High Blood Pressure Research Council of Australia

HBPRCA Enews – March 2011

Greetings from Rob Widdop and the HBPRCA Executive

RobWiddop

This e-news is an opportunity to update you on HBPRCA activities, and also to encourage you to renew your membership if you haven’t yet done so. We are asking everyone to use the online form.As the new Secretary for HBPRCA e-news, I would like to introduce a few new items to maintain the high interest that has been developed for this publication over recent years by Geoff Head and the previous Council. For starters, I will be asking a senior member of the Council to write a small piece in which he/she identifies an important paper published recently in their field (preferably in the last 12 months), and articulate why this paper is, or will be, important and influential. This opinion piece or ‘sound bite’ will hopefully provide an opportunity to share the collective wisdom of our Council members on a range of topics that will be appreciated by our newer and established members alike. Speaking of new members, we are introducing a snapshot segment promoting our new Student and Full members each e-news. Remember the photos and introduce yourself to our new members and make them welcome at the next Council event! Please feel free to email me with any comments and suggestions. Rob Widdop, HBPRCA Secretary 

ISH2012 – As you are all aware, the HBPRCA will be hosting ISH 2012 in Sydney, 30 September – 3 October. As members of the HBPRCA, we would like you to advertise the Symposium, by downloading this slide and including it at the end of your presentations. Please click here to download.

  • Are you going to ESH? We will be promoting ISH 2012 – Hypertension Sydney 2012 – at the ESH meeting. It’s really important that HBPRCA members are visible during the refreshment breaks at the promotional stand. Please email the secretariat if you are going – a roster will be drawn up so that everyone gets a chance to be involved!
  • Are you under 40 and willing to be part of the ISH 2012 New Investigator Ambassador Program? The Organising Committee would very much like to attact New Investigators from around the world, and need your help to promote the meeting, with ideas which might appeal to those of similar age and, let’s be real, with the new technology. A great line on your CV …. to apply, please email the secretariat

In This Issue

President’s Message
2011 Annual Scientific Meeting News
Soundbite
Membership Update
Membership Initiatives Research Grants/Project
Society Liaison News Franco Exchange Applications open, ASMR call for action, BHS meeting invite
Executive
Upcoming Meetings  Travel grants/YI awrds @ APCH 

President’s Message – Jaye Chin-Dusting

Chin-DustingJayeThe new HBPRCA Executive has hit the ground running. As so many on the committee were newly elected, we held a Strategy Day in early February. This enabled everyone to very rapidly get up to speed as to how the Council is managed on a day to day basis, and to brain-storm on new initiatives and concepts. The enthusiasm from all elected has been terrific and all I can say is watch this space. Critically, and as highlighted by ASMR and many other peak medical research interest groups, there are currently some very real concerns with regards potential NHMRC budget cuts. These will have significant impact not only for our sector but indeed on the nation’s long term health and economic wellbeing. The HBPRCA Exec has written to the PM, the Hon Julia Gillard with our concerns on this issue and urge all members to similarly get behind the campaign to defend the NHMRC budget (see below). As we know better than most, “Discoveries need Dollars“.

As well

  • We have been inundated with requests from medical journalists for comments on newly published articles, with “The Australian Doctor Magazine” now seeing the HBPRCA as the primary reference point for blood pressure and cardiovascular issues. This periodical reaches many thousands of GPs and have requested that we proactively feed to them topical issues as we see fit. Let me know if there is such an issue you would like to offer.
  • The Better Blood Pressure Measurement Initiative continues, with a recent letter to GPs outlining the benefits of using automated devices (thanks to Servier for distributing the letter). We have since been swamped with over 100 further requests for more machines! There are, however, none left. Interestingly a handful have also written for advice with regards the accuracy of automated BP readings in such situations as atrial fibrillation.
    • The Off the Cuff DVD is also still being requested
    • We are in discussion with Boehringer-Ingelheim regarding a new pilot project for the placement of automated BP machines in GP waiting rooms
  • Plans for World Hypertension Day continue, with thanks to Ogilvy Healthworld for their support
  • Plans for the ASM are underway, more details are below – please mark your diary (December 7-9) and check out fares and hotels now, as Perth will be very busy at that time of year

Finally, our congratulations to Eduardo Pimenta, on the birth of his first child. He tells us he is up to his eyeballs in nappies!

2011 Annual Scientific Meeting News from Anne Barden and Jim Sharman

As Jaye mentioned, please check out airfares and accommodation now – we really would like to see you in Perth, for the 2011 Annual Scientific Meeting (December 7 – 9).

Highlights

  • Professor Peter Rothwell, Professor of Clinical Neurology, John Radcliffe Hospital Oxford – RD Wright Lecture
  • Professor Rob Parton, University of Queensland – Austin Doyle Lecture
  • Associate Professor Martin Ng, University of Sydney – Colin I Johnston Lecture
  • Wednesday is conjoint with ASCEPT and AuPS – a great chance for networking!
  • Joint conference dinner on Wednesday evening
  • Student symposium and function on Tuesday evening
  • Student poster judging (yes, the students adjudicate on the poster quality) will be incorporated
  • ANCHA will again be joining us – please make sure any nurses working in the field know about the meeting
  • Student registration fees will be highly subsidised by HBPRCA

We look forward to seeing you in Perth – Anne Barden and Jim Sharman

Soundbite

Australia has been punching above it’s weight in the field of blood pressure research for several decades, which means that the depth of knowledge and insight which members of HBPRCA possess is really quite astounding. I have invited one of our founding members, Professor John Chalmers of The George Institute for Global health to contribute the first HBPRCA Soundbite – thoughts on an important paper published recently with a comment on why this paper is, or will be, important and JohnChalmersinfluential. Over time, Soundbite will provide an opportunity to share the collective wisdom of Council members on a range of topics.

Soundbite from John Chalmers
Emeritus Professor of Medicine, University of Sydney
The George Institute for Global Health

The Scandinavian Candesartan Acute Stroke Trial (SCAST). Lancet 2011; 377:741-50.

This is the first truly large scale randomized placebo controlled trial to report on the effects of blood pressure lowering in acute stroke. Sandset et al report that treatment with oral candesartan administered to patients with stroke, either haemorrhagic or ischaemic, did not confer any significant benefits. (1) In fact there was a trend to higher risk of major vascular events and of poor functional outcome at 6 months in patients receiving active treatment. This will be very disappointing for patients who suffer stroke and for their doctors and nurses, since there are few alternative treatments that can be offered, particularly for patients with haemorrhagic stroke. (2)

It is, however, important to stress that the results of SCAST are not definitive and do not exclude the possibility of real benefits from blood pressure lowering in acute stroke. While the trial was rigorously conducted in full double blind manner, it did have two design features that mitigated against a positive outcome. Firstly, the oral regimen for active treatment with candesartan involved a slowly increasing “fixed dose escalation” scheme that delivered only very small reductions in systolic blood pressure compared to placebo – <1mmHg in the first 24 hours, 3.3 mm Hg on day 2 and 5mmHg from day 4 to 7, after which active treatment ceased.

Secondly, SCAST allowed a time window of up to 30 hours between onset of stroke and admission to the trial, with an average interval of 18 hours before the start of active treatment. The problem is that the only evidence we have for benefit of treatment for acute stroke is for strategies implemented in the first few hours after onset. Thus thrombolytic treatment is associated with improved outcome when treatment is initiated in the first 3 hours or at most the first 4.5 hours (3-5). And the pilot phase of the INTERACT trial in patients with cerebral haemorrhage reported a trend to restriction of haematoma growth when intravenous blood pressure lowering treatment was initiated within the first 6 hours. (6, 7) Indeed, in the SCAST trial, the only significant benefit reported was in a subgroup of patients treated within 6 hours, where there was a halving of the primary composite outcome of vascular death, myocardial infarction or stroke at 6 months.(1)

Therefore, we must suspend judgment on what we should do about blood pressure in acute stroke until other large scale trials provide more evidence. Fortunately, some are under way (these include ENOS, INTERACT2, ATTACH II and ENCHANTED). (8-11)

References

  1. Sandset, E.C. bath P, Boysen G et al. on behalf of the SCAST Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 377, 741-750 (2011).
  2. Bath P, Chalmers J, Powers W, et al. International Society of Hypertension (ISH): statement on the management of blood pressure in acute stroke. J Hypertens 2003;21: 665-72.
  3. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581-7.
  4. The ATLANTIS, ECASS and NINDS rt-PA study group investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials. Lancet 2004;363:768-74.
  5. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-29.
  6. Anderson CS, Huang Y, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 2008;7:391-9.
  7. Arima, H. et al. Effects of early intensive blood pressure lowering on haematoma growth in acute intracerebral haemorrhage according to time from onset to treatment: the INTERACT study. Cerebrovasc. Dis. 27(Suppl 6), 16 (2009).
  8. The ENOS Trial Investigators. Glyceryl trinitrate vs. control, and continuing vs. stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the Efficacy of Nitric Oxide in Stroke (ENOS) trial (ISRCTN99414122). Int. J. Stroke. 1, 245-249 (2006).
  9. Delcourt C, Huang Y, Wang J, et al. The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT2). Int J Stroke 2010;5:110-16.
  10. Antihypertensive Treatment in Acute Cerebral Hemorrhage-II (ATTACH-II). http://clinicaltrials.gov/ct2/show/NCT01176565 (Accessed 15 Mar, 2011)
  11. Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). http://www.anzctr.org.au/ACTRN1261000236998.aspx (Accessed 15 Mar, 2011)

Membership News from Janna Morrison

JannaMorrisonThank you to those of you (about 80) that have taken the time to renew your membership in the HBPRCA . And welcome to the three membership applicants – go Tassie! It is a great time to be part of this vibrant and growing scientific society. If you haven’t yet renewed your membership, please visit the Meetings First website via this link, log in, follow the prompts, and voila! All done. Membership renewal is due by March 31. Don’t forget, students don’t pay membership fees – so why not invite appropriate colleagues to be a member?

Rob Widdop has also been busy making sure that new members feel a real part of the Council. We would like to introduce some new members – Kayla Viegas,  Daniela Sartor, Brad Broughton and Ivy Shiue.

New student member – Kayla Viegas

New full member – Daniela Sartor

KaylaViegasI completed my Bachelors degree in Manufacturing Engineering at the University of Ontario Institute of Technology, in Oshawa, Ontario, Canada, the small city I grew up in. I then went on to do a Master of Science in Biomedical Engineering in western Canada at the University of Calgary. My master’s thesis examined the influence of shear stress on adherence of methicillin-resistant Staphylococcus aureus to human endothelial cells. In July of 2010, after taking some time off to do some travelling and volunteer work, I moved to beautiful Sydney, Australia. I’m now in the first year of my PhD with Professor Alberto Avolio’s research group in the Australian School of Advanced Medicine at Macquarie University. My research here involves investigating cellular and molecular mechanisms of arterial stiffness. In particular, I’ll be using knockout mice to look at the role of nitric oxide in regulating the activity of the enzyme transglutaminase 2, which can crosslink extracellular matrix proteins, thereby affecting arterial stiffness. DanielaSartorI conducted my PhD studies in the Department of Clinical Pharmacology, University of Melbourne at Austin Health in Heidelberg under the supervision of A/Prof Tony Verberne. My doctoral research involved the use of complex electrophysiological techniques to evaluate the role of the gastrointestinal hormones in sympathetic vasomotor function and cardiovascular regulation. Since the completion of my PhD in 2005, I have become increasingly interested in understanding the pathophysiology of obesity-related hypertension and have been able to attract funding to carry out independent research. In 2009 I was awarded an NH&MRC New Investigator Project Grant (2010-2012) to examine the potential role of gastrointestinal signals in the aetiology of obesity-related hypertension using a polygenic rodent model, and was promoted to Senior Research Officer in the Department of Medicine (University of Melbourne) at Austin Health. Most recently I have also been working in collaboration with A/Prof James Brock and Professor John Furness to examine the cardiovascular actions of compounds acting at the ghrelin receptor (NH&MRC Project Grant 2011-2013). I have recently been given the opportunity to establish my own laboratory and research team. Becoming a member of the HBPRCA presents a great opportunity to be a part of the vibrant cardiovascular research community and for forging links with peers and senior council members.
 New student member – Ivy Shiue New full member – Brad Broughton
IvyShiue I am a PhD candidate in my last year working with Professor Craig S. Anderson and Dr Hisatomi Arima at The George Institute for Global Health, University of Sydney. My PhD focus is on epidemiology of subarachnoid haemorrhage (SAH), the least common but most lethal type of stroke, assessing incidence, case-fatality, and risk factors. I run secondary analysis for ACROSS (Australasian Cooperative Research Of Subarachnoid haemorrage Study) specific on life events, dietary intake, blood pressure measurement, and impact of size and location of ruptured aneurysm on medical complications and in-hospital deaths after SAH. I also calculate population attributable risks for SAH. In addition, I initiated a new 2-year study based on ACROSS, CHERISH (CHina Epidemiology Research In Subarachnoid Haemorrhage), in Baotou, Inner Mongolia with follow-up at 6 months to finish in November 2011. The aim is to study incidence, case-fatality, risk factors, management, and outcomes in the Chinese population. At the moment, my thesis is under review by my supervisor and I plan to submit by the end of this March. BroughtonBrad Broughton obtained his Ph.D. in 2005 in the School of Biological and Chemical Sciences at Deakin University under the supervision of Associate Professor John Donald in the area of nitric oxide signalling in lower vertebrate blood vessels. Brad then moved to the University of New Mexico in the United States where he was an American Heart Foundation Postdoctoral Fellow under the mentorship of Associate Professor Tom Resta. During this time, the overall focus of his research was to better understand the calcium signalling mechanisms associated with chronic hypoxia induced-pulmonary hypertension. Shortly after returning to Australia in 2008, Brad was awarded a National Heart Foundation Postdoctoral Fellowship and joined the Vascular Biology and Immunopharmacology Group in the Department of Pharmacology at Monash University under the supervision of Associate Professor Chris Sobey. Brad’s current studies involve examining apoptosis and G protein-coupled oestrogen receptor signalling in the brain following stroke and using stem cells to treat stroke-induced injury in the setting of cardiovascular diseases (i.e. hypertension, hypercholesterolaemia).

Member Initiatives

CALL FOR INTEREST IN PARTICIPATION OF THE ‘EXERCISE-BP-CONTROL STUDY’ – AN INITIATIVE SUPPORTED BY THE EXECUTIVE COMMITTEE OF THE HBPRCA

The general aim of this initiative is to determine the prognostic utility of BP acquired during an exercise stress test to predict BP control. The findings may help improve the identification of individuals at higher risk related to BP who may otherwise go undetected. If you have access to BP acquired during an exercise stress test, as well as ambulatory (or home) BP data and basic clinical information on these individuals, please read on……

Background
Healthy people with ‘normal’ BP at rest (<140/90 mmHg) but an exaggerated BP response to exercise (e.g. ≥210/105 mmHg in men or ≥190/105 mmHg in women) are at significantly greater risk of cardiovascular events and mortality. Interestingly, exercise BP predicts future development of hypertension and cardiovascular outcomes independent from resting blood pressure. The reasons underlying the additional prognostic value of exercise BP beyond resting BP are unknown. However, recent data suggests that people with exaggerated exercise BP may have masked hypertension (‘normal’ clinic BP and raised BP outside the clinic) and this could be a major factor contributing to increased risk.

This also raises the possibility that individuals at increased risk related to BP may be identified from the BP response to exercise. Exercise stress testing is commonly used to screen for myocardial ischaemia. The test is usually supervised by a clinician who records resting BP as well as the exercise BPs through increasing intensity of effort. An exaggerated BP response may be noted as an abnormality of the exercise test, but there are no guidelines as to appropriate management thereafter. To our knowledge there has never been a study to determine if exercise BP can help identify BP control and this is the principle aim of the initiative. It is hypothesised that an exaggerated BP response to exercise will have good sensitivity and specificity for predicting the presence of masked hypertension.

Data required for analysis**

  • Exercise BP (acquired during a conventional exercise stress test – preferably including BPs at all levels of exercise)
  • Clinic BP
  • Out of office BP (24 ABPM or home BP)
  • Basic patient characteristics (e.g. age, gender, BMI, antihypertensive medications)

**Since the presence of left ventricular dysfunction due to coronary artery disease is known to impair the ‘normal’ exercise BP response, it will be important to know the result of the exercise stress test (i.e. positive or negative for ischaemia) or other relevant clinical tests to rule out coronary artery disease.

Similar to the recent ABPM initiative headed by Geoff Head it is expected that pooling data from several thousand study participants will be required to assess the study question. Findings are expected to be published in a peer-reviewed journal with authorship offered to contributing parties.

Would those interested in participating this this initiative please email James.Sharman@menzies.utas.edu.au

ANNOUNCEMENT – BETTER BLOOD PRESSURE MEASUREMENT INITIATIVE RESEARCH GRANTS

In 2004, the High Blood Pressure Research Council of Australia established the Better Blood Pressure Measurement initiative with the support of Servier Australia Ltd. Through this initiative the Council has supported several important research projects regarding the measurement of blood pressure. These have included grants to:

The Executive would like to announce that two grants of AUD10,000 + GST will be made available during 2011. It is envisaged that these grants might be used to fund small projects in the broader area of blood pressure, perhaps in generating pilot data needed for a larger application to another funding body.

Expressions of interest should be no longer than 2 pages and should include potential investigators, rationale, experimental design and an indicative budget. They should be sent to the Secretariat by email to be received no later than Friday 27 May.

We look forward to receiving your plans.

Society Liaison from Chris Reid

Parlez vous Francais? Franco Australian Exchange Program

The HBRPCA maintains a link with our French counterparts Société Française d’Hypertension Artérielle (SFHTA) in which we will provide financial support (airfare and accommodation) for members wishing to spend a short time (1-3 month(s)) working in a laboratory in each other’s country. The exchange program will sponsor one person each way, fostering collaborative projects between French and Australian Hypertension researchers. There are no age limits or prerequisites apart from being a member of either group. To apply complete the application form and send to the HBPRCA secretariat, along with your CV. Please be sure you have agreement of the host laboratory before you apply.

  • The deadline for applications will be Friday 27 May 2011 – for travel during 2012
  • To download an application form, please click FrancoExchangeAppForm
  • Applications will be judged by a panel of the HBPRCA Executive Committee and notification expected to be made within 4 weeks of the application deadline.
  • The degree of support is anticipated to be AUD$2,500 toward the airfare and 900 euros per month towards the cost of accommodation (approx AUD7000 max).
  • The winner will be required to write a feature article (in English) with photos for the e-news!!

We would like to thank Servier Laboratories for their continued support of this program.

ASMR Call for Action

In this time of fiscal pressure from both the global economic decline and recent onslaught of natural disasters, government budgetary constraints will ensue. The current NHMRC budget, which in real terms is declining, is under significant threat of being cut.

It is imperative that we unite as a sector and continue to advocate that HMR underpins health delivery and is a pivotal component of the governments vision for healthcare reform in Australia. In the 2011/2012 Federal Budget ASMR is asking the government to:

  1. Maintain NHMRC budget in real terms
  2. Facilitate the implementation of the Government’s health reform agenda through increased support for Australia’s world-class health and medical research (HMR) workforce.

The ASMR is urging all of its members to write to the Prime Minister, Treasurer, Health Ministers and your local MP to advocate for the maintenance of NHMRC funding in the Federal Budget. Also, visit your local MP or invite them to your institution so they can observe HMR at the coalface.

For your information a fact sheet and template letter is attached along with the email addresses for the PM, Treasurer, Health Ministers and their Opposition shadows. Email addresses of other MP’s are all available on the ASMR website http://www.asmr.org.au/campaign.html

We can make a difference in Canberra, and we have the track record to prove it …. please send your letters today!

Dr Emma Parkinson-Lawrence
President, The Australian Society for Medical Research (ASMR)

Another site designed to help you campaign “Discoveries need Dollars“.

British Hypertension Society invites HBPRCA members to attend their meeting

For the first time in its 30 year history, the meeting is open to both members and non-members and you are invited to submit abstracts (deadline: 3rd May 2011). The Society wrote saying they very much look forward to welcoming the HBPRCA winner from last December, Eduardo Pimenta, to the conference, and espeically invited HBPRCA to attend and may register at BHS members rates. BHS 2011 – Main Announcement and Call for Abstracts

DROP THE SALT!

Click here for the latest AWASH Campaign Bulletin which includes information on International Salt Awareness Week 2011, our latest research on salt levels in Australian bread products, details of the outcomes of a string of international meetings on salt reduction and current media work.

Become an AWASH Supporter: Don’t forget that the success of the Drop the Salt! campaign depends on widespread support from all stakeholders including consumers, industry, government and other interested groups. If you support AWASH’s mission and goals, why not sign on to become a supporter? Becoming an AWASH supporter is free. Click here for more information, or to sign up as a supporter.

Who are the Executive – really?

Each e-news, we will highlight one or two of the Executive so that members get to know them better. This issue, Faline Howes – Student Representative.

HowesFalineI am delighted to be the student representative on the High Blood Pressure Research Council of Australia. I am a general practitioner and have been working as a research associate at the Menzies Research Institute, Tasmania. I will continue my research as a PhD which commences this year [2011]. My research interests include further developing our understanding of clinical decision-making in the management of hypertension in general practice, knowledge translation and primary prevention. I have an interest in combining qualitative and quantitative research methods in order to fully explore the complex questions that face the primary health care setting. The Council has a strong history of supporting and encouraging students as the next generation of leaders in BP research and I want to play a major role in continuing to represent the needs and views of students. Please feel free to contact me with any ideas or issues that you feel need to be addressed further Faline.Howes@utas.edu.au.

Meetings in 2011

1st Asia Pacific Congress on Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)2-5 June 2011
Kerry Hotel Pudong, Shanghai, China
Click here for meeting website
8th Asian-Pacific Congress of Hypertension 2011 (8th APCH 2011)24 – 27 November 2011
Taipei International Convention Center (TICC), Taiwan
Click here for meeting website APSH invite HBPRCA members to attend. To assist the attendance of young investigators (<45y) there are a number of young investigator awards ($1000US) together with complimentary registration. There is also a Young Investigators Award ($1000US) for the best oral presentation.Details about the meeting can be obtained an www.apch2011.tw and the secretariat can be contacted on secretariat@apch2011.tw

Acknowledgements

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