DETECT, PROSPECT, and REVEAL Aim to Improve Hypertension Care

The CHEST 2012 meeting features a number of newly published studies for a wide variety of disease states ranging from tuberculosis to lung disease. The following are highlights of hypertension abstracts.

Frantz et al presented the data from their study, Bloodstream Infection Rates in Patients With Pulmonary Arterial Hypertension Treated With Epoprostenol for Injection: A PROSPECT Registry Analysis. According to the study authors, patients with pulmonary arterial hypertension receiving IV therapy are at increased risk of bloodstream infections (BSIs). For this study, the research team determined BSI rates in the first 300 patients enrolled in the PROSPECT registry, an ongoing, multicenter, observational, US registry following patients with PAH for 1 year who are currently receiving, initiating, or transitioning from other pulmonary arterial hypertension (PAH) prostacyclin analogs to epoprostenol for injection (Veletri, EFI). After evaluating the first 300 patients enrolled in the registry, the authors found that “BSI rates associated with patients on EFI were similar to those previously documented in PAH patients receiving parenteral therapy,” and that “Gram-negative infections did not predominate.”

For more about this study, see AJMC’s video interview with Dr Frantz.

McLaughlin et al released information for their study, An Evidence-Based Screening Algorithm for Pulmonary Arterial Hypertension in Systemic Sclerosis: The DETECT Study. Because current PAH screening recommendations result in a high false positive rate, the researchers aimed to develop an evidence-based screening algorithm for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) that would limit the number of missed PAH diagnoses. The prospective, multicenter, cohort study required adult patients to undergo multiple non-invasive screening tests followed by right heart catheterization. The research team then used “univariable and multivariable logistic regression, followed by clinical expert input addressing clinical feasibility to select the best discriminatory variables for identifying PAH,” before incorporating their findings into a 2-step screening algorithm. They found that the DETECT algorithm is a “highly discriminatory, flexible and non-invasive screening tool for PAH in SSc, which can reduce missed PAH diagnoses to 4%.” They also reported that “even at a RHC referral rate that is in line with the current guidelines, the missed diagnoses rate was halved.”

Yung et al presented the findings from their study, Pulmonary Arterial Hypertension in Pediatric Patients With Chronic Lung Disease: Insights From REVEAL. The researchers focused on survival estimates for patients with chronic lung disease (CLD) or for patients with asthma versus patients without CLD, noting that “Because the pulmonary vasculature is intricately linked to pulmonary growth and development during childhood, such comorbidities could worsen pulmonary arterial hypertension (PAH) severity and affect outcome.” Through their analysis of the REVEAL registry (Registry to EValuate Early And Long-term PAH Disease Management), the study authors concluded that “although there were no significant differences in 3-year survival estimates for patients with CLD or for patients with asthma versus patients without CLD, the tendency toward worse survival in patients with CLD would be of interest if it were replicated in other studies.”

To read more about research highlights at CHEST 2012, please visit the American College of Chest Physicians website.