Gala for the HMPRG

On October 13, The HMPRG (Health Medicine Policy Research Group) will be holding a gala to celebrate HMPRG’s 35th Anniversary and to honor former Surgeon General Dr. David Satcher, Illinois activist and former APHA President Dr. Linda Rae Murray, and the Louise H. Landau Foundation. They’re offering tickets for anyone under 30 for reduced rates. Details are available on the event page:  http://hmprg.org/Events/35thAnniversaryGala 

In addition to being a fun event, this is a great networking opportunity for students (events are attended by hundreds of Chicago’s top public health, medical, and government officials). It’s the HMPRG's biggest fundraiser of the year, enabling it to carry out the mission of challenging inequity in health and healthcare in Illinois, helping  to strengthen the health care system and the important role that Health & Medicine has in creating health policy solutions, as well as educating and connecting together businesses, government, and stakeholders to bring about important health systems change.

Please send your questions to Magda Slowik at MSlowik@hmprg.org.

SPRINT blood pressure trial demonstrates that lower is better

 More intensive management of high blood pressure, below a commonly recommended blood pressure target, significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure. This is according to the initial results of a landmark clinical trial sponsored by the National Institutes of Health called the Systolic Blood Pressure Intervention Trial (SPRINT). The intervention in this trial, which carefully adjusts the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter, as compared to the target systolic pressure of 140 mm Hg.

“This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), the primary sponsor of SPRINT. “We are delighted to have achieved this important milestone in the study in advance of the expected closure date for the SPRINT trial and look forward to quickly communicating the results to help inform patient care and the future development of evidence-based clinical guidelines.”

High blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems. An estimated 1 in 3 people in the United States has high blood pressure.

The SPRINT study evaluates the benefits of maintaining a new target for systolic blood pressure, the top number in a blood pressure reading, among a group of patients 50 years and older at increased risk for heart disease or who have kidney disease. A systolic pressure of 120 mm Hg, maintained by this more intensive blood pressure intervention, could ultimately help save lives among adults age 50 and older who have a combination of high blood pressure and at least one additional risk factor for heart disease, the investigators say.

The SPRINT study, which began in the fall of 2009, includes more than 9,300 participants age 50 and older, recruited from about 100 medical centers and clinical practices throughout the United States and Puerto Rico. It is the largest study of its kind to date to examine how maintaining systolic blood pressure at a lower than currently recommended level will impact cardiovascular and kidney diseases. NIH stopped the blood pressure intervention earlier than originally planned in order to quickly disseminate the significant preliminary results.

The study population was diverse and included women, racial/ethnic minorities, and the elderly. The investigators point out that the SPRINT study did not include patients with diabetes, prior stroke, or polycystic kidney disease, as other research included those populations.

When SPRINT was designed, the well-established clinical guidelines recommended a systolic blood pressure of less than 140 mm Hg for healthy adults and 130 mm Hg for adults with kidney disease or diabetes. Investigators designed SPRINT to determine the potential benefits of achieving systolic blood pressure of less than 120 mm Hg for hypertensive adults 50 years and older who are at risk for developing heart disease or kidney disease.

Between 2010 and 2013, the SPRINT investigators randomly divided the study participants into two groups that differed according to targeted levels of blood pressure control. The standard group received blood pressure medications to achieve a target of less than 140 mm Hg. They received an average of two different blood pressure medications. The intensive treatment group received medications to achieve a target of less than 120 mm Hg and received an average of three medications.

“Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall,” said Lawrence Fine, M.D., chief, Clinical Applications and Prevention Branch at NHLBI. “But patients should talk to their doctor to determine whether this lower goal is best for their individual care.”

The study is also examining kidney disease, cognitive function, and dementia among the patients; however, those results are still under analysis and are not yet available as additional information will be collected over the next year. The primary results of the trial will be published within the next few months.

In addition to primary sponsorship by the NHLBI, SPRINT is co-sponsored by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the National Institute on Aging. Loyola University Chicago is one of several sites throughout the U.S. that recruited and followed SPRINT participants.  Drs. Kramer and Bansal were the site investigators for Loyola University Chicago.

2 Research Opportunities for MPH/CPH students.

Please see the 2 research opportunities for MPH and CPH students below.

 

1)      Family-based Lifestyle Intervention Program (FLIP)

We are looking for students to assist with 4 community health screenings during the months of September and October and join an inter-professional research team to assist in lifestyle coaching (diet and physical activity). The health fairs will be on weekends. If you are interested please email: Demika Washingtondwashington6@luc.edu or Dr Lara Dugas ldugas@luc.edu for more information. All students need to have completed the mandatory CITI training.

 

2)      Office employees health program

We are looking for students to assist  with research testing in office-based employees. There are 2 locations, Maguire building (Loyola) and downtown Chicago. The testing will take place during the day, Mon-Fri. If you are interested in assisting please contact Dr Lara Dugas, ldugas@luc.edu. All students need to have completed the mandatory CITI training.

Thoughts from the PHS Chair

The National Heart, Lung and Blood Institute (NHLBI) of the NIH is in the midst of developing a long-term plan – or what they call “Visioning”.  Scientists, physicians and the general public are being given the opportunity to offer opinions about future directions of research and implementation.  The post below is the material sent as a comment by Dr. Cooper.

            I have grave concerns about the outcome of the NHLBI “Visioning” exercise.  A vast array of new and important ideas have emerged from this exercise.  At the same time, however, I am left wondering whether we are still on course to extend the phenomenal success achieved by the NHLBI and the cardiovascular community in reducing heart disease and stroke over the last 50 years.  If anyone needed to be reminded, the figure below – charting a decline in CHD death > 80% - demonstrates the greatest advances in control of a major chronic disease ever observed.  In the US alone this trend represents ~ 600,000 fewer deaths each year. A similar massive decrease in stroke has occurred.  As demonstrated by Ford et all in the NEJM in 2007, the majority of that decline resulted from control of basic risk factors.  While it is certainly true that better drugs and better interventional tools have helped, particularly in the latter years, there are still have huge potential gains in primary and secondary prevention.  It is hardly worth mentioning that reductions in tobacco use have rapidly driven down rates of lung disease – and is the primary reason death from cancer has fallen 30% in the last 2 decades.  

            Unfortunately – as I read it – the Visioning document does not adequately build on this unparalleled record of success.  A “word scan” retrieves topics that are heavily weighted toward research on mechanisms rather than etiology and prevention – viz, pathobiology, ‘omics, prevention linked to gene therapy, mechanistic interactions, systems biology, developmental biology.  I do not want to enter into a debate over the relative merits of genomics – or all ‘omic’s – vs. population-based research, prevention and translation.  I recognize that the case could be made that we now know what we need to know about etiology, and in the words of Claude Lenfant, Director of the NHLBI during the “golden age” captured in the figure, the challenge is to “use what we know”.   Using medical knowledge in the care of patients is not the mission of the NHLBI.  However, while taking advantage of the powerful new tools of genomics, we should not lose sight of the needs of patients.  Most patients at risk of CVD will never benefit from genomics or the offspring of genomic research.  My point is simply to state that the debate between “’omics” vs “prevention” is heavily weighted toward the latter by the most fundamental evidence in biomedicine – the health experience of our population over he last 50 years.  No matter what perspective one brings to planning for the future of CVD science, extending the success of the past must rank as the highest priority. 

            I, for one, do not see how the proposals for genomics and system biology in this Visioning statement can achieve that goal.  As the erstwhile Director of the NCI said, “genomics is a good way of doing science, but not medicine.”  I understand that population cohorts and trials are expensive, and that we currently face a dearth of exciting new ideas for prevention.  But the degree of difficulty of challenge does not diminish its importance.  As I suggested before, the Institute appears to have made a dramatic shift in direction from advancing prevention and treatment to research on mechanisms and genomics.  This shift from etiology to biology ignores the lessons of success that we have learned from the period when we did make huge progress toward reducing disease burden.  Basic research has a crucial role, there is no dispute on that point, but the integrity of our enterprise requires that we evaluate the relative merit of a field research against the potential to reduce disease burden.  Control of heart disease, stroke and lung disease are not, in my view, where they should be – at the center of any vision of the future of the Institute.  

Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388-98.