Patrice Wendling

Chicago — Having diabetes significantly increases the cost of treating stroke, particularly for African Americans, new research suggests.

An analysis of 18,847 stroke patients discharged from Tennessee hospitals in 2006 showed that 31% had diabetes. The stroke rate was 7% among diabetic patients versus 4% for nondiabetic patients. The difference was statistically significant.

Among African American women, the stroke rate was significantly higher in those with diabetes than in those without (8% vs. 5%). This trend was also found among the subgroups of African American men and white females and males, Baqar Husaini, Ph.D., and his associates reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The average total treatment cost was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients, a significant difference. This could be due to diabetes complications that required longer hospitalization, said Dr. Husaini, director of the Center for Health Research, Tennessee State University, Nashville. The average hospital stay was 16 days for diabetes patients versus 11 days for nondiabetic patients, a significant difference.

Overall, patients with diabetes were significantly more likely than were those without diabetes to have hypertension (87% vs. 75%), a previous MI (10% vs. 7%), and heart failure (26% vs. 15%), but transient ischemic attacks (TIAs) were significantly less common among diabetes patients (6% vs. 8%).

Both stroke cost and total cost were significantly higher for African Americans than for whites within each diabetes subgroup, he reported. Among patients with diabetes, the stroke cost was $37,964 for African Americans, compared with $21,469 for whites. African American men had the highest stroke-related costs at $39,685, compared with $36,835 for African American women, $25,464 for white women, and $26,729 for white men.

“A higher rate of comorbidities among diabetic African Americans may contribute to longer hospitalization and additional clinical services, which constitute higher treatment costs,” the researchers reported.

Black men and women had higher rates of hypertension, TIAs, and diabetes than did white, but whites of both sexes had higher rates of previous MI. Women of both races were more likely than were men to have heart failure. The average age of the cohort was 70 years; 55% were female. Because the clinical data did not indicate the severity of patients' comorbid conditions, it is difficult to determine which factors contribute to racial differences in stroke treatment costs, the authors wrote.

The authors disclosed no conflicts of interest. The study was sponsored by the Centers for Disease Control and Prevention and the National Institute of Mental Health.

The average total was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients.

Source DR. HUSAINI

Chicago — Having diabetes significantly increases the cost of treating stroke, particularly for African Americans, new research suggests.

An analysis of 18,847 stroke patients discharged from Tennessee hospitals in 2006 showed that 31% had diabetes. The stroke rate was 7% among diabetic patients versus 4% for nondiabetic patients. The difference was statistically significant.

Among African American women, the stroke rate was significantly higher in those with diabetes than in those without (8% vs. 5%). This trend was also found among the subgroups of African American men and white females and males, Baqar Husaini, Ph.D., and his associates reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The average total treatment cost was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients, a significant difference. This could be due to diabetes complications that required longer hospitalization, said Dr. Husaini, director of the Center for Health Research, Tennessee State University, Nashville. The average hospital stay was 16 days for diabetes patients versus 11 days for nondiabetic patients, a significant difference.

Overall, patients with diabetes were significantly more likely than were those without diabetes to have hypertension (87% vs. 75%), a previous MI (10% vs. 7%), and heart failure (26% vs. 15%), but transient ischemic attacks (TIAs) were significantly less common among diabetes patients (6% vs. 8%).

Both stroke cost and total cost were significantly higher for African Americans than for whites within each diabetes subgroup, he reported. Among patients with diabetes, the stroke cost was $37,964 for African Americans, compared with $21,469 for whites. African American men had the highest stroke-related costs at $39,685, compared with $36,835 for African American women, $25,464 for white women, and $26,729 for white men.

“A higher rate of comorbidities among diabetic African Americans may contribute to longer hospitalization and additional clinical services, which constitute higher treatment costs,” the researchers reported.

Black men and women had higher rates of hypertension, TIAs, and diabetes than did white, but whites of both sexes had higher rates of previous MI. Women of both races were more likely than were men to have heart failure. The average age of the cohort was 70 years; 55% were female. Because the clinical data did not indicate the severity of patients' comorbid conditions, it is difficult to determine which factors contribute to racial differences in stroke treatment costs, the authors wrote.

The authors disclosed no conflicts of interest. The study was sponsored by the Centers for Disease Control and Prevention and the National Institute of Mental Health.

The average total was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients.

Source DR. HUSAINI

Chicago — Having diabetes significantly increases the cost of treating stroke, particularly for African Americans, new research suggests.

An analysis of 18,847 stroke patients discharged from Tennessee hospitals in 2006 showed that 31% had diabetes. The stroke rate was 7% among diabetic patients versus 4% for nondiabetic patients. The difference was statistically significant.

Among African American women, the stroke rate was significantly higher in those with diabetes than in those without (8% vs. 5%). This trend was also found among the subgroups of African American men and white females and males, Baqar Husaini, Ph.D., and his associates reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The average total treatment cost was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients, a significant difference. This could be due to diabetes complications that required longer hospitalization, said Dr. Husaini, director of the Center for Health Research, Tennessee State University, Nashville. The average hospital stay was 16 days for diabetes patients versus 11 days for nondiabetic patients, a significant difference.

Overall, patients with diabetes were significantly more likely than were those without diabetes to have hypertension (87% vs. 75%), a previous MI (10% vs. 7%), and heart failure (26% vs. 15%), but transient ischemic attacks (TIAs) were significantly less common among diabetes patients (6% vs. 8%).

Both stroke cost and total cost were significantly higher for African Americans than for whites within each diabetes subgroup, he reported. Among patients with diabetes, the stroke cost was $37,964 for African Americans, compared with $21,469 for whites. African American men had the highest stroke-related costs at $39,685, compared with $36,835 for African American women, $25,464 for white women, and $26,729 for white men.

“A higher rate of comorbidities among diabetic African Americans may contribute to longer hospitalization and additional clinical services, which constitute higher treatment costs,” the researchers reported.

Black men and women had higher rates of hypertension, TIAs, and diabetes than did white, but whites of both sexes had higher rates of previous MI. Women of both races were more likely than were men to have heart failure. The average age of the cohort was 70 years; 55% were female. Because the clinical data did not indicate the severity of patients' comorbid conditions, it is difficult to determine which factors contribute to racial differences in stroke treatment costs, the authors wrote.

The authors disclosed no conflicts of interest. The study was sponsored by the Centers for Disease Control and Prevention and the National Institute of Mental Health.

The average total was $62,598 for diabetic stroke patients versus $45,344 for nondiabetic stroke patients.

Source DR. HUSAINI

Chicago — Plasma levels of the proinflammatory cytokines tumor necrosis factor–alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

The tumor necrosis factor–alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites, at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Dr. Janice P. Lea of Emory University in Atlanta, session chair, questioned what percentage of African Americans were on ACE inhibitors because they traditionally have had lower prescriptions of angiotension blockade. Dr. Watson said they have not yet done that analysis, but plan to do so.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

Chicago — Plasma levels of the proinflammatory cytokines tumor necrosis factor–alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

The tumor necrosis factor–alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites, at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Dr. Janice P. Lea of Emory University in Atlanta, session chair, questioned what percentage of African Americans were on ACE inhibitors because they traditionally have had lower prescriptions of angiotension blockade. Dr. Watson said they have not yet done that analysis, but plan to do so.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

Chicago — Plasma levels of the proinflammatory cytokines tumor necrosis factor–alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

The tumor necrosis factor–alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites, at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Dr. Janice P. Lea of Emory University in Atlanta, session chair, questioned what percentage of African Americans were on ACE inhibitors because they traditionally have had lower prescriptions of angiotension blockade. Dr. Watson said they have not yet done that analysis, but plan to do so.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — As in outpatients, cystatin C levels appear to offer additional prognostic information in patients admitted with heart failure exacerbations, according to an analysis of 240 consecutive inpatients.

Although there was no significant association between the serum protein levels on admission and the study's primary end point of length of hospitalization, cystatin C was more predictive of all-cause mortality and the combined end point of readmission or death than was creatinine, Dr. Daniel J. Brotman and his colleagues reported in a poster at the annual meeting of the Society of Hospital Medicine.

Patients in the highest quartile of cystatin C (mean 2.44 mg/L) were at significantly increased risk of death (hazard ratio 2.07) and of readmission or death (HR 1.61) during the first year after admission, compared with those in the lower three cystatin C quartiles (mean 0.66-1.43 mg/L).

The association between cystatin C and the risk of readmission or death remained significant on multivariate analysis after adjustment for age, race, gender, and creatinine level (HR 1.65), according to Dr. Brotman, director of the hospitalists program at Johns Hopkins Hospital in Baltimore. The relationship also remained significant when ejection fraction was included in the model.

Cystatin C level has been shown to be a stronger predictor of the risk of death and cardiovascular events in elderly patients, compared with creatinine level (N. Engl. J. Med. 2005;352:2049-60). Accumulating evidence also supports its use as an alternative and more sensitive endogenous marker, compared with serum creatinine, for the estimation of glomerular filtration rate.

In the current analysis, there was a trend toward increased risk of readmission or death (HR 1.44) for patients in the top quartile of creatinine (mean 2.0 mg/dL), compared with those in the lower three creatinine quartiles (1.0-1.3 mg/dL), but this difference did not reach statistical significance.

The combination of cystatin C and creatinine, however, was significantly more predictive of the combined end point of readmission or death than was either variable alone (HR 1.81).

“We are looking into whether serial changes in this biomarker during the course of hospitalization will have any potential clinical utility,” Dr. Brotman said in an interview. Clinical application is currently limited, as most labs do not routinely test for cystatin C.

Dr. Brotman disclosed receiving research funding from Siemens Healthcare Diagnostics Inc., serving on the hospitalist leadership panel for Quantia Communications LLC, and being on the advisory boards of several pharmaceutical companies.

The combination of cystatin C and creatinine was more predictive of readmission or death than was either one alone.

Source DR. BROTMAN

CHICAGO — As in outpatients, cystatin C levels appear to offer additional prognostic information in patients admitted with heart failure exacerbations, according to an analysis of 240 consecutive inpatients.

Although there was no significant association between the serum protein levels on admission and the study's primary end point of length of hospitalization, cystatin C was more predictive of all-cause mortality and the combined end point of readmission or death than was creatinine, Dr. Daniel J. Brotman and his colleagues reported in a poster at the annual meeting of the Society of Hospital Medicine.

Patients in the highest quartile of cystatin C (mean 2.44 mg/L) were at significantly increased risk of death (hazard ratio 2.07) and of readmission or death (HR 1.61) during the first year after admission, compared with those in the lower three cystatin C quartiles (mean 0.66-1.43 mg/L).

The association between cystatin C and the risk of readmission or death remained significant on multivariate analysis after adjustment for age, race, gender, and creatinine level (HR 1.65), according to Dr. Brotman, director of the hospitalists program at Johns Hopkins Hospital in Baltimore. The relationship also remained significant when ejection fraction was included in the model.

Cystatin C level has been shown to be a stronger predictor of the risk of death and cardiovascular events in elderly patients, compared with creatinine level (N. Engl. J. Med. 2005;352:2049-60). Accumulating evidence also supports its use as an alternative and more sensitive endogenous marker, compared with serum creatinine, for the estimation of glomerular filtration rate.

In the current analysis, there was a trend toward increased risk of readmission or death (HR 1.44) for patients in the top quartile of creatinine (mean 2.0 mg/dL), compared with those in the lower three creatinine quartiles (1.0-1.3 mg/dL), but this difference did not reach statistical significance.

The combination of cystatin C and creatinine, however, was significantly more predictive of the combined end point of readmission or death than was either variable alone (HR 1.81).

“We are looking into whether serial changes in this biomarker during the course of hospitalization will have any potential clinical utility,” Dr. Brotman said in an interview. Clinical application is currently limited, as most labs do not routinely test for cystatin C.

Dr. Brotman disclosed receiving research funding from Siemens Healthcare Diagnostics Inc., serving on the hospitalist leadership panel for Quantia Communications LLC, and being on the advisory boards of several pharmaceutical companies.

The combination of cystatin C and creatinine was more predictive of readmission or death than was either one alone.

Source DR. BROTMAN

CHICAGO — As in outpatients, cystatin C levels appear to offer additional prognostic information in patients admitted with heart failure exacerbations, according to an analysis of 240 consecutive inpatients.

Although there was no significant association between the serum protein levels on admission and the study's primary end point of length of hospitalization, cystatin C was more predictive of all-cause mortality and the combined end point of readmission or death than was creatinine, Dr. Daniel J. Brotman and his colleagues reported in a poster at the annual meeting of the Society of Hospital Medicine.

Patients in the highest quartile of cystatin C (mean 2.44 mg/L) were at significantly increased risk of death (hazard ratio 2.07) and of readmission or death (HR 1.61) during the first year after admission, compared with those in the lower three cystatin C quartiles (mean 0.66-1.43 mg/L).

The association between cystatin C and the risk of readmission or death remained significant on multivariate analysis after adjustment for age, race, gender, and creatinine level (HR 1.65), according to Dr. Brotman, director of the hospitalists program at Johns Hopkins Hospital in Baltimore. The relationship also remained significant when ejection fraction was included in the model.

Cystatin C level has been shown to be a stronger predictor of the risk of death and cardiovascular events in elderly patients, compared with creatinine level (N. Engl. J. Med. 2005;352:2049-60). Accumulating evidence also supports its use as an alternative and more sensitive endogenous marker, compared with serum creatinine, for the estimation of glomerular filtration rate.

In the current analysis, there was a trend toward increased risk of readmission or death (HR 1.44) for patients in the top quartile of creatinine (mean 2.0 mg/dL), compared with those in the lower three creatinine quartiles (1.0-1.3 mg/dL), but this difference did not reach statistical significance.

The combination of cystatin C and creatinine, however, was significantly more predictive of the combined end point of readmission or death than was either variable alone (HR 1.81).

“We are looking into whether serial changes in this biomarker during the course of hospitalization will have any potential clinical utility,” Dr. Brotman said in an interview. Clinical application is currently limited, as most labs do not routinely test for cystatin C.

Dr. Brotman disclosed receiving research funding from Siemens Healthcare Diagnostics Inc., serving on the hospitalist leadership panel for Quantia Communications LLC, and being on the advisory boards of several pharmaceutical companies.

The combination of cystatin C and creatinine was more predictive of readmission or death than was either one alone.

Source DR. BROTMAN

CHICAGO — Terminal digit bias analysis can be used to gauge the accuracy of blood pressure measurements at primary care clinics, a new study suggests.

Terminal digit bias is the tendency of an observer to round off a measurement to a digit of his or her own choosing. It has been shown in several studies to cause significant discrepancies in BP measurements in both the clinical and research settings.

No clear guidelines have been established for what is an acceptable range of end-digit preference, especially for zero—the most common terminal digit recorded. One study proposed a “0” end-digit preference by BP observers of less than 25% as being “optimal,” less than 30% as “acceptable,” and less than 35% as “minimal standard” (J. Clin. Epidemiol. 1996;49:869-77).

In the current study, Dr. Ahmed Dalmar and associates measured the terminal digit preference of 2,202 blood pressure readings at an inner-city hospital before caregiver training and 2,154 readings 3 months after training, which included a video on proper techniques.

Terminal digit bias for zero significantly decreased among systolic and diastolic BP measurements from 57% (a very minimal standard) before training to 16% (optimal) after training, Dr. Dalmar, a research scientist with Aurora Health Care in Milwaukee, reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The use of 2, 4, 6, and 8 as the last digit significantly increased after training, although the terminal-digit bias remained in the optimal range post intervention for all of the digits except 2, which fell into the minimal standard range.

The goal was to decrease or eliminate the zero-digit bias, with the hope that subsequently the bias for other digits would be in the acceptable or optimal range, Dr. Dalmar said in an interview.

“Unfortunately this did not happen in our study and, yes, these digits are also prone to bias,” he said. “We think this happened because after training many providers tended to avoid zero.”

The researchers disclosed no conflicts of interest and received no funding for the study.

CHICAGO — Terminal digit bias analysis can be used to gauge the accuracy of blood pressure measurements at primary care clinics, a new study suggests.

Terminal digit bias is the tendency of an observer to round off a measurement to a digit of his or her own choosing. It has been shown in several studies to cause significant discrepancies in BP measurements in both the clinical and research settings.

No clear guidelines have been established for what is an acceptable range of end-digit preference, especially for zero—the most common terminal digit recorded. One study proposed a “0” end-digit preference by BP observers of less than 25% as being “optimal,” less than 30% as “acceptable,” and less than 35% as “minimal standard” (J. Clin. Epidemiol. 1996;49:869-77).

In the current study, Dr. Ahmed Dalmar and associates measured the terminal digit preference of 2,202 blood pressure readings at an inner-city hospital before caregiver training and 2,154 readings 3 months after training, which included a video on proper techniques.

Terminal digit bias for zero significantly decreased among systolic and diastolic BP measurements from 57% (a very minimal standard) before training to 16% (optimal) after training, Dr. Dalmar, a research scientist with Aurora Health Care in Milwaukee, reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The use of 2, 4, 6, and 8 as the last digit significantly increased after training, although the terminal-digit bias remained in the optimal range post intervention for all of the digits except 2, which fell into the minimal standard range.

The goal was to decrease or eliminate the zero-digit bias, with the hope that subsequently the bias for other digits would be in the acceptable or optimal range, Dr. Dalmar said in an interview.

“Unfortunately this did not happen in our study and, yes, these digits are also prone to bias,” he said. “We think this happened because after training many providers tended to avoid zero.”

The researchers disclosed no conflicts of interest and received no funding for the study.

CHICAGO — Terminal digit bias analysis can be used to gauge the accuracy of blood pressure measurements at primary care clinics, a new study suggests.

Terminal digit bias is the tendency of an observer to round off a measurement to a digit of his or her own choosing. It has been shown in several studies to cause significant discrepancies in BP measurements in both the clinical and research settings.

No clear guidelines have been established for what is an acceptable range of end-digit preference, especially for zero—the most common terminal digit recorded. One study proposed a “0” end-digit preference by BP observers of less than 25% as being “optimal,” less than 30% as “acceptable,” and less than 35% as “minimal standard” (J. Clin. Epidemiol. 1996;49:869-77).

In the current study, Dr. Ahmed Dalmar and associates measured the terminal digit preference of 2,202 blood pressure readings at an inner-city hospital before caregiver training and 2,154 readings 3 months after training, which included a video on proper techniques.

Terminal digit bias for zero significantly decreased among systolic and diastolic BP measurements from 57% (a very minimal standard) before training to 16% (optimal) after training, Dr. Dalmar, a research scientist with Aurora Health Care in Milwaukee, reported in a poster at a meeting sponsored by the International Society on Hypertension in Blacks.

The use of 2, 4, 6, and 8 as the last digit significantly increased after training, although the terminal-digit bias remained in the optimal range post intervention for all of the digits except 2, which fell into the minimal standard range.

The goal was to decrease or eliminate the zero-digit bias, with the hope that subsequently the bias for other digits would be in the acceptable or optimal range, Dr. Dalmar said in an interview.

“Unfortunately this did not happen in our study and, yes, these digits are also prone to bias,” he said. “We think this happened because after training many providers tended to avoid zero.”

The researchers disclosed no conflicts of interest and received no funding for the study.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor-alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensives, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

The few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson said the white hypertensives were slightly heavier at a mean weight of 202 pounds than were the black patients at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues plan to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensives.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor-alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensives, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

The few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson said the white hypertensives were slightly heavier at a mean weight of 202 pounds than were the black patients at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues plan to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensives.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor-alpha (TNF-alpha) was 1.19 pg/mL in 14 white hypertensives, compared with 0.62 pg/mL in 12 black hypertensives.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL versus 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

The few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson said the white hypertensives were slightly heavier at a mean weight of 202 pounds than were the black patients at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for black hypertensives. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

Notably, IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 pg/mL vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 pg/mL vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in persons with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair, which begins during the early phases of inflammation.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives, and whether elevated levels of inflammatory markers in white hypertensives contribute to their lower rates of end-organ damage.”

Dr. Watson and colleagues plan to validate the findings in another 50 black and white hyper- and normotensive patients and to assess the effect of hypertensive medications on TNF-alpha and IL-6 levels in hypertensives.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Although Hispanics are grossly underrepresented in heart failure trials, emerging evidence suggests they have unique risk factors and heart failure outcomes that must be taken into clinical consideration.

The evidence also underscores the importance of recognizing the vast heterogeneity of Hispanics, Dr. Ileana Piña said at a meeting sponsored by the International Society on Hypertension in Blacks.

“Hispanics represent a cultural group, not a racially identifiable group,” said the Cuban-born cardiologist. “You can't lump them all together.”

But that's exactly what has happened. Until the Medicare enrollment files were changed in 1994, Hispanics or Native Americans were simply classified as either “white” or “black.” It wasn't until the 2000 U.S. census that the term “Hispanic” was changed to “Spanish, Hispanic, or Latino” to describe persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Several studies have made the observation—coined the “Hispanic paradox”—that Hispanics have lower all-cause and cardiovascular mortality, despite increased obesity and diabetes, and lower socioeconomic status, said Dr. Piña, professor of medicine at Case Western Reserve University in Cleveland, and a Veterans Affairs National Quality Scholar.

A study of Medicare enrollees aged 65 years or older found that Hispanics were 1.2 times more likely to be hospitalized for heart failure than were whites, while blacks were 1.5 times more likely. But after adjustment for sex and age, in-hospital mortality was significantly lower among Hispanics and blacks than among whites (Am. Heart J. 2005;150:448-54).

Sociocultural factors are often used to explain the Hispanic paradox, but more recent data are causing some to rethink the paradox or at least to differentiate Hispanics by birthplace. Among diabetics in the San Antonio Heart Study, age- and sex-adjusted hazard ratios indicated that U.S.-born Mexican Americans have a 66% greater risk of all-cause mortality and of cardiovascular mortality, compared with non-Hispanic whites, while Mexico-born Mexican Americans appeared to be at similar risk (Diabetes Care 2002;25:1557-63).

A recently published “state-of-the-art” paper on the subject notes that Hispanic ethnicity is marked by a disproportionate cardiometabolic risk burden, largely because of exceedingly high rates of insulin resistance. The authors hypothesize that “the central concept of insulin resistance—compounded by inflammation and neuroendocrine overactivity—may be a predominant etiologic factor for cardiomyopathy in Hispanics” (J. Am. Coll. Cardiol. 2009;53;1167-75).

The authors called for greater representation in patient registries, research studies, and clinical trials, a call echoed by Dr. Piña. She noted that Hispanic or Latino patients made up just 3% of HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), even though they make up about 15% of the total U.S. population. Still, among nine other recent heart failure trials, it was the only one to specifically differentiate Hispanics, instead of lumping them together with other ethnicities as “nonwhites” or “other.”

Dr. Piña disclosed serving as a speaker for AstraZeneca, Novartis, and Merck, and as a consultant for the Food and Drug Administration.

CHICAGO — Although Hispanics are grossly underrepresented in heart failure trials, emerging evidence suggests they have unique risk factors and heart failure outcomes that must be taken into clinical consideration.

The evidence also underscores the importance of recognizing the vast heterogeneity of Hispanics, Dr. Ileana Piña said at a meeting sponsored by the International Society on Hypertension in Blacks.

“Hispanics represent a cultural group, not a racially identifiable group,” said the Cuban-born cardiologist. “You can't lump them all together.”

But that's exactly what has happened. Until the Medicare enrollment files were changed in 1994, Hispanics or Native Americans were simply classified as either “white” or “black.” It wasn't until the 2000 U.S. census that the term “Hispanic” was changed to “Spanish, Hispanic, or Latino” to describe persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Several studies have made the observation—coined the “Hispanic paradox”—that Hispanics have lower all-cause and cardiovascular mortality, despite increased obesity and diabetes, and lower socioeconomic status, said Dr. Piña, professor of medicine at Case Western Reserve University in Cleveland, and a Veterans Affairs National Quality Scholar.

A study of Medicare enrollees aged 65 years or older found that Hispanics were 1.2 times more likely to be hospitalized for heart failure than were whites, while blacks were 1.5 times more likely. But after adjustment for sex and age, in-hospital mortality was significantly lower among Hispanics and blacks than among whites (Am. Heart J. 2005;150:448-54).

Sociocultural factors are often used to explain the Hispanic paradox, but more recent data are causing some to rethink the paradox or at least to differentiate Hispanics by birthplace. Among diabetics in the San Antonio Heart Study, age- and sex-adjusted hazard ratios indicated that U.S.-born Mexican Americans have a 66% greater risk of all-cause mortality and of cardiovascular mortality, compared with non-Hispanic whites, while Mexico-born Mexican Americans appeared to be at similar risk (Diabetes Care 2002;25:1557-63).

A recently published “state-of-the-art” paper on the subject notes that Hispanic ethnicity is marked by a disproportionate cardiometabolic risk burden, largely because of exceedingly high rates of insulin resistance. The authors hypothesize that “the central concept of insulin resistance—compounded by inflammation and neuroendocrine overactivity—may be a predominant etiologic factor for cardiomyopathy in Hispanics” (J. Am. Coll. Cardiol. 2009;53;1167-75).

The authors called for greater representation in patient registries, research studies, and clinical trials, a call echoed by Dr. Piña. She noted that Hispanic or Latino patients made up just 3% of HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), even though they make up about 15% of the total U.S. population. Still, among nine other recent heart failure trials, it was the only one to specifically differentiate Hispanics, instead of lumping them together with other ethnicities as “nonwhites” or “other.”

Dr. Piña disclosed serving as a speaker for AstraZeneca, Novartis, and Merck, and as a consultant for the Food and Drug Administration.

CHICAGO — Although Hispanics are grossly underrepresented in heart failure trials, emerging evidence suggests they have unique risk factors and heart failure outcomes that must be taken into clinical consideration.

The evidence also underscores the importance of recognizing the vast heterogeneity of Hispanics, Dr. Ileana Piña said at a meeting sponsored by the International Society on Hypertension in Blacks.

“Hispanics represent a cultural group, not a racially identifiable group,” said the Cuban-born cardiologist. “You can't lump them all together.”

But that's exactly what has happened. Until the Medicare enrollment files were changed in 1994, Hispanics or Native Americans were simply classified as either “white” or “black.” It wasn't until the 2000 U.S. census that the term “Hispanic” was changed to “Spanish, Hispanic, or Latino” to describe persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Several studies have made the observation—coined the “Hispanic paradox”—that Hispanics have lower all-cause and cardiovascular mortality, despite increased obesity and diabetes, and lower socioeconomic status, said Dr. Piña, professor of medicine at Case Western Reserve University in Cleveland, and a Veterans Affairs National Quality Scholar.

A study of Medicare enrollees aged 65 years or older found that Hispanics were 1.2 times more likely to be hospitalized for heart failure than were whites, while blacks were 1.5 times more likely. But after adjustment for sex and age, in-hospital mortality was significantly lower among Hispanics and blacks than among whites (Am. Heart J. 2005;150:448-54).

Sociocultural factors are often used to explain the Hispanic paradox, but more recent data are causing some to rethink the paradox or at least to differentiate Hispanics by birthplace. Among diabetics in the San Antonio Heart Study, age- and sex-adjusted hazard ratios indicated that U.S.-born Mexican Americans have a 66% greater risk of all-cause mortality and of cardiovascular mortality, compared with non-Hispanic whites, while Mexico-born Mexican Americans appeared to be at similar risk (Diabetes Care 2002;25:1557-63).

A recently published “state-of-the-art” paper on the subject notes that Hispanic ethnicity is marked by a disproportionate cardiometabolic risk burden, largely because of exceedingly high rates of insulin resistance. The authors hypothesize that “the central concept of insulin resistance—compounded by inflammation and neuroendocrine overactivity—may be a predominant etiologic factor for cardiomyopathy in Hispanics” (J. Am. Coll. Cardiol. 2009;53;1167-75).

The authors called for greater representation in patient registries, research studies, and clinical trials, a call echoed by Dr. Piña. She noted that Hispanic or Latino patients made up just 3% of HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), even though they make up about 15% of the total U.S. population. Still, among nine other recent heart failure trials, it was the only one to specifically differentiate Hispanics, instead of lumping them together with other ethnicities as “nonwhites” or “other.”

Dr. Piña disclosed serving as a speaker for AstraZeneca, Novartis, and Merck, and as a consultant for the Food and Drug Administration.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor (TNF)-alpha was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensive patients.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL vs. 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for blacks. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in patients with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor (TNF)-alpha was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensive patients.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL vs. 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for blacks. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in patients with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Plasma levels of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 were surprisingly higher in whites vs. blacks with hypertension in a pilot study of 46 patients.

Tumor necrosis factor (TNF)-alpha was 1.19 pg/mL in 14 white hypertensive patients, compared with 0.62 pg/mL in 12 black hypertensive patients.

Interleukin-6 (IL-6) levels were higher in whites at 1.31 pg/mL vs. 0.79 pg/mL in blacks, Dr. Ralph Watson said at a meeting sponsored by the International Society on Hypertension in Blacks. The difference between groups did not reach statistical significance for either cytokine, likely because of small patient numbers.

The finding is surprising because inflammation is thought to be one of the driving forces behind high blood pressure and end-organ damage, both of which have been shown in several studies to be worse in black than in white hypertensives.

In addition, the few studies that have compared IL-6, TNF-alpha, or C-reactive protein levels in blacks and whites have found either higher levels in blacks or no difference between races.

Dr. Keith Norris, ISHIB conference cochair and interim president of Charles Drew University in Los Angeles, called the data provocative and asked whether weight could be driving the finding. Dr. Watson acknowledged that white hypertensives were slightly heavier at a mean weight of 202 pounds than were African Americans at a mean weight of 193 pounds.

White hypertensives had a slightly lower mean blood pressure of 128/78 mm Hg vs. 134/85 mm Hg for blacks. Members of both groups were aged 59 years, but were on a variety of different antihypertensive medication regimens that may have affected their IL-6 or TNF-alpha levels, said Dr. Watson, director of the hypertension clinic at Michigan State University in East Lansing.

IL-6 levels were significantly higher in the 26 patients with hypertension than in the 20 normotensive patients (1.34 vs. 0.60 pg/mL), as were TNF-alpha levels (1.06 vs. 0.46 pg/mL). This finding confirms several previous studies showing increased levels of inflammatory cytokines in patients with prehypertension and hypertension.

Still, the relationship between inflammation and hypertension remains unclear, Dr. Watson said. IL-6 and TNF-alpha are produced and secreted mainly by activated tissue macrophages in response to injury or infection, and act on endothelial cells at the DNA transcription level. The inflammatory response, however, is also closely intertwined with the process of repair.

“Blacks have far more strokes, end-stage renal disease, and coronary artery disease as a result of their hypertension than whites, and the assumption has been that this is because of increased inflammation contributing to the damage,” Dr. Watson said in an interview. “The question now is whether a lack of inflammation repair of the endothelial damage caused by hypertension could be contributing to the elevated rates of end-organ damage we see in black hypertensives.”

Dr. Watson and colleagues are planning to validate the findings in another 50 black and white hyper- and normotensive patients.

The study was funded by a grant from the National Institutes of Health. The investigators disclosed no relevant conflicts of interest.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg.

Significant improvements were seen in aortic augmentation index, which decreased from 16.6% to 11.1% post treatment, and in time to wave reflection, decreasing from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also quite a significant jump in flow mediated dilation, which increased from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can first of all decrease blood pressure significantly, but also there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease,” she said.

In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is also director of investor relationships for InVasc Therapeutics Inc., a biopharmaceutical company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg.

Significant improvements were seen in aortic augmentation index, which decreased from 16.6% to 11.1% post treatment, and in time to wave reflection, decreasing from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also quite a significant jump in flow mediated dilation, which increased from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can first of all decrease blood pressure significantly, but also there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease,” she said.

In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is also director of investor relationships for InVasc Therapeutics Inc., a biopharmaceutical company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg.

Significant improvements were seen in aortic augmentation index, which decreased from 16.6% to 11.1% post treatment, and in time to wave reflection, decreasing from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also quite a significant jump in flow mediated dilation, which increased from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can first of all decrease blood pressure significantly, but also there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease,” she said.

In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is also director of investor relationships for InVasc Therapeutics Inc., a biopharmaceutical company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.

CHICAGO — Ethnic differences in dyslipidemia should be factored into screening programs for metabolic syndrome, Dr. Anne E. Sumner said at a meeting sponsored by the International Society on Hypertension in Blacks.

Atherogenic dyslipidemia, one of the key criteria used to identify metabolic syndrome, is present more often in whites and Hispanics than in blacks, who tend to have normal triglycerides and low HDL cholesterol levels.

“This challenges the conventional thinking about the interrelationship of triglycerides and HDL,” she said.

A recent unpublished study using National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 showed that the frequency of increased triglycerides was significantly lower in blacks than whites and Hispanics, even after adjustment for sex and body mass index, said Dr. Sumner of the National Institute of Diabetes and Digestive and Kidney Diseases.

An earlier study she published showed that blacks are more likely than whites or Mexican Americans to be insulin resistant and to have triglyceride levels below threshold values used to define enlarged-waist elevated-triglyceride syndrome, overweight lipid syndrome, or hypertriglyceridemic waist syndrome (Athero-sclerosis 2008;196:696-703).

The three syndromes—proposed as better predictors of the onset of coronary artery disease and type 2 diabetes, compared with metabolic syndrome—were defined on the basis of data from populations that were predominantly non-Hispanic white.

“From a public health point of view, the absence of elevated triglycerides in blacks does not mean the absence of risk,” she said. “We need then to beware of screening programs that use triglycerides to diagnose risk.

“Isolated low HDL is a manifestation of insulin resistance and represents a cardiovascular disease risk and therefore should be treated.”

She noted that three studies have shown the benefits of treating low HDL—the Helsinki Heart Study; the Veterans Affairs High-Density Lipoprotein Intervention Trial, which had excellent representation of African Americans; and the INTERHEART Africa Study, conducted in sub-Saharan Africa.

Still, the latest report from the American Heart Association shows that death rates from cardiovascular disease are highest among blacks, despite an overall decline of 26.4% from 1995 to 2005. The death rate from CVD in 2005 was 278.9 per 100,000 persons overall, but was 438.4/100,000 in black men and 319.7/100,000 in black women (Circulation 2009;119:e21-181).

Several factors may contribute to the dyslipidemia pattern seen in blacks, explained Dr. Sumner, who stressed that her views are not those of the U.S. government or the National Institutes of Health. Blacks have higher lipoprotein lipase levels and lower apolipoprotein CIII levels, which promotes elevated triglycerides. Blacks also have less visceral adipose tissue and intrahepatic fat, which results in less production of very-low-density lipoprotein, a major carrier of triglycerides.

Dr. Sumner noted that there is a push underway worldwide to use hypertriglyceridemic waist syndrome to predict cardiovascular risk. The test is cheaper to perform than the metabolic triad, requiring only the simple variables of waist circumference of 90 cm or more in men and at least 85 cm in women and a plasma triglyceride level of 177 mg/dL or more.

This approach works in whites, but not in blacks, Dr. Sumner said. She cited unpublished results from ongoing research in 120 overweight, obese, or prediabetic African Americans showing that 40 had the metabolic triad, but only 3 had a triglyceride level over 177 mg/dL. She suggested that prospective studies are needed to explore whether a reformulation of metabolic syndrome parameter thresholds might optimize risk identification in populations of African ancestry.

Dr. Sumner disclosed no conflicts of interest or study support.

CHICAGO — Ethnic differences in dyslipidemia should be factored into screening programs for metabolic syndrome, Dr. Anne E. Sumner said at a meeting sponsored by the International Society on Hypertension in Blacks.

Atherogenic dyslipidemia, one of the key criteria used to identify metabolic syndrome, is present more often in whites and Hispanics than in blacks, who tend to have normal triglycerides and low HDL cholesterol levels.

“This challenges the conventional thinking about the interrelationship of triglycerides and HDL,” she said.

A recent unpublished study using National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 showed that the frequency of increased triglycerides was significantly lower in blacks than whites and Hispanics, even after adjustment for sex and body mass index, said Dr. Sumner of the National Institute of Diabetes and Digestive and Kidney Diseases.

An earlier study she published showed that blacks are more likely than whites or Mexican Americans to be insulin resistant and to have triglyceride levels below threshold values used to define enlarged-waist elevated-triglyceride syndrome, overweight lipid syndrome, or hypertriglyceridemic waist syndrome (Athero-sclerosis 2008;196:696-703).

The three syndromes—proposed as better predictors of the onset of coronary artery disease and type 2 diabetes, compared with metabolic syndrome—were defined on the basis of data from populations that were predominantly non-Hispanic white.

“From a public health point of view, the absence of elevated triglycerides in blacks does not mean the absence of risk,” she said. “We need then to beware of screening programs that use triglycerides to diagnose risk.

“Isolated low HDL is a manifestation of insulin resistance and represents a cardiovascular disease risk and therefore should be treated.”

She noted that three studies have shown the benefits of treating low HDL—the Helsinki Heart Study; the Veterans Affairs High-Density Lipoprotein Intervention Trial, which had excellent representation of African Americans; and the INTERHEART Africa Study, conducted in sub-Saharan Africa.

Still, the latest report from the American Heart Association shows that death rates from cardiovascular disease are highest among blacks, despite an overall decline of 26.4% from 1995 to 2005. The death rate from CVD in 2005 was 278.9 per 100,000 persons overall, but was 438.4/100,000 in black men and 319.7/100,000 in black women (Circulation 2009;119:e21-181).

Several factors may contribute to the dyslipidemia pattern seen in blacks, explained Dr. Sumner, who stressed that her views are not those of the U.S. government or the National Institutes of Health. Blacks have higher lipoprotein lipase levels and lower apolipoprotein CIII levels, which promotes elevated triglycerides. Blacks also have less visceral adipose tissue and intrahepatic fat, which results in less production of very-low-density lipoprotein, a major carrier of triglycerides.

Dr. Sumner noted that there is a push underway worldwide to use hypertriglyceridemic waist syndrome to predict cardiovascular risk. The test is cheaper to perform than the metabolic triad, requiring only the simple variables of waist circumference of 90 cm or more in men and at least 85 cm in women and a plasma triglyceride level of 177 mg/dL or more.

This approach works in whites, but not in blacks, Dr. Sumner said. She cited unpublished results from ongoing research in 120 overweight, obese, or prediabetic African Americans showing that 40 had the metabolic triad, but only 3 had a triglyceride level over 177 mg/dL. She suggested that prospective studies are needed to explore whether a reformulation of metabolic syndrome parameter thresholds might optimize risk identification in populations of African ancestry.

Dr. Sumner disclosed no conflicts of interest or study support.

CHICAGO — Ethnic differences in dyslipidemia should be factored into screening programs for metabolic syndrome, Dr. Anne E. Sumner said at a meeting sponsored by the International Society on Hypertension in Blacks.

Atherogenic dyslipidemia, one of the key criteria used to identify metabolic syndrome, is present more often in whites and Hispanics than in blacks, who tend to have normal triglycerides and low HDL cholesterol levels.

“This challenges the conventional thinking about the interrelationship of triglycerides and HDL,” she said.

A recent unpublished study using National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 showed that the frequency of increased triglycerides was significantly lower in blacks than whites and Hispanics, even after adjustment for sex and body mass index, said Dr. Sumner of the National Institute of Diabetes and Digestive and Kidney Diseases.

An earlier study she published showed that blacks are more likely than whites or Mexican Americans to be insulin resistant and to have triglyceride levels below threshold values used to define enlarged-waist elevated-triglyceride syndrome, overweight lipid syndrome, or hypertriglyceridemic waist syndrome (Athero-sclerosis 2008;196:696-703).

The three syndromes—proposed as better predictors of the onset of coronary artery disease and type 2 diabetes, compared with metabolic syndrome—were defined on the basis of data from populations that were predominantly non-Hispanic white.

“From a public health point of view, the absence of elevated triglycerides in blacks does not mean the absence of risk,” she said. “We need then to beware of screening programs that use triglycerides to diagnose risk.

“Isolated low HDL is a manifestation of insulin resistance and represents a cardiovascular disease risk and therefore should be treated.”

She noted that three studies have shown the benefits of treating low HDL—the Helsinki Heart Study; the Veterans Affairs High-Density Lipoprotein Intervention Trial, which had excellent representation of African Americans; and the INTERHEART Africa Study, conducted in sub-Saharan Africa.

Still, the latest report from the American Heart Association shows that death rates from cardiovascular disease are highest among blacks, despite an overall decline of 26.4% from 1995 to 2005. The death rate from CVD in 2005 was 278.9 per 100,000 persons overall, but was 438.4/100,000 in black men and 319.7/100,000 in black women (Circulation 2009;119:e21-181).

Several factors may contribute to the dyslipidemia pattern seen in blacks, explained Dr. Sumner, who stressed that her views are not those of the U.S. government or the National Institutes of Health. Blacks have higher lipoprotein lipase levels and lower apolipoprotein CIII levels, which promotes elevated triglycerides. Blacks also have less visceral adipose tissue and intrahepatic fat, which results in less production of very-low-density lipoprotein, a major carrier of triglycerides.

Dr. Sumner noted that there is a push underway worldwide to use hypertriglyceridemic waist syndrome to predict cardiovascular risk. The test is cheaper to perform than the metabolic triad, requiring only the simple variables of waist circumference of 90 cm or more in men and at least 85 cm in women and a plasma triglyceride level of 177 mg/dL or more.

This approach works in whites, but not in blacks, Dr. Sumner said. She cited unpublished results from ongoing research in 120 overweight, obese, or prediabetic African Americans showing that 40 had the metabolic triad, but only 3 had a triglyceride level over 177 mg/dL. She suggested that prospective studies are needed to explore whether a reformulation of metabolic syndrome parameter thresholds might optimize risk identification in populations of African ancestry.

Dr. Sumner disclosed no conflicts of interest or study support.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg. Significant improvements were seen in aortic augmentation index, from 16.6% to 11.1% post treatment, and in time to wave reflection, from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also a significant jump in flow mediated dilation, from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can … decrease blood pressure significantly,” she said, adding that “there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease.” In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is director of investor relationships for InVasc Therapeutics Inc., a company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg. Significant improvements were seen in aortic augmentation index, from 16.6% to 11.1% post treatment, and in time to wave reflection, from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also a significant jump in flow mediated dilation, from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can … decrease blood pressure significantly,” she said, adding that “there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease.” In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is director of investor relationships for InVasc Therapeutics Inc., a company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.

CHICAGO — Monotherapy with the cardioselective beta-1 blocker nebivolol improved vascular function and significantly reduced blood pressure in high-risk, obese African Americans with recently diagnosed stage 1 hypertension, in an open-label study of 43 patients.

The findings are encouraging because the observed vasodilatory effects may be protective against cardiovascular and renal disease in African Americans, a group at high risk of these diseases and in whom hypertension treatment with conventional beta blockers is often suboptimal, Nadya Merchant, Ph.D., and associates reported at a meeting sponsored by the International Society on Hypertension in Blacks.

Mean systolic blood pressure decreased from 143.8 mm Hg at baseline to 133.0 mm Hg in 33 patients who completed 8 weeks of treatment with nebivolol (Bystolic). Diastolic blood pressure decreased from 90.4 mm Hg to 83.6 mm Hg. Significant improvements were seen in aortic augmentation index, from 16.6% to 11.1% post treatment, and in time to wave reflection, from 164 milliseconds to 137 milliseconds. These findings suggest nebivolol improves arterial compliance, said Dr. Merchant, a research fellow in the cardiology department at Emory University in Atlanta.

She noted there was also a significant jump in flow mediated dilation, from 3.4% before treatment to 11% post treatment. Finally, levels of erythrocyte extracellular superoxide dismutase increased with nebivolol treatment from 465.2 units/mL to 537.4 units/mL, suggesting increased bioavailability of nitric oxide.

“These findings imply that nebivolol, if used by obese hypertensive African Americans, can … decrease blood pressure significantly,” she said, adding that “there may be some positive vascular changes and therefore protection against the development of cardiovascular and renal disease.” In the current trial, patients received nebivolol 5 mg per day and were titrated to 10 mg/day if at week 2 there was no change in blood pressure. Their average body mass index was 36.5 kg/m

Forest Pharmaceuticals Inc., which markets nebivolol, provided an unrestricted grant and the study drug. Dr. Merchant is director of investor relationships for InVasc Therapeutics Inc., a company in Tucker, Ga., that develops drugs for diabetes and cardiovascular diseases.