Research led by investigators at Mass General Brigham suggests that the health benefits of more aggressive blood pressure control outweigh concerns about overtreating people with high blood pressure readings. Results of the simulation study are published in Annals of Internal Medicine.

The study used data from the Systolic Blood Pressure Intervention Trial (SPRINT) trial, the National Health and Nutrition Examination Survey (NHANES), and other published literature to simulate lifetime health outcomes -- including heart attack, stroke, and heart failure -- for patients whose systolic blood pressure targets were set at <120 mm Hg, <130 mm Hg, and <140 mm Hg. Recognizing that blood pressure medication comes with side effects, the researchers also simulated and compared the risk of serious events resulting from the treatment.

The simulation model also accounted for common errors in patients' blood pressure readings based on what has been observed in routine clinical practice.

Even when including this error rate, the simulation model found the <120 mm Hg target prevented more cardiovascular events, such as heart attacks, strokes, and heart failure than the <130 mm Hg target. However, the lower target led to additional adverse events related to treatment, such as falls, kidney injury, hypotension, and bradycardia. The lower target also increased overall healthcare spending due to increased antihypertensive use and more frequent visits with clinicians.

Comparing the cost-effectiveness of the three blood pressure targets with typical levels of measurement error, the researchers found the <120 mm Hg target was cost-effective, associated with a cost of $42,000 per quality-adjusted life-year gained.

"This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal," said lead author Karen Smith, PhD, an investigator at the Department of Orthopedic Surgery at Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system. "Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value, and this holds true even when measurements aren't perfect."

Smith also cautioned, "Our results examine the cost-effectiveness of intensive treatment at the population level. However, given the additional risk of adverse events related to antihypertensives, intensive treatment will not be optimal for all patients. Patients and clinicians should work together to determine the appropriate medication intensity based on patient preferences."

Authorship: In addition to Smith, Mass General Brigham authors include Thomas Gaziano. Additional authors include Alvin Mushlin, David Cutler, Nicolas Menzies, and Ankur Pandya.

Funding: The study was funded by the National Science Foundation and the National Institute of Neurological Disorders and Stroke.

Read more …How low should blood pressure go? New study has the answer

Reproductive timing matters when it comes to aging and age-related disease. In a study now online at eLife¸ Buck researchers determine that girls who go through puberty (the onset of menstruation) before the age of 11 or women who give birth before the age of 21 have double the risk of developing type 2 diabetes, heart failure and obesity and quadruple the risk of developing severe metabolic disorders. The study also reveals that later puberty and childbirth are genetically associated with longer lifespan, lower frailty, slower epigenetic aging and reduced risk of age-related diseases, including type 2 diabetes and Alzheimer's.

Buck professor Pankaj Kapahi, PhD, senior author of the study says the public health implications of the research are significant. "Even though women are routinely asked about their menstrual and childbirth history when they receive medical care, this information has rarely factored into the care they receive outside of OB/GYN," he says. "These risk factors, whether positive or negative, clearly have significant influence on a variety of age-related diseases and should be considered in the larger context of overall health."

The research was based on one of the most comprehensive analyses to date, using regression analysis on nearly 200,000 women in the UK Biobank to confirm genetic associations. "We identified 126 genetic markers that mediate the effects of early puberty and childbirth on aging," said postdoctoral fellow Yifan Xiang, MD, who led the research. "Many of these markers are involved in well-known longevity pathways, such as IGF-1, growth hormone, AMPK and mTOR signaling, key regulators of metabolism and aging."

Genetic associations for antagonistic pleiotropy in humans

Evolution is based on natural selection acting on traits early in life to encourage reproduction and survival of the species. The antagonistic pleiotropy theory of aging suggests that traits beneficial in the young can have negative effects later in life. "Our study provides some of the strongest human evidence for this theory," Kapahi says. "We show that genetic factors favoring early reproduction come with the significant cost later in life including accelerated aging and disease. It makes sense that the very factors that help enhance survival of the offspring may lead to detrimental consequences for the mother."

The role of BMI in aging and disease risk

Kapahi says the study highlights the role of Body Mass Index (BMI) as a critical mediator of this process, finding that early reproductive events contribute to a higher BMI, which in turn increases the risk of metabolic disease. "One can envisage that enhancing the ability to absorb nutrients would benefit the offspring but if nutrients are plentiful then it can enhance the risk of obesity and diabetes."

Implications for public health and basic science

Kapahi says understanding the long-term impact of reproductive timing allows for the development of personalized healthcare strategies that could help mitigate the risks associated with early puberty and early childbirth, adding that lifestyle modifications, metabolic screenings and tailored dietary recommendations could improve long-term health in women. He says taking reproductive timing into account is currently relevant based on research that shows the age at which girls in the US begin menstruating has dropped by about three months per decade since the 1970s. No specific causes for the phenomena have been identified, but research suggests obesity may play a role.

While updated research guidelines call for the use of both sexes in preclinical research in mice, Kapahi says this current study still challenges traditional experimental design, noting that most disease models use virgin female mice, which may not accurately represent real-world aging patterns.

"If evolution has shaped us to prioritize early reproduction at the cost of aging, how can we leverage this knowledge to extend healthspan in modern society? Kapahi asks. "While we cannot change our genetic inheritance, understanding these genetic tradeoffs empowers us to make informed choices about health, lifestyle and medical care." The study also identifies several genetic pathways that can be manipulated to optimize health for mothers as well as her offspring Kapahi says.

Other Buck researchers involved in the study include: Vineeta Tanwar, Parminder Singh, and Lizellen La Follette.

Acknowledgments: This research was supported by Hevolution Foundation (PK), National Institute of Health grant R01AG068288 and R01AG045835 (PK), Larry L. Hillblom Foundation (PK), and Larry L. Hillblom Foundation (PS).

Read more …Genetic evidence confirms early puberty accelerates aging and disease

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