliations with a variety of device and pharmaceutical companies.

NEW YORK – Boosting patient awareness and use of a new equation for measuring glomerular filtration rate are showing early signs of being the cornerstones to the prevention of chronic kidney disease among people at risk for the disease, according to preliminary results from the National Kidney Foundation’s nationwide screening initiative.

The Kidney Early Evaluation Program (KEEP) has enrolled 150,000 people so far, making it the nation’s largest perpetual chronic kidney disease screening program, according to Dr. Joseph Vassalotti, chief medical officer of the National Kidney Foundation and a faculty member at Mount Sinai School of Medicine, New York.

The point is to identify "individuals in the community with kidney disease along with the risk factors that go with it," said Dr. George Bakris of the University of Chicago Medical Center and a former KEEP principal investigator. All of the participants have some stage of kidney disease or hypertension and are referred to the registry by physicians. Enrollment is voluntary and participants complete a questionnaire and undergo a medical evaluation that includes standard panels plus testing for calcium, phosphorus, and parathyroid hormone. The program does not accept people who have had a kidney transplant or are on dialysis, he said.

Under the program, a new method for estimating glomerular filtration rate (eGFR), known as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, has been used. This equation is more accurate in determining kidney function than is the Modification of Diet in Renal Disease (MDRD) Study equation, said Dr. Lesley Stevens of Tufts Medical Center, Boston. "The use of the CKD-EPI equation more accurately reflects measured GFR and results in a lower prevalence of eGFR below 60 mL/min per 1.73 m²," said Dr. Stevens, a KEEP committee member. As a result, there are fewer false positives and "ultimately, fewer tests and lower costs," she said.

According to Dr. Stevens, the equation has been validated in two clinical studies (Am. J. Kidney Dis. 2010;55:648-59 and Am. J. Kidney Dis. 2010;55:660-70).

One of the goals of KEEP is to determine factors that help slow the slide into chronic kidney disease, as well as the loss of kidney function over time, Dr. Vassalotti said. "Multiple trials on systolic blood pressure show that untreated hypertension results in a loss of 10-12 mL/min per 1.73 m² eGFR a year," he said. "In individuals with blood pressure in the target range, the annual loss is approximately 2-3 mL/min per 1.73 m². By educating participants and fostering their engagement with local clinicians, KEEP can impact care."

Managing blood pressure early in kidney disease is critical because as eGFR declines, hypertension becomes more difficult to control, Dr. Vassalotti said. Thus, self-reported hypertension is one of the qualifiers for KEEP enrollment, he said. He cited early data from KEEP that showed prevalence, awareness and treatment of hypertension increased with stage of chronic kidney disease, but that didn’t necessarily translate to control with severe disease. Among those with stage 3 disease, only 82% were undergoing treatment, compared with 92% of those with stage 4 disease. However, 38% of the stage 3 group had systolic blood pressure below 140 mm Hg, while only 35% of the stage 4 group did (Am. J. Med. 2008; 121:332-40).

KEEP data have shown an uptick in overall blood pressure control, from 45% at the initial screening to 49% at rescreening, Dr. Vassalotti said, and even some improvement in control without medication. "But I wouldn’t overstate this."

The project involves merging data with the National Death Index and the United States Renal Data System to track survival and chronic kidney failure outcomes, respectively. Future goals include additional data links with Medicare Parts B and D to gain clarity on morbidity and medication use, Dr. Vassalotti said. "Preliminary longitudinal data show that community screening appears to influence hypertension despite progression of chronic kidney disease," he said.

Patient awareness is the cornerstone of hypertension management, noted Dr. Adam Whaley-Connell of the University of Missouri. "Awareness has a very important role in not only understanding blood pressure control, especially in the context of the early stages of kidney disease, but in improving kidney related patient outcomes," he said. However, he noted that awareness of kidney disease, particularly in its early stages, "is alarmingly low."

He noted that KEEP data on awareness reflect that of National Health and Nutrition Examination Survey and other CKD cohort studies: Only about 5% of those with stages 1-3 are aware of their disease. "Roughly 95% of individuals entering into the screening program are unaware they have chronic kidney disease," Dr. Whaley-Connell said.

KEEP enrollees with cardiovascular disease had a keener awareness of the risks of kidney disease, he said. "While awareness may be triggered by cardiovascular disease, those unaware in the earlier stages of kidney disease are particularly vulnerable to poor risk factor control and increased risk for mortality and progression to end-stage renal disease," Dr. Whaley-Connell said. "We advocate for targeted education and awareness at earlier stages of kidney disease to improve risk factor control."

"I think any general practitioner seeing patients needs to pay attention to eGFR," Dr. Bakris said. "If the patient has stage 2 disease and an eGFR of 60-80 mL/min per 1.73 m² now, especially with the CKD-EPI equation, the next question out of his mouth should be, ‘Do you have a family history of kidney disease?’"

However, he cited National Kidney Foundation data that showed only 31% of physicians considered family history an important factor. "If your patient has a family history of kidney disease and an eGFR of 50 mL/min per 1.73 m² ... you really do need to pay attention to that and do something about it."

KEEP is funded by Amgen, Abbott, Siemens, Astellas, Genzyme, Fresenius Medical Care, Pfizer, Nephroceuticals and the LifeScan unit of Johnson & Johnson. Panel participants disclosed affiliations with a variety of device and pharmaceutical companies.

Major Finding: In older patients with type 2 diabetes, intensive blood pressure therapy significantly reduced the risk of fracture, compared with standard therapy (hazard ratio 0.78), but not the risk of falls (HR, 0.81).

Data Source: A subgroup analysis of 3,282 ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

Disclosures: The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on an analysis presented at the meeting.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD, which showed that treating patients to a blood pressure target of less than 130/80 mm Hg offered no more protection against cardiovascular events than did treating them to a goal of less than 140 mm Hg.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

“Intensive control of systolic blood pressure did not result in an increased risk of falls,” reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. “And fewer intensive than standard group patients developed nonspinal fractures.”

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects' average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients' average body mass index was 32.5 kg/m

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. “About 20% in the intensive group and 21% in the standard group fell,” she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. “This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

“With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip,” said Dr. Margolis. “Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78,” she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. “One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that's a very suggestive mechanism,” she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average body mass index.

“I'm not sure that overweight people aren't protected in some way against blood pressure–related falls,” Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. “To some extent falls are not always due to just people getting possible hypotension; they're related to amount of activity,” he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

Major Finding: In older patients with type 2 diabetes, intensive blood pressure therapy significantly reduced the risk of fracture, compared with standard therapy (hazard ratio 0.78), but not the risk of falls (HR, 0.81).

Data Source: A subgroup analysis of 3,282 ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

Disclosures: The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on an analysis presented at the meeting.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD, which showed that treating patients to a blood pressure target of less than 130/80 mm Hg offered no more protection against cardiovascular events than did treating them to a goal of less than 140 mm Hg.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

“Intensive control of systolic blood pressure did not result in an increased risk of falls,” reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. “And fewer intensive than standard group patients developed nonspinal fractures.”

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects' average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients' average body mass index was 32.5 kg/m

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. “About 20% in the intensive group and 21% in the standard group fell,” she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. “This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

“With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip,” said Dr. Margolis. “Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78,” she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. “One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that's a very suggestive mechanism,” she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average body mass index.

“I'm not sure that overweight people aren't protected in some way against blood pressure–related falls,” Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. “To some extent falls are not always due to just people getting possible hypotension; they're related to amount of activity,” he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

Major Finding: In older patients with type 2 diabetes, intensive blood pressure therapy significantly reduced the risk of fracture, compared with standard therapy (hazard ratio 0.78), but not the risk of falls (HR, 0.81).

Data Source: A subgroup analysis of 3,282 ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD.

Disclosures: The National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases funded the ACCORD-BONE study. Dr. Margolis had no other disclosures to report.

NEW YORK – Intensive therapy to control systolic blood pressure did not appear to be associated with more falls and fractures in a study of patients under age 80 years with hypertension and type 2 diabetes, based on an analysis presented at the meeting.

The finding was noted in a subgroup analysis of ACCORD-BONE, an ancillary study of skeletal health in ACCORD study participants. The subgroup analysis looked at ACCORD-BONE participants in the ACCORD Blood Pressure Clinical Trial arm of ACCORD, which showed that treating patients to a blood pressure target of less than 130/80 mm Hg offered no more protection against cardiovascular events than did treating them to a goal of less than 140 mm Hg.

For the subgroup analysis, the researchers examined data from 3,282 people who were randomly assigned to standard systolic blood pressure goals of 130-139 mm Hg or to intensive systolic goals of less than 120 mm Hg.

“Intensive control of systolic blood pressure did not result in an increased risk of falls,” reported Dr. Karen Margolis of the Health Partners Research Foundation in Minneapolis. “And fewer intensive than standard group patients developed nonspinal fractures.”

Average blood pressure at entry was 138/75 mm Hg. Those in the intensive therapy group received a thiazide-type diuretic in combination with another class of antihypertensive drug to a goal of 120 mm Hg. The standard intervention group used the same drugs and combinations, but the systolic goal was 130-135 mm Hg and treatment was only intensified if systolic blood pressure rose above 160 mm Hg, according to Dr. Margolis.

Systolic blood pressure averaged 133 mm Hg in the standard treatment group and 119 mm Hg in the intensive treatment group. Subjects' average age was 62 years, and patients over age 80 years were excluded; 44% were women; 66% were white, 26% were black, and 2% Latino. Patients' average body mass index was 32.5 kg/m

With an average follow-up of almost 5 years, ACCORD-BONE study results bucked conventional wisdom about risk of falls, according to Dr. Margolis. “About 20% in the intensive group and 21% in the standard group fell,” she said. The intensive group had a 0.81 relative risk of falling, compared with the standard group. The study found no differences across age, sex, ethnicity, or status of baseline diabetes.

The overall rate of self-reported falls was 70/100 person-years, Dr. Margolis said. “This also was lower in the intensive group at 62/100 person-years vs. the standard group at 74/100.

“With regard to nonspinal fractures, the study identified 273 individuals with at least one fracture, including 63 ankle, 34 humerus, 29 foot, 25 wrist, and 19 hip,” said Dr. Margolis. “Overall, fracture risk was significantly lower in the intensive vs. the standard blood pressure group with a hazard ratio of 0.78,” she said.

Dr. Margolis acknowledged the ACCORD-BONE study had some limits. “One of the most striking findings from the blood pressure treatment data was that there was a very, very large difference in thiazide use – thiazides being known to improve bone density – so that's a very suggestive mechanism,” she said.

Dr. Joseph L. Izzo of the University of Buffalo, N.Y., remarked about obesity in the study group, noting the high average body mass index.

“I'm not sure that overweight people aren't protected in some way against blood pressure–related falls,” Dr. Izzo said.

Physical activity might also explain why those on intensive therapy were less prone to falls and fractures, noted Dr. Bryan Williams of the University of Leicester, England. “To some extent falls are not always due to just people getting possible hypotension; they're related to amount of activity,” he said.

Dr. Margolis said that a substudy would further investigate physical activity in this population.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new-onset spondyloarthritis, according to data presented by Dr. Mikkel Østergaard.

In discussing research that pointed to the usefulness of MRI in managing patients with spondyloarthritis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted.

By ordering MRI “at an earlier and more appropriate phase in the patient's disease,” radiologists could help patients get a quick diagnosis and allow early initiation of the relevant therapy, he added.

Dr. Østergaard discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later.

The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20% vs. 3.3%), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

To watch an interview with Dr. Østergaard, scan this QR code with a smartphone.

By allowing earlier detection of sacroiliitis, MRI has “enabled physicians to diagnose spondyloarthritis up to 5–10 years earlier,” said Dr. Mikkel Østergaard.

Source Heidi Splete/Elsevier Global Medical News

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new-onset spondyloarthritis, according to data presented by Dr. Mikkel Østergaard.

In discussing research that pointed to the usefulness of MRI in managing patients with spondyloarthritis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted.

By ordering MRI “at an earlier and more appropriate phase in the patient's disease,” radiologists could help patients get a quick diagnosis and allow early initiation of the relevant therapy, he added.

Dr. Østergaard discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later.

The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20% vs. 3.3%), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

To watch an interview with Dr. Østergaard, scan this QR code with a smartphone.

By allowing earlier detection of sacroiliitis, MRI has “enabled physicians to diagnose spondyloarthritis up to 5–10 years earlier,” said Dr. Mikkel Østergaard.

Source Heidi Splete/Elsevier Global Medical News

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new-onset spondyloarthritis, according to data presented by Dr. Mikkel Østergaard.

In discussing research that pointed to the usefulness of MRI in managing patients with spondyloarthritis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted.

By ordering MRI “at an earlier and more appropriate phase in the patient's disease,” radiologists could help patients get a quick diagnosis and allow early initiation of the relevant therapy, he added.

Dr. Østergaard discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later.

The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20% vs. 3.3%), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

To watch an interview with Dr. Østergaard, scan this QR code with a smartphone.

By allowing earlier detection of sacroiliitis, MRI has “enabled physicians to diagnose spondyloarthritis up to 5–10 years earlier,” said Dr. Mikkel Østergaard.

Source Heidi Splete/Elsevier Global Medical News

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Magnetic resonance imaging is at least as sensitive as other modalities at predicting treatment response in patients with new onset spondyloarthritis, according to data presented on May 25 by Dr. Mikkel Østergaard at the annual European Congress of Rheumatology.

In discussing research that pointed to the usefulness of MRI in managing patients with ankylosing spondylitis (SpA), Dr. Østergaard reviewed the varied manifestations SpA can take on MRI, and how imaging can be a useful tool for predicting the formation of new bone.

“MRI has brought a major improvement in the evaluation and management of patients with spondyloarthritis,” he said. “It allows earlier detection of sacroiliitis than [does] any other modality, and has thereby enabled physicians to diagnose spondyloarthritis up to 5-10 years earlier than they could before.” He added that MRI provides physicians with an objective way to monitor disease activity in SpA.

Dr. Østergaard explained how to use MRI to identify disease in the sacroiliac joints, the spine, and the peripheral joints. “Given the major improvement in evaluation and management of spondyloarthritis patients that MRI has brought, it is very important that rheumatologists are aware of the findings that indicate actual spondyloarthritis and of the advantages of MRI so that they can order the correct examinations,” he said.

“It is important that not only rheumatologists but also radiologists are aware of the large impact of early diagnosis and treatment of patients with SpA concerning pain relief and better function,” he noted. Radiologists should prioritize to do early and adequate MRI examinations in patients with suspected spondyloarthritis. Ordering MRI “at an earlier and more appropriate phase in the patient’s disease” could help those patients get a quick diagnosis and allow early initiation of the relevant therapy, Dr. Østergaard added.

He discussed a study in which he participated that involved 50 patients with SpA who had an MRI done once at baseline and again on follow-up at an average of 19.2 months later. Patients also underwent spinal radiography at baseline and follow-up more than 2 years later. The goal of the study was to use imaging to evaluate the effectiveness of anti–tumor necrosis factor (TNF)–alpha agents for treatment of vertebral corner inflammatory lesions. The study aimed to evaluate whether MRI could be used to predict the growth of new syndesmophytes after anti-TNF-alpha therapy, said Dr. Østergaard of the department of rheumatology at the University of Copenhagen and Glostrup (Denmark) Hospital, who was a coauthor.

The study showed that in patients who receive anti-TNF-alpha therapy, new syndesmophytes developed more frequently from vertebral corners where follow-up MRI had shown a completely resolved corner inflammatory lesion, compared with vertebral corners with no inflammatory lesions (42.9 % vs. 2.4 %). For patients who received standard treatment, the study reported a similar pattern (20 % vs. 3.3 %), he added.

The study findings indicated that MRI can predict new bone formation on radiograph, and supported the theory that anti-TNF-alpha acts to inhibit new bone formation. However, because the sample size was so small, further study will be needed to validate these findings, Dr. Østergaard said.

Dr. Østergaard had no disclosures to report.

Updated World Health Organization estimates are showing a downward trend in the incidence of gout in North America among 65-year-olds, but men in that age group on the continent are far more likely to suffer from gout than are men in Africa.

That’s a sampling of the updated data on a host of musculoskeletal disorders worldwide, including rheumatoid arthritis, said Dr. Lyn March at the Annual European Congress of Rheumatology.

She presented a preliminary report from the Musculoskeletal Expert Group that’s part of the new Global Burden of Diseases, Injuries, and Risk Factors Study, which began in the spring of 2007. This is the first major effort since the original Global Burden of Disease in 1990 study to carry out a complete systematic assessment of the data on all diseases and injuries, and to produce comprehensive and comparable estimates of the burden of diseases, injuries, and risk factors for two time periods (1990 and 2005), according to the WHO. The project is due to produce final estimates in the spring, said Dr. March of the Royal North Shore Hospital in Sydney.

Dr. March said the specific aims for the Musculoskeletal Expert Group are to include more population-based self-report data; to develop health-state descriptions for different levels of severity of osteoarthritis, rheumatoid arthritis, back pain, neck pain, gout, and other musculoskeletal disorders; and to update systematic literature reviews of incidence, prevalence, and mortality risk for these conditions. The group will also evaluate bone mineral density (g/cm²) as a risk factor for disability-adjusted life-year (DALY) burden, "which will put the [degenerative] bone condition on the map for policy making," she said.

"The methodology employed in the systematic review, development of lay health state descriptions, and generation of data estimates for calculating [DALYs] will be revealed," Dr. March said.

In 2000, the beginning of what the WHO declared "the Bone and Joint Decade," results from the previous Global Burden of Disease (GBD) study reported that rheumatoid arthritis accounted for 0.3% of global DALYs (a time-based measure that combined years of life lost to premature mortality and years of life lost to time lived in health states of less-than-ideal health). "These data enable, in part, an evaluation of the impact of the Bone and Joint Decade and the setting of the research agenda for the next decade," Dr. March said.

The GBD study investigated the incidence of 109 diseases and injuries and 10 risk factors across eight World Bank regions. In 2000, the WHO reported that osteoarthritis accounted for 1.1% of global DALYs, ranking 19th among all diseases and disorders, and rheumatoid arthritis accounted for 0.3% of DALYs. All musculoskeletal disorders combined had a prevalence of 2.1% of the worldwide population and ranked 12th in DALYs among all disorders, according to Dr. March. Preliminary data from the 2005 study show trends toward increases in the prevalence of osteoarthritis of the knee and hip, rheumatoid arthritis, and other musculoskeletal disease, and slight decreases in low-back pain and gout, she said, noting that the findings will likely have policy implications.

A 2005 update reported that musculoskeletal disorders are more common in developed countries.

Dr. March had no disclosures to report. The study received funding from the Bill and Melinda Gates Foundation and the Australian Commonwealth Government’s Department of Health and Aging.

Updated World Health Organization estimates are showing a downward trend in the incidence of gout in North America among 65-year-olds, but men in that age group on the continent are far more likely to suffer from gout than are men in Africa.

That’s a sampling of the updated data on a host of musculoskeletal disorders worldwide, including rheumatoid arthritis, said Dr. Lyn March at the Annual European Congress of Rheumatology.

She presented a preliminary report from the Musculoskeletal Expert Group that’s part of the new Global Burden of Diseases, Injuries, and Risk Factors Study, which began in the spring of 2007. This is the first major effort since the original Global Burden of Disease in 1990 study to carry out a complete systematic assessment of the data on all diseases and injuries, and to produce comprehensive and comparable estimates of the burden of diseases, injuries, and risk factors for two time periods (1990 and 2005), according to the WHO. The project is due to produce final estimates in the spring, said Dr. March of the Royal North Shore Hospital in Sydney.

Dr. March said the specific aims for the Musculoskeletal Expert Group are to include more population-based self-report data; to develop health-state descriptions for different levels of severity of osteoarthritis, rheumatoid arthritis, back pain, neck pain, gout, and other musculoskeletal disorders; and to update systematic literature reviews of incidence, prevalence, and mortality risk for these conditions. The group will also evaluate bone mineral density (g/cm²) as a risk factor for disability-adjusted life-year (DALY) burden, "which will put the [degenerative] bone condition on the map for policy making," she said.

"The methodology employed in the systematic review, development of lay health state descriptions, and generation of data estimates for calculating [DALYs] will be revealed," Dr. March said.

In 2000, the beginning of what the WHO declared "the Bone and Joint Decade," results from the previous Global Burden of Disease (GBD) study reported that rheumatoid arthritis accounted for 0.3% of global DALYs (a time-based measure that combined years of life lost to premature mortality and years of life lost to time lived in health states of less-than-ideal health). "These data enable, in part, an evaluation of the impact of the Bone and Joint Decade and the setting of the research agenda for the next decade," Dr. March said.

The GBD study investigated the incidence of 109 diseases and injuries and 10 risk factors across eight World Bank regions. In 2000, the WHO reported that osteoarthritis accounted for 1.1% of global DALYs, ranking 19th among all diseases and disorders, and rheumatoid arthritis accounted for 0.3% of DALYs. All musculoskeletal disorders combined had a prevalence of 2.1% of the worldwide population and ranked 12th in DALYs among all disorders, according to Dr. March. Preliminary data from the 2005 study show trends toward increases in the prevalence of osteoarthritis of the knee and hip, rheumatoid arthritis, and other musculoskeletal disease, and slight decreases in low-back pain and gout, she said, noting that the findings will likely have policy implications.

A 2005 update reported that musculoskeletal disorders are more common in developed countries.

Dr. March had no disclosures to report. The study received funding from the Bill and Melinda Gates Foundation and the Australian Commonwealth Government’s Department of Health and Aging.

Updated World Health Organization estimates are showing a downward trend in the incidence of gout in North America among 65-year-olds, but men in that age group on the continent are far more likely to suffer from gout than are men in Africa.

That’s a sampling of the updated data on a host of musculoskeletal disorders worldwide, including rheumatoid arthritis, said Dr. Lyn March at the Annual European Congress of Rheumatology.

She presented a preliminary report from the Musculoskeletal Expert Group that’s part of the new Global Burden of Diseases, Injuries, and Risk Factors Study, which began in the spring of 2007. This is the first major effort since the original Global Burden of Disease in 1990 study to carry out a complete systematic assessment of the data on all diseases and injuries, and to produce comprehensive and comparable estimates of the burden of diseases, injuries, and risk factors for two time periods (1990 and 2005), according to the WHO. The project is due to produce final estimates in the spring, said Dr. March of the Royal North Shore Hospital in Sydney.

Dr. March said the specific aims for the Musculoskeletal Expert Group are to include more population-based self-report data; to develop health-state descriptions for different levels of severity of osteoarthritis, rheumatoid arthritis, back pain, neck pain, gout, and other musculoskeletal disorders; and to update systematic literature reviews of incidence, prevalence, and mortality risk for these conditions. The group will also evaluate bone mineral density (g/cm²) as a risk factor for disability-adjusted life-year (DALY) burden, "which will put the [degenerative] bone condition on the map for policy making," she said.

"The methodology employed in the systematic review, development of lay health state descriptions, and generation of data estimates for calculating [DALYs] will be revealed," Dr. March said.

In 2000, the beginning of what the WHO declared "the Bone and Joint Decade," results from the previous Global Burden of Disease (GBD) study reported that rheumatoid arthritis accounted for 0.3% of global DALYs (a time-based measure that combined years of life lost to premature mortality and years of life lost to time lived in health states of less-than-ideal health). "These data enable, in part, an evaluation of the impact of the Bone and Joint Decade and the setting of the research agenda for the next decade," Dr. March said.

The GBD study investigated the incidence of 109 diseases and injuries and 10 risk factors across eight World Bank regions. In 2000, the WHO reported that osteoarthritis accounted for 1.1% of global DALYs, ranking 19th among all diseases and disorders, and rheumatoid arthritis accounted for 0.3% of DALYs. All musculoskeletal disorders combined had a prevalence of 2.1% of the worldwide population and ranked 12th in DALYs among all disorders, according to Dr. March. Preliminary data from the 2005 study show trends toward increases in the prevalence of osteoarthritis of the knee and hip, rheumatoid arthritis, and other musculoskeletal disease, and slight decreases in low-back pain and gout, she said, noting that the findings will likely have policy implications.

A 2005 update reported that musculoskeletal disorders are more common in developed countries.

Dr. March had no disclosures to report. The study received funding from the Bill and Melinda Gates Foundation and the Australian Commonwealth Government’s Department of Health and Aging.