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High Blood Pressure Research Council of Australia |
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HBPRCA Email
Newsletter
March-April 2010
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Welcome Note from
Geoff Head
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ISH2012 – As you are all aware, the HBPRCA
will be hosting ISH2012 in Sydney, 30 September – 3 October. As members of
the HBPRCA, we would like you to advertise the Congress, by downloading the
slides and including them at the end of your presentations. Please click here to download. ISH2010 – will be in Vancouver on the 26th-30th
September. PowerPoint slides available here. 2010 Annual
Scientific Meeting News Ambulatory
Blood Pressure Monitoring (ABPM) Working Group Initiative |
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President’s Message from Stephen Harrap |
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However, WHD 2010 will be even bigger
and of greater impact if things go according to plan. We have been delighted
that one of the biggest advertising agencies in the world – Ogilvy – has,
through Ogilvy Healthworld in Australia, taken on the HBPRCA as a pro bono
client. We owe a debt of thanks to Vicky Stavroulakis from
Boehringer-Ingelheim who through contacts with Ibi Szentirmay and Graham
Edwards put us in touch with Ogilvy Healthworld.
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2010 Annual Scientific Meeting News from Kate Denton
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Mark this in your diaries! Wednesday 1 – Friday 3
December 2010 |
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The grants are in (hopefully), and now
we are making advances with this year’s Annual Scientific Meeting to be held
at the Crown Conference Centre, Melbourne in December. Our three main speakers have been invited
and they have all accepted; Professor David Harrison, Professor David
Celermajer and Dr Anthony Ashton. This
year the meeting will commence late
Wednesday afternoon with our Austin Doyle lecturer presenting “Voyages in
vessels – non-invasive detection of vascular disease” followed by posters,
including some moderated prizes, and welcome drinks! A convivial evening of friends and science
to get our meeting off to a great start.
Colin Johnston lecturer – Dr
Anthony Ashton is an R. Douglas Wright Fellow,
NH&MRC, Senior Lecturer, University of Sydney and Scientific Director,
Division of Perinatal Research, Royal North Shore Hospital. Anthony is a
vascular biologist with significant experience in the manipulation of blood
vessel formation. He undertook post-doctoral training at the Albert Einstein
College of Medicine in New York. Whilst in New York he published several
seminal manuscripts on the regulation of blood vessel formation in
cardiovascular disease. In 2006 Anthony was awarded a NHMRC Biomedical Career
Development Award to return to the Perinatal group and explore his unique
findings examining the role of human-specific genes in complications of
pregnancy. In January 2007 he was awarded the positions of Scientific
Director of Basic Research and Team Leader of the Program into Vascular
Development and Placentation at the Perinatal Research group in the Kolling
Institute. His main research interests are in understanding the basis
for the formation of new blood vessels, the destruction of existing blood vessels
and how these processes are altered to complicate multiple processes,
including placental formation and fetal development. |
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Workshop News from Geoff Head
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This years annual workshop will be for
a half day only in order to give the main meeting more time and allow a less
crowded feeling. The theme for the
workshop hasn’t yet been finally decided but our working title is ”Better Blood Pressure Measurement”
which will focus on issues relating to clinic, ambulatory and home blood
pressure measurements and techniques. If you would like to make a
contribution to the sessions please feel free to contact me via the Secretariat. |
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Membership News from Doug
McKitrick
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March 31st was the annual subscription
due date for the HBPRCA. If you have thus far overlooked paying it’s still
not too late! Simply go to the HBPRCA website (http://www.hbprca.com.au/)
and follow the link on the left for access to the secure payment site or to
download a form for return by post. If you don’t have internet access, can’t
remember if you have paid, or just need a bit of help, contact the
Secretariat by phone, fax or post (details below). Don’t forget to encourage your
graduate students and post docs to take out membership with the Council (free
for students!). The special initiatives that have been introduced are
specifically intended to benefit student and early career members. And of
course participating in the vibrant Annual Scientific Meeting is a tremendous
opportunity for you, your post-docs, students and research associates to see
and discuss the broad research interests of the council and share your own. |
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Society Liaison News from Bruce
Neal
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Not a great deal to report after the flurry
of announcements about the winners of the various HBPRCA awards in the last
Update. January is definitely a slow
news quarter. I am, however, pleased
to tell you that we now have the name of the winner of the Goldblatt Award
from the US. Christian Delles from Glasgow will be joining us at our meeting
in Melbourne at the end of the year.
Fortunately, Michael De Silva, has saved my skin with a very nice
report on his trip to the US last year.
So I will leave you with that: “As a
recipient of the High Blood Pressure Research Council of Australia Young
Investigator Award, I was given the wonderful opportunity to attend the 63rd
High Blood Pressure Research Conference held by the American Council for High
Blood Pressure Research in Chicago, USA (September 23rd - 26th 2009). The
High Blood Pressure Research Council of Australia was extremely generous in
providing me with financial assistance to attend this conference, and in
organizing the opportunity to present my research as an oral communication. The
conference attracted numerous distinguished scientists in the field of
cardiovascular research and the presentations I attended by these researchers
were both varied and stimulating. Following the Harry Goldblatt Awards
session, which was full of interesting presentations by young post-doctoral
researchers, I tried to suppress my nerves as I gave my presentation titled
“Defining the Role(s) of Nox2-Containing NADPH Oxidase in the Cerebral
Circulation”. This was an immense honour to be able to present my work at
this conference and it no doubt increased my exposure to the international
scientific community. In
addition to attending the conference, I was fortunate to visit the research
laboratories of Professor Frank Faraci at the University of Iowa in Iowa City
and Professor Neil Granger at the Louisiana State University Health Sciences
Center in Shreveport. These lab visits were extremely beneficial as I was
able to meet two highly regarded scientists in the field of cardiovascular
research. I was also fortunate to be invited to present a seminar and
received many positive comments about my research. I am
extremely grateful to the High Blood Pressure Research Council of Australia
for organizing this amazing opportunity. Thank you.”
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63rd
High Blood Pressure Research Conference Report T.
Michael De Silva Chicago,
Illinois, USA |
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Ambulatory Blood Pressure Monitoring (ABPM) Working Group Initiative
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Members:
Geoff Head, Susie Mihailidou, Karen Duggan, Alexandra Bune, James Sharman,
Arduino Mangoni, Peter Howe, Narelle Berry, Diane Cowley, Michael Stowasser,
Lawrie Beilin, Jonathan Hodgson, John Chalmers, Carla Morey, Mark
Nelson, Mark Brown, Barry McGrath and John Ludbrook We have continued our
analysis of the very large dataset we have gathered and this time compared
the influence of obesity of setting ambulatory targets for hypertension
management. To this end we submitted the abstract below to ISH. Objective: Although
ambulatory blood pressure (ABP) equivalents exist for the diagnosis of
hypertension, there are limited ABP equivalents for target blood pressure (BP)
in the management of hypertension. Our collaborative initiative has derived
reference ABP equivalents for the clinic BP targets used in hypertension
diagnosis and management (BMJ, in press). Considering the increasing
prevalence of obesity as a risk factor for hypertension, we have since
compared these targets in age and gender matched cohorts of obese with body
mass index (BMI) >30 and lean subjects (BMI < 25). Design and Methods: Data
obtained from 2023 individuals using validated devices for 24 hour ABPM were
collated from multiple centres across Australia. Seated or supine clinic BP
was measured by trained non-medical health professionals to minimise white
coat effect. Least product linear regression analysis was used to relate
clinic BP and ABP values, with the resultant regression equations being used
to generate ABP equivalents for the lower limit of grade 1 hypertension
(equivalent to 140/90 mmHg) or therapeutic target (130/80 mmHg). Results: Both groups were
50% female and aged 53.8 years. Obese subjects had average BMI of 34.4 and
clinic BP 143/85 mmHg (n=1403). Lean subjects had BMI of 22.6 and clinic BP
140/83 mmHg (n=619). Daytime ABP equivalent for clinic 140/90 mmHg was 132/86
mmHg for lean and 134/83 mmHg for obese. Day ABP equivalents of target clinic
BP of 130/80 mmHg values were 126/78 for lean and 126/75 mmHg for obese
subjects. Conclusions: The similarity
of clinic BP and daytime ABP readings across a wide BP range in both lean and
obese individuals indicates that accepted targets for clinic BP management
are also applicable as targets for ABP, regardless of the presence of
obesity. Feature Article - How do general practitioners manage their hypertensive patients? from Faline Howes and Mark Nelson, University of Tasmania
We conducted a qualitative
study that was presented at the HBPRCA ASM in 2009. Six focus groups were
undertaken with 30 GPs and GP registrars in 2008. Common emerging themes were derived by an
iterative thematic analysis. Analysis was contemporary and ceased when no new
issues emerged suggesting data saturation. The themes developed capture GPs’
descriptions of why it is difficult for them to diagnose and manage
hypertension. Barriers to initiating treatment and treating to target were
often discussed at the same time, with issues surrounding treatment to target
dominating conversation. Clinical
uncertainty about the true blood pressure value and a distrust of the
technology used to measure blood pressure Most participants expressed
uncertainty regarding the accuracy and representativeness of individual BP
readings taken in the clinic. Participants expressed a lack of confidence in
the HBPRCA distributed OMRON HEM-907, questioning their accuracy and
reliability. GPs described a process of “mental adjustment” of BP readings.
They were adjusted down to ‘better represent’ what was thought to be the
patient’s ‘true’ underlying BP. It also involved taking multiple readings and
accepting the lowest as the most representative. Distrust of
the evidence underpinning hypertension management Rather than large gaps in
knowledge and awareness of the management of hypertension, there was an
element of distrust toward the evidence underpinning it. Participants had
seen major changes in the evidence during their own careers, for example,
“systolic was previously 100 plus your age”. Questions were raised about the
risk-benefit ratio for treating the elderly. Distrust was also reflected in
comments such as “targets are continually being revised lower and lower”. Patient age,
gender and co-morbidity The two extremes of the
lifecycle were felt to fall outside the limits of the available evidence.
Children and adolescents were seen as a challenge and one that would increase
in the future given the obesity epidemic. Participants were reluctant to
initiate and treat to target in the elderly due to the witnessing of adverse
events. The fear of the consequences of treating a person’s hypertension was
far greater than the fear of the consequences of not treating it. Men were described as
difficult particularly if young, busy, overweight, single or heavy consumers
of alcohol. In terms of co-morbidity the main groups included: the anxious,
those with another disease as the main focus of treatment, and renal patients
with lower targets, and difficult to manage side effects and interactions.
Culturally and linguistically diverse populations were also seen as
challenging. Perceived
patient attitude Patients were often
described as being reluctant or unwilling to both commence anti-hypertensives
and to adhere to treatment in the long term. Delay or failure to initiate was
attributed to some patients preferring an initial trial of lifestyle
modification, reluctance to take an additional medication, patient’s previous
experience with side effects, a lack of understanding of risk, and a lack of
persuasiveness by the GP. Particularly with regards
to making lifestyle changes, GPs described patients’ as often lacking the
motivation to change and being reluctant to take responsibility for their own
healthcare. The medical literacy of patients was raised and concern expressed
about how the public perceives both the concepts of BP and cardiovascular
risk. Clinical
inertia Clinical inertia was
evident in discussions around making a diagnosis, providing advice on
lifestyle change and treating to target. Associated issues included a time
poor environment, perceived patient attitude and difficulties encountered in
a group practice: a few participants described reluctance to initiate
treatment in ‘someone else’s patient’ despite repeated high BPs having been
recorded. Most participants’ stated
that their knowledge of lifestyle factors and how to manage them was
adequate; the overriding problem was the lack of success seen in practice. This
led to a lack of motivation. With regards to reaching
target, waning motivation was also described as a ‘mental slowing down’. This was related to how close to target the
patient’s BP was, the number of comorbidities they had, and the degree of polypharmacy.
Failure to reach target was further justified by discussing BP as a
continuum, with small improvements viewed as a therapeutic success. Patient-centred
care The GPs described a
comprehensive, holistic approach to patient care. Participants stated they
individualised the approach to hypertension management. Biomedical
information was integrated with patient concerns and context. Cost was viewed as a major
barrier for some patients, particularly those who did not qualify for
government healthcare benefits. One practice located in a socioeconomically
disadvantaged area, described financial costs and the role of stress in their
patients’ lives as a major contributor to their decision-making. Systems issues Systems issues included a
lack of resources and a lack of time. To monitor therapy more accurately,
more automated machines for home monitoring and greater access to ambulatory
BP monitoring were considered of need.
Hypertension was viewed as a general practice area of speciality
rather than a specialist area of care. However, practitioners found it
difficult to identify specialists with a primary interest in hypertension
management to refer to and identified timely access to specialists and allied
health practitioners as an issue. Time was raised as an
issue. The lack of time in consultations related to the complexity of
managing hypertension concurrently with other chronic disease and it related
to competing demands where doctor and patient agendas may not harmonise. Addressing
these concerns Further research is
required into the process of care to further develop the evidence base for
hypertension management strategies. The HBPRCA is funding us to conduct
further qualitative research to address the barriers to the uptake of
evidence-based care. REFERENCES 1. Britt H, Miller GC,
Charles J, Henderson J, et al. General
practice activity in Australia 2007-08. General practice series no. 22.
Cat. no. GEP 22 Canberra: AIHW; 2008. 2. Phillips LS, Branch WT,
Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med 2001; 135(9):825-34. |
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Upcoming Meetings
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The 23rd Scientific Meeting of the International Society of Hypertension
Register now! Click here
to register. The one-year Countdown to the 23rd
Scientific Meeting of the International Society of Hypertension (ISH
2010) to be held September 26 - 30, 2010 in beautiful Vancouver, British
Columbia, Canada is on! This important International Meeting, focussing
on Global Cardiovascular Risk Reduction will be at the forefront of
new concepts in basic, clinical and population science. Online abstract
submission ISH 2010 is already
accepting abstract submissions. Early decisions on acceptance of abstracts
will give participants who require travel visas a longer lead time for
applications. The three major program tracts are Basic Science, Clinical
Science, and Population Health / Public Policy. The target audience includes
Basic Scientists, Clinicians (Cardiology, Endocrinology, General Medicine,
Neurology, Nephrology, Primary Care Physicians, Nurses, Nutritionists and
Pharmacists), and Population Health and Public Policy specialists and is
inclusive of all individuals interested in cardiovascular health. Complete
guidelines and directions on how to submit an abstract can be found on the ISH 2010 website. Meeting objectives The ISH 2010 theme, Global
Cardiovascular Risk Reduction, will capture the newest information in the
field of hypertension and will also focus on all aspects of cardiovascular
risk. Future perspectives, new research, treatment and prevention will be
showcased over four days of invited plenary talks and oral and poster
presentations. Special Symposium initiatives include an Alaskan Cruise
and several high profile Summits to discuss priority needs and actions for
non-communicable disease prevention. The meeting will provide a forum for
scientific exchange, global interaction and global initiatives with the
objective of a legacy of new initiatives in Global Cardiovascular Risk
Reduction. Accommodation &
optional tour and social event program ISH 2010 has arranged for a
selection of hotels close to the Meeting venue that will meet everyone’s
budget. The Meeting has also arranged a fabulous optional Tour and Social
Event program exclusively for ISH 2010 attendees. Accommodation as well as
Tours and Social Events can be booked conveniently during the online
registration process, or you may update your registration with Accommodation
and/or Tour and Social Event Participation once your travel arrangements are
made. Everything at your
fingertips Visit the ISH 2010 website for
detailed information on the Meeting including Scientific Program,
Registration, Abstract Submission, Accommodation, Tours and Social Events. The
Main Announcement is available on the website as a pdf download to review at
your leisure. HBPRCA younger members able to apply for FHBPR travel grant |
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Articles of interest
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Australian Division of
World Action on Salt and Health (AWASH) Response to Government Salt Targets
(Bruce Neal quoted) AWASH congratulates the
Australian government on yesterday’s announcement of salt targets for bread
and breakfast cereals and keenly anticipates hearing the salt targets for
other food categories. … read more If you have been quoted in
the media, please email us the link to hbprca@meetingsfirst.com.au |
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HBPRCA would like to
acknowledge the support of the following companies: Corporate members
Corporate Sponsors
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Meetings in 2010 |
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Meetings in 2011 |
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HBPRCA Secretariat
Jennifer Seabrook at Meetings First PO Box 448 YARRA JUNCTION VIC 3797 Phone +61 3 5967 4479 Fax +61 3 9015 6409 |
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