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CARDIOVASCULAR 06.29.2009

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Angina Frequency Linked to

Depression, Anxiety

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by Chris

Emery
Contributing Writer, MedPage Today

PRINCETON, June 29 -- Ischemic heart patients with depression and anxiety were
more likely to suffer chest pain than patients without those psychosocial
symptoms, a new study shows.
The findings, published in the June 30 edition of Circulation, suggest that angina
associated with blocked arteries may also have a psychosocial component.
Coronary artery disease patients with even moderate anxiety were four times more
likely to have angina (95% CI 1.91 to 11.66, P=0.001), while patients with clinical
depression were three times more likely to have frequent angina (95% CI 1.45 to
6.69, P=0.004).
The results suggested that some patients' anginal symptoms might have a
psychosomatic origin and not be directly related to the extent of their heart
disease, wrote Mark Sullivan, MD, PhD, a professor at the University of
Washington School of Medicine, and colleagues.

"Among patients with a similar burden of inducible ischemia, a history of

coronary revascularization and current anxiety and depressive symptoms were
associated with more frequent angina," they wrote.

"These results support the study of angina treatment strategies that aim to reduce
psychosocial distress in conjunction with efforts to lessen myocardial ischemia."

The researchers assessed 788 patients (mean age 63) who were undergoing
single-photo emission computed tomography stress imaging at two Seattle
hospitals between April 2004 and 2006.

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CARDIOVASCULAR 02.17.2015

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New Hypertension Recs Planned in

2016
AHA/ACC recommendations will replace JNC
schema.

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Crystal Phend
Senior Staff Writer, MedPage
Today
by

An update to the 12-year-old JNC 7 recommendations for hypertension

management is underway and expected out in 2016, the American Heart
Association and American College of Cardiology announced.
Those organizations officially took over the reins in 2013 on the suite of national
cardiovascular prevention guidelines formerly managed by National Heart, Lung
and Blood Institute (NHLBI) writing groups.
The last official report from the NHLBI Joint National Committee on Prevention,
Evaluation, and Treatment of High Blood Pressure (JNC 7) came in 2003.
Panel members who had been appointed to release what would have been JNC 8
went ahead and released an unofficial report on hypertension management in
2014, but its recommendations have been contentious.
That has particularly been the case for its loosening of the antihypertensive
treatment threshold from 140 mmHg to 150 mmHg for older adults and from 130
mmHg to 140 mmHg for those with diabetes or chronic kidney disease. Recent
analyses have suggested potential for poorer outcomes in both cases.
The new report, to be known as the 2016 Guideline on the Management of
Hypertension, will involve a separate evidence review committee to generate a
systematic review for specific critical questions.
The AHA and ACC declined to specify what those questions might be.
However, if the first product of the new guideline arrangement -- a set released in
November 2013 that included controversial lipid recommendations that did away
with LDL targets and a much criticized cardiovascular risk calculator -- was any
clue, the coming hypertension recommendations might not see an end to the
dissension.
Nine additional partners who have signed on to the guidelines are: the American

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