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Rahimi K. Mounting evidence in favour of the lower, the better blood pressure paradigm. Lancet 2024; 404:216-217. [PMID: 38945141 DOI: 10.1016/s0140-6736(24)01261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford OX1 2BQ, UK.
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Lamy A, Tong W, Joseph P, Gao P, Huffman MD, Roshandel G, Malekzadeh R, Lopez-Jaramillo P, Pais P, Xavier D, Avezum A, Dans AL, Gamra H, Yusuf S. Cost effectiveness analysis of a fixed dose combination pill for primary prevention of cardiovascular disease from an individual participant data meta-analysis. EClinicalMedicine 2024; 73:102651. [PMID: 38841710 PMCID: PMC11152900 DOI: 10.1016/j.eclinm.2024.102651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Background Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis. Methods Countries were categorized using World Bank economic groups: Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC) and High Income Countries (HIC). Country specific costs were obtained for hospitalized events, procedures, and non-study medications (2020 USD). FDC price was based on the cheapest equivalent substitute (CES) for each component. Findings For the CES-FDC pill versus control the difference in cost was $346 (95% CI: $294-$398) per participant in Lower Middle Income Countries, $838 (95% CI: $781-$895) in Upper Middle Income Countries and $42 (95% CI: -$155 to $239) (cost-neutral) in High Income Countries. During the study period the CES-FDC pill was associated with incremental gain in quality-adjusted life years of 0.06 (95% CI: 0.04-0.08) resulting in an incremental cost-effectiveness ratio (ICER) of $5767 (95% CI: 5735-$5799), $13,937 (95% CI: $13,893-$14,041) and $700 (95% CI: $662-$738) respectively. In subgroups analyses, the highest 10 years CVD risk subgroup had ICERs of $2033, $7322 and -$6000/QALY. Interpretation A FDC pill produced at CES costs is cost-neutral in HIC. Governments of LMI and UMI countries should assess these results based on the ICER threshold accepted in their own country and own specific health care priorities but should consider prioritizing this strategy for patients with high 10 years CVD risk as a first step. Funding Population Health Research Institute.
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Affiliation(s)
- Andre Lamy
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Wesley Tong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Peggy Gao
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mark D. Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, USA
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Prem Pais
- St. John's Research Institute, Bangalore, India
| | | | - Alvaro Avezum
- International Research Center, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
| | | | - Habib Gamra
- Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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3
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Wang S, Yang Z, Tian L, Sha F, Tang J, Yang Z. Remission to normal blood pressure in older adults with hypertension who did not receive antihypertensive medication: analysis of data from two longitudinal cohorts. EClinicalMedicine 2024; 73:102678. [PMID: 39050585 PMCID: PMC11267020 DOI: 10.1016/j.eclinm.2024.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024] Open
Abstract
Background How often hypertensive patients could achieve remission to normal blood pressure (BP) (i.e., <140/90 mmHg) in the absence of antihypertensive drugs, which is important for the management of hypertension, remains largely unknown. This observational study aimed to investigate the change of BP in older adults with hypertension who did not take antihypertensive drugs and preliminarily examine whether the remission from hypertension to normal BP observed in this setting was associated with lower risk of cardiovascular disease (CVD). Methods 2760 participants aged 33-99 years (median 60 years, interquartile 54-68 years) from the Health and Retirement Study (wave 2006 to wave 2018) and the English Longitudinal Study of Ageing (wave 1998 to wave 2016), who had no major CVD, were hypertensive, and were not on antihypertensive drugs at the time of baseline BP measurement, and had at least one follow-up BP measurement before which no antihypertensive drugs were taken, were included for analysis. The main outcome was the proportion of patients who achieved remission of hypertension at the last wave of measurement. Findings During a median follow-up of six years, 52% of the participants showed a reduction of ≥6 mmHg in systolic BP and 60% a reduction of ≥3 mmHg in diastolic BP. 1171 participants (42%, 95% CI: 41-44%) achieved remission at the last measurement, and by that time 67%, 43%, and 29% of them had maintained the normotensive state for around 4, 8, and 12 years, respectively. Various supplementary analyses that aimed to examine the impact of chance and bias yielded similar results. Preliminary analyses showed that being non-smokers at baseline, achieving a normal body mass index during follow-up, and quitting alcohol drinking during follow-up, among others, were associated with the remission of hypertension. Compared with the participants who remained hypertensive, those who achieved remission had a lower CVD risk (adjusted hazard ratio 0.66, 95% CI: 0.47-0.92). Interpretation In many of this study population, hypertension could be reversed without the intervention of drug treatment in the first few years after diagnosis. This finding may have implications for more individualized management of hypertension. Further studies to identify the factors or algorithms predictive of such hypertension remission are warranted. Funding The Chinese University of Hong Kong (7106452; 7105959),Shenzhen Science and Technology Program (KQTD20190929172835662), Strategic Priority Research Program of Chinese Academy of Sciences (XDB 38040200), National Institute on Aging (R01AG017644; NIA U01AG009740).
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Affiliation(s)
- Shuting Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhirong Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
- Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Longben Tian
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Feng Sha
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Jinling Tang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Mancia G, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Kjeldsen SE, Kreutz R. Rationale of treatment recommendations in the 2023 ESH hypertension guidelines. Eur J Intern Med 2024; 121:4-8. [PMID: 38216445 DOI: 10.1016/j.ejim.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
No abstract available.
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Affiliation(s)
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens, Greece
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Institute for Clinical Medicine, and Ulleval Hospital, University of Oslo, Oslo, Norway
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt- Universitaet zu Berlin, Berlin, Germany
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Makawi AT, Tawfik YM, Dixon DL, McMahon GM, Buckley LF. Expanding the Impact of SGLT2 Inhibitors in Chronic Kidney Disease. Am J Nephrol 2024; 55:417-420. [PMID: 38417403 PMCID: PMC11305959 DOI: 10.1159/000536540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Alaa T. Makawi
- Department of Pharmacy, Brigham and Women’s Hospital, Boston MA
- Department of Pharmacy Practice, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Yahya M.K. Tawfik
- Department of Pharmacy, Brigham and Women’s Hospital, Boston MA
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Dave L. Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond VA
| | | | - Leo F. Buckley
- Department of Pharmacy, Brigham and Women’s Hospital, Boston MA
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Greenstein AS, Reusch JEB, Heagerty AM. Is it time to recommend cardiovascular protection for all? J Hypertens 2024; 42:224-226. [PMID: 38165051 DOI: 10.1097/hjh.0000000000003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Adam S Greenstein
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, UK
| | - Jane E B Reusch
- University of Colorado, Division of Endocrinology, CU Anschutz Medical Center and Rocky Mountain Regional VAMC Research I South, Aurora, Colorado, USA
| | - Anthony M Heagerty
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, UK
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Jung HH. Blood pressure control in patients aged above and below 75 years. PLoS One 2024; 19:e0297103. [PMID: 38300966 PMCID: PMC10833546 DOI: 10.1371/journal.pone.0297103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/24/2023] [Indexed: 02/03/2024] Open
Abstract
It remains unclear what the blood pressure target is and at which point in life it is appropriate for antihypertensive treatment. This study aimed to determine age-specific systolic blood pressure (SBP) targets. In a nationwide cohort of 296,470 hypertensive patients aged ≥75 years and a representative cohort of 259,028 hypertensives aged 45-74 years, multivariable-adjusted incidence rates of cardio-kidney composite events, overt dementia, and all-cause deaths were estimated across yearly-averaged on-treatment SBP levels according to age and the presence of 4 additional risk factors (diabetes, dyslipidemia, albuminuria, and smoking). For cardio-kidney events, on-treatment SBP showed positive curvilinear associations with higher risks at ≥135 mm Hg in most while an attenuated association in age ≥85 years. For overt dementia, SBP showed flat or slightly inverted associations in elderly while a small positive association in age 45-64 years. For all-cause mortality, SBP showed J-shaped associations having right-shifting tendency with age. For risk categories with ≥2, 1, and no additional risk factors, the respective mortality rate differences between SBP 145-154 mm Hg and 125-134 mm Hg were 4.6 (95% confidence interval [CI], 2.0 to 7.3), 1.2 (95% CI, -0.3 to 2.8), and 0.1 (95% CI, -1.4 to 1.8) per 1000 person-years in age ≥75 years and 2.9 (95% CI, 1.7 to 4.3), 0.7 (95% CI, 0.1 to 1.4), and 0.9 (95% CI, 0.2 to 1.6) per 1000 person-years in age 45-74 years. In conclusion, the BP target can be relaxed in very old patients and in elderly patients with few risk factors. However, strict BP control may be needed in patients with multiple risk factors even in those with advanced age.
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Affiliation(s)
- Hae Hyuk Jung
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
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Liu W, Yang C, Lei F, Huang X, Cai J, Chen S, She ZG, Li H. Major lipids and lipoprotein levels and risk of blood pressure elevation: a Mendelian Randomisation study. EBioMedicine 2024; 100:104964. [PMID: 38181703 PMCID: PMC10789600 DOI: 10.1016/j.ebiom.2023.104964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Quantitative nuclear magnetic resonance (NMR) metabolomics techniques provide detailed measurements of lipoprotein particle concentration. Metabolic dysfunction often represents a cluster of conditions, including dyslipidaemia, hypertension, and diabetes, that increase the risk of cardiovascular diseases (CVDs). However, the causal relationship between lipid profiles and blood pressure (BP) remains unclear. We performed a Mendelian Randomisation (MR) study to disentangle and prioritize the potential causal effects of major lipids, lipoprotein particles, and circulating metabolites on BP and pulse pressure (PP). METHODS We employed single-nucleotide polymorphisms (SNPs) associated with major lipids, lipoprotein particles, and other metabolites from the UK Biobank as instrumental variables. Summary-level data for BP and PP were obtained from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Two-sample MR and MR Bayesian model averaging approaches (MR-BMA) were conducted to analyse and rank causal associations. FINDINGS Genetically predicted TG was the most likely causal exposure among the major lipids to increase systolic blood pressure (SBP) and diastolic blood pressure (DBP), with marginal inclusion probabilities (MIPs) of 0.993 and 0.847, respectively. Among the majority of lipoproteins and their containing lipids, including major lipids, genetically elevated TG in small high-density lipoproteins (S_HDL_TG) had the strongest association with the increase of SBP and DBP, with MIPs of 0.416 and 0.397, respectively. HDL cholesterol (HDL_C) and low-density lipoprotein cholesterol (LDL_C) were potential causal factors for PP elevation among the major lipids (MIP = 0.927 for HDL_C and MIP = 0.718 for LDL_C). Within the sub-lipoproteins, genetically predicted atherogenic lipoprotein particles (i.e., sub-very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and LDL particles) had the most likely causal impact on increasing PP. INTERPRETATION This study provides genetic evidence for the causality of lipids on BP indicators. However, the effect size on SBP, DBP, and PP varies depending on the lipids' components and sizes. Understanding this potential relationship may inform the potential benefits of comprehensive management of lipid profiles for BP control. FUNDING Key Research and Development Program of Hubei Province, Science and Technology Innovation Project of Huanggang Central Hospital of Yangtze University, the Hubei Industrial Technology Research Institute of Heart-Brain Diseases, and the Hubei Provincial Engineering Research Centre of Comprehensive Care for Heart-Brain Diseases.
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Affiliation(s)
- Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Chengzhang Yang
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China; Huanggang Institute of Translational Medicine, Huanggang, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China; Medical Science Research Centre, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shaoze Chen
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China.
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China; Institute of Model Animal, Wuhan University, Wuhan, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China; Institute of Model Animal, Wuhan University, Wuhan, China.
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Hussain A, Ahmed N, Marlowe S, Piercy J, Kommineni SS. A Case of Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalaemia (BRASH) Syndrome in an Elderly Male and Its Management: A Case Report and Literature Review. Cureus 2023; 15:e49489. [PMID: 38152818 PMCID: PMC10751601 DOI: 10.7759/cureus.49489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BRASH syndrome, characterized by bradycardia, renal dysfunction, atrioventricular (AV) nodal blockage, shock, and hyperkalemia, is a rare but potentially life-threatening condition resulting from the interplay between AV nodal blockers and hyperkalemia. This complex syndrome poses significant challenges in diagnosis and management, with patients often presenting with bradycardia and high potassium levels. This case report highlights the need for increased awareness of BRASH syndrome, especially in an aging population and evolving cardiovascular treatments. Early recognition and a comprehensive, multidisciplinary approach are crucial for improving outcomes in affected patients.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Nazneen Ahmed
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Stanley Marlowe
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Jonathan Piercy
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | - Sai S Kommineni
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
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Karavasili C, Babaee S, Kutty S, Chu JN, Min S, Fitzgerald N, Morimoto J, Inverardi N, Traverso G. Modular Titratable Polypills for Personalized Medicine and Simplification of Complex Medication Regimens. Adv Healthc Mater 2023; 12:e2301101. [PMID: 37526266 PMCID: PMC10836191 DOI: 10.1002/adhm.202301101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 08/02/2023]
Abstract
Simplification of complex medication regimens in polypharmacy positively contributes to treatment adherence and cost-effective improved health outcomes. Even though fixed dose combination (FDC) drug products are the only currently available single dose poly-pill regimens, the lack of flexibility in dose adjustment of a single drug in the combination limits their efficacy. To fill the existing gap in drug dose personalization and simplification of complex medication regimens commonly encountered in the treatment of cardiovascular disease, tuberculosis, and tapering of corticosteroid therapy, a modular titratable polypill approach that simultaneously addresses both aspects is proposed. The polypill consists of modular units that contain different drugs at incremental or decremental doses to be assembled in a single titratable polypill at the required dose for each drug through a stacking or interlocking process. The variable dose (VD) modular tablets are subjected to quality control tests and found to comply to pharmacopeia's acceptance criteria and requirements specified in the respective drug monographs. A cost-effectiveness analysis is conducted supporting the VD strategy as cost-effective compared to the FDC strategy and more effective and less expensive than standard of care. The VD approach stands to enable pill burden reduction, ease of administration, enhancement of treatment adherence, and potential cost-saving benefits.
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Affiliation(s)
- Christina Karavasili
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sahab Babaee
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shruti Kutty
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jacqueline N Chu
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Integrated Gastroenterology Consultants, N. Chelmsford, MA, 01863, USA
| | - Seokkee Min
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Nina Fitzgerald
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joshua Morimoto
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Nicoletta Inverardi
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research and Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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Birla S, Angural A, Madathumchalil A, Shende RV, Shastry SV, Mahadevappa M, Shambhu SK, Vishwanath P, Prashant A. Redefining the polypill: pros and cons in cardiovascular precision medicine. Front Pharmacol 2023; 14:1268119. [PMID: 37799963 PMCID: PMC10549989 DOI: 10.3389/fphar.2023.1268119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients' adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors.
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Affiliation(s)
- Siddharth Birla
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Arshia Angural
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Arya Madathumchalil
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Ritika V. Shende
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Sharvani V. Shastry
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Manjappa Mahadevappa
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Sunil Kumar Shambhu
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Prashant Vishwanath
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
- Department of Medical Genetics, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, Karnataka, India
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Muíño-Domínguez D, Gómez-Sánchez L, Gallego-Fernández V, Seoane-Pillado T, López-Álvarez XL. [Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain]. Semergen 2023; 49:101999. [PMID: 37302207 DOI: 10.1016/j.semerg.2023.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND AIMS During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. PATIENTS AND METHODS The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. RESULTS Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). CONCLUSIONS The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.
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Affiliation(s)
- D Muíño-Domínguez
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | | | - T Seoane-Pillado
- Área de Medicina Preventiva y Salud Pública, Departamento de Ciencias de la Salud, Universidad de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España
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13
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Yang T, Yuan X, Gao W, Lu MJ, Hu MJ, Sun HS. Causal effect of hypertension and blood pressure on aortic diseases: evidence from Mendelian randomization. Hypertens Res 2023; 46:2203-2212. [PMID: 37443259 DOI: 10.1038/s41440-023-01351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 07/15/2023]
Abstract
Hypertension or elevated blood pressure was documented to be an important risk factor for aortic diseases in observational studies, yet the causality remains to be determined. By applying a two-sample Mendelian randomization (MR) approach, we aim to determine whether hypertension or elevated blood pressure (systolic blood pressure [SBP] or diastolic blood pressure [DBP]) is linked causally to aortic aneurysm or aortic dissection. Genetic instruments and summary statistics for hypertension and aortic diseases were obtained from large genome-wide association studies. The traditional inverse variance weighted (IVW) method was used to obtain the causal estimates. Sensitivity analyses including MR-Egger, weighted median and multivariable MR were also performed. Our results suggested that genetic liability to hypertension was associated with aortic dissection (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.27-2.58; P = 1.13 × 10-3) and aortic aneurysm (OR: 1.43; 95% CI: 1.22-1.66; P = 7.79 × 10-6). Per standard deviation increase in genetically-determined DBP was significantly associated with increased aortic dissection (OR: 1.14; 95% CI: 1.09-1.19; P = 1.58 × 10-9) and aortic aneurysm (OR: 1.07; 95% CI: 1.05-1.09; P = 8.37 × 10-14). There was a null association between SBP and aortic dissection (OR: 1.01; 95% CI: 0.99-1.94; P = 0.38) or aortic aneurysm (OR: 1.00; 95% CI: 0.99-1.01; P = 0.92). Sensitivity analyses documented similar results. Therefore, hypertension and elevated DBP are causally associated with higher risks of aortic aneurysm and aortic dissection. Preventive interventions for aortic diseases may consider individuals with hypertension, especially those with higher DBP. Meanwhile, further research is required to determine the mechanisms underlying the significantly greater correlation between DBP and aortic diseases than SBP.
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Affiliation(s)
- Tao Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xin Yuan
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Gao
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Min-Jie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
| | - Meng-Jin Hu
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Han-Song Sun
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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14
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Razeghian-Jahromi I, Ghasemi Mianrood Y, Dara M, Azami P. Premature Death, Underlying Reasons, and Preventive Experiences in Iran: A Narrative Review. ARCHIVES OF IRANIAN MEDICINE 2023; 26:403-410. [PMID: 38301100 PMCID: PMC10685823 DOI: 10.34172/aim.2023.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/03/2023] [Indexed: 02/03/2024]
Abstract
Premature mortality (PM) has emerged as a global health challenge. This is of eminent importance in low- and middle-income countries, where nearly three fourths of the deaths occur. The concerning issue is the early occurrence of fatal events in productive age. Fatal events before the age of 70 are called PM, which mainly result from cardiovascular diseases (CVDs). Iran as a middle- income country greatly suffers from the cardiovascular burden, which accounts for almost 50% of all PM. Despite substantial success in reducing mortality due to communicable diseases across different age ranges, urbanization and pervasiveness of cardiovascular risk factors have increased the death rate in adults in recent years. Undoubtedly, such lifestyles have imposed heavy costs on the healthcare system; it is possible that PM reduction, as one of the fundamental elements of sustainable development goals defined by the World Health Organization (WHO), would not be reached by the due date. Recently, researchers have introduced a cost-effective fixed-dose drug combination, the so-called polypill, in order to attenuate the detrimental effects of hypertension and hyperlipidemia, as two strong cardiovascular risk factors. PolyIran and PolyIran-Liver studies are two pivotal clinical trials that revealed the feasibility of primary and secondary prevention of premature cardiovascular mortality, both in an urban and a rural population. In the present narrative review, we tried to present a comprehensive appraisal on PM status, its underlying reasons, and the impact of polypill strategy on PM prevention in Iran.
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Affiliation(s)
| | | | - Mahintaj Dara
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Azami
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Li X, Zhang J, Xing Z, Liu Q, Zhou S, Xiao Y. Intensive blood pressure control for patients aged over 60: A meta-analysis of the SPRINT, STEP, and ACCORD BP randomized controlled trials. Maturitas 2023; 172:52-59. [PMID: 37099984 DOI: 10.1016/j.maturitas.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES To evaluate the effects of intensive treatment to lower blood pressure (BP) on the risk of cardiovascular disease (CVD) among patients aged over 60 years. STUDY DESIGN We extracted individual-level data of participants aged over 60 years from the SPRINT study and ACCORD study first, and then conducted a meta-analysis of major adverse cardiovascular events (MACEs) and other adverse events (hypotension and syncope) and renal outcomes across the SPRINT, STEP, ACCORD BP trials, which included 18,806 participants over 60 years of age. Participants were randomized to receive standard BP treatment or intensive BP treatment. MAIN OUTCOME MEASURES Hazard ratios (HRs) were used to calculate summary statistics. RESULTS In this meta-analysis, intensive treatment did not decrease either the all-cause mortality rate (HR: 0.98; 95 % confidence interval [CI]: 0.76-1.26; p = 0.87) or the cardiovascular mortality rate (HR: 0.77; 95 % CI: 0.54-1.08; p = 0.13). The incidence of MACEs (HR: 0.83; 95 % CI: 0.74-0.94; p = 0.003) and stroke (HR: 0.70; 95 % CI: 0.56-0.88; p = 0.002) was reduced, however. Intensive treatment had no effect on acute coronary syndrome (HR: 0.87; 95 % CI: 0.69-1.10; p = 0.24) or heart failure (HR: 0.70; 95 % CI: 0.40-1.22; p = 0.21). Intensive treatment increased the risk of hypotension (HR: 1.46; 95 % CI: 1.12-1.91; p = 0.006) and syncope (HR: 1.43; 95 % CI: 1.06-1.93; p = 0.02). Intensive treatment did not increase the risk of impaired kidney function among patients with chronic kidney disease (HR: 0.98; 95 % CI: 0.41-2.34; p = 0.96) or without chronic kidney disease (HR: 1.77; 95 % CI: 0.48-6.56; p = 0.40) at baseline. CONCLUSIONS Intensive BP goals reduced the incidence of MACEs and increased the risk of other adverse events without significant changes in mortality or renal outcome.
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Affiliation(s)
- Xiaoting Li
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China.
| | - Jiejun Zhang
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China.
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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Drug repurposing and molecular mechanisms of the antihypertensive drug candesartan as a TMEM16A channel inhibitor. Int J Biol Macromol 2023; 235:123839. [PMID: 36842737 DOI: 10.1016/j.ijbiomac.2023.123839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
TMEM16A, a Ca2+-activated chloride channel (CaCC), and its pharmacological inhibitors can inhibit the growth of lung adenocarcinoma cells. However,the poor efficacy, safety, and stability of TMEM16A inhibitors limit the development of these agents. Therefore, finding new therapeutic directions from already marketed drugs is a feasible strategy to obtain safe and effective therapeutic drugs. Here, we screened a library contain more than 2400 FDA, EMA, and NMPA-approved drugs through virtual screening. We identified a drug candidate, candesartan (CDST), which showed strong inhibitory effect on the TMEM16A in a concentration-dependent manner with an IC50 of 24.40 ± 3.21 μM. In addition, CDST inhibited proliferation, migration and induced apoptosis of LA795 cells targeting TMEM16A, and significantly inhibited lung adenocarcinoma tumor growth in vivo. The molecular mechanism of CDST inhibiting TMEM16A channel indicated it bound to R515/R535/E623/E624 in the drug pocket, thereby blocked the pore. In conclusion, we identified a novel TMEM16A channel inhibitor, CDST, which exhibited excellent inhibitory activity against lung adenocarcinoma. Considering that CDST has been used in clinical treatment of hypertension, it may play an important role in the combined treatment of hypertension and lung adenocarcinoma as a multi-target drug in the future.
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17
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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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Saini T, Reny J, Hennawi HA, Cox A, Janga C, DeLiana D, McCaffrey J. The vicious cycle of BRASH syndrome: A case report. Glob Cardiol Sci Pract 2023; 2023:e202302. [PMID: 36890842 PMCID: PMC9988297 DOI: 10.21542/gcsp.2023.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
First described in 2016, BRASH syndrome is an underreported clinical entity characterized by bradycardia, renal dysfunction, atrioventricular nodal blockade (AVNB), shock, and hyperkalemia. The recognition of BRASH syndrome as a clinical entity is crucial for early and effective management. Patients with BRASH syndrome present with symptomatic bradycardia that is resistant to treatment with standard agents such as atropine. In this report, we present the case of a 67-year-old male patient who presented with symptomatic bradycardia with an ultimate diagnosis of BRASH syndrome. We also shed light on predisposing factors and challenges encountered during the management of affected patients.
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Affiliation(s)
- Twinkle Saini
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Jacky Reny
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Andrew Cox
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Chaitra Janga
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Danila DeLiana
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - James McCaffrey
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
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Kim BJ, Cha KS, Cho WH, Kim EJ, Choi SH, Kim MH, Kim SH, Park JB, Park SM, Sohn IS, Ryu KH, Chae IH. Efficacy and Safety of a Single-Pill Triple Combination of Olmesartan, Amlodipine, and Rosuvastatin in Hypertensive Patients with Low-to-Moderate Cardiovascular Risk: A Multicenter, Randomized, Open-Label, Active-Control, Phase IV Clinical Trial. J Cardiovasc Pharmacol Ther 2023; 28:10742484231205204. [PMID: 37814541 DOI: 10.1177/10742484231205204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This study evaluated the efficacy and safety of a single-pill triple-combination of olmesartan/amlodipine/rosuvastatin (Olme/Amlo/Rosu) in comparison with a single-pill dual-combination of olmesartan/amlodipine (Olme/Amlo) in hypertensive patients with low-to-moderate cardiovascular risk. METHODS This multicenter, active-control, randomized study included 106 hypertensive patients at low-to-moderate cardiovascular risk who were randomly assigned to receive either Olme/Amlo/Rosu 20/5/5 mg (Treatment 1), Olme/Amlo/Rosu 20/5/10 mg (Treatment 2), or Amlo/Olme 20/5 mg (Control) once daily for 8 weeks. The primary endpoint was the difference of the percent change in low-density lipoprotein cholesterol (LDL-C) level at 8 weeks from baseline in the 3 groups. RESULTS The difference in the least square mean percent change (standard deviation) of LDL-C in the Treatment 1 and 2 groups compared with the Control group at 8 weeks was -32.6 (3.7) % and -45.9 (3.3) %, respectively (P < .001). The achievement rates of LDL-C level <100 mg/dL at 8 weeks were significantly different between the 3 groups (65.8%, 86.7%, and 6.3% for Treatment 1, 2, and Control groups, respectively, P < .001). The results of total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 were superior in the Treatment 1 and 2 groups compared with the Control group. Serious adverse drug reaction did not occur in the 3 groups. Medication adherence rates were excellent in the 3 groups (98.0% for Treatment 1 group, 99.7% for Treatment 2 group, and 96.3% for the Control group, P > .05). CONCLUSION Single-pill triple-combination of olmesartan/amlodipine/rosuvastatin was superior to the single-pill dual-combination of amlodipine/olmesartan in LDLC-lowering effects, with excellent safety profiles and adherence rates, in hypertensive patients at low-to-moderate cardiovascular risk.Trial Registration: CLinicalTrials.gov identifier NCT04120753.
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Affiliation(s)
- Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Soo Cha
- Department of Internal Medicine and Medial Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Wook Hyun Cho
- Department of Cardiology, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Eung Ju Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Sang-Hyun Kim
- Department of Cardiology, Boramae Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kyu Hyung Ryu
- Department of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University, Bundang Hospital, Gyeonggi-do, Republic of Korea
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Iordani MM, Polikandrioti M, Kapadohos T, Maggita A, Kourea K, Koutelekos I, Dousis E, Zartaloudi A. Depression and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:131-139. [PMID: 37581787 DOI: 10.1007/978-3-031-31986-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Cardiovascular disease remains a major cause of morbidity and premature mortality worldwide. The aim of the present study was to investigate the association of atherosclerotic cardiovascular disease (ASCVD) risk estimator with depression in women undergoing cardiological evaluation. MATERIAL AND METHOD Three hundred women undergoing cardiological evaluation completed the Zung Self-Rating Depression Scale (ZSDS) questionnaire which included women's characteristics. RESULTS A percentage of 57.4% of our participants exhibited ASCVD risk <5%; while the 18.3% had ASCVD risk between 5% and 7.4%, the 18.3% between 7.5% and 20%, and the remaining 6% > 20%. In terms of depression, 50% of the women had a score of less than 38 (median), according to Zung scale and mean score was 38.4. In addition, 25% of women had a score below 32. These scores indicate low levels of depression in women. Statistically significant higher rates of depression were found in women who were not involved with physical activities (p = 0.030). CONCLUSIONS The negative impact of depression on the ASCVD risk could potentially be prevented by modifying individuals' behavior with regard to their engagement in physical activity.
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Affiliation(s)
| | | | | | | | | | | | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
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21
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Wyss F, Valdez O, Camafort M, Coca A. [Comprehensive Therapeutic Approach to Hypertension. Recommendations for Central America and the Caribbean]. HIPERTENSION Y RIESGO VASCULAR 2023; 40:40-47. [PMID: 35697633 DOI: 10.1016/j.hipert.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Latin American hypertension guidelines, tailored to the needs of countries of Central and South America, should be applied and known by most Latin American physicians. The knowledge and implementation of the Guidelines is one of the greatest challenges of hypertension societies in Latin America such as the Central American and Caribbean Society of Arterial Hypertension (SCCH), the Latin American Society of Hypertension (LASH) and the Inter-American Society of Cardiology (SIAC). In 2020, the Inter-American Society of Cardiology (SIAC) published its position on the current Guidelines for Arterial Hypertension due to the need to standardize the evaluation, diagnosis, treatment and control of hypertension, establishing recommendations that should be adopted in all Latin American countries, aimed at optimizing the management of cardiovascular risk and achieving a substantial improvement in the reduction of cardiovascular events and mortality. This document intends to reinforce all proposals by the LASH guidelines and the position of the SIAC in relation to the therapeutic approach and pharmacological recommendations for patients with hypertension (HT), in order to achieve better HT control in the Central American and Caribbean area, and the consequently prognosis improvement of cardiovascular disease in the area.
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Affiliation(s)
- F Wyss
- Servicios y Tecnología Cardiovascular de Guatemala, Sociedad Centroamericana y del Caribe de Hipertensión Arterial y Prevención Cardiovascular, Ciudad de Guatemala, Guatemala.
| | - O Valdez
- Unidad de Cardiología, Hospital Central Romana, y Centro Especialidades Médicas Romana (CEMER), Sociedad Centroamericana y del Caribe de Hipertensión Arterial y Prevención Cardiovascular, Santo Domingo, República Dominicana
| | - M Camafort
- Unidad de Hipertensión, Unidad de Insuficiencia Cardiaca, Servicio de Medicina Interna, ICMID, Hospital Clínic IDIBAPS, Universidad de Barcelona, Barcelona, España; CIBER-OBN, Instituto de Salud Carlos III, Madrid, España
| | - A Coca
- Unidad de Hipertensión, Unidad de Insuficiencia Cardiaca, Servicio de Medicina Interna, ICMID, Hospital Clínic IDIBAPS, Universidad de Barcelona, Barcelona, España; Sociedad Europea de Hipertensión, Zug, Suiza
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22
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Navar AM, Fine LJ, Ambrosius WT, Brown A, Douglas PS, Johnson K, Khera AV, Lloyd-Jones D, Michos ED, Mujahid M, Muñoz D, Nasir K, Redmond N, Ridker PM, Robinson J, Schopfer D, Tate DF, Lewis CE. Earlier treatment in adults with high lifetime risk of cardiovascular diseases: What prevention trials are feasible and could change clinical practice? Report of a National Heart, Lung, and Blood Institute (NHLBI) Workshop. Am J Prev Cardiol 2022; 12:100430. [PMID: 36439649 PMCID: PMC9691440 DOI: 10.1016/j.ajpc.2022.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
Abstract
More than half of U.S. young adults have low ten-year but high lifetime risk of cardiovascular disease (CVD). Improving primary prevention in young adulthood may help reduce persistent CVD disparities and overall CVD morbidity and mortality. The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop in 2021 to identify potential trial opportunities in CVD prevention in young adults. The workshop identified promising interventions that could be tested, including interventions that focus on a single cardiovascular risk factor (e.g., lipids or inflammation) to multiple risk factor interventions (e.g., multicomponent lifestyle interventions or fixed-low dose combination of medications). Given the sample size and duration for a trial with hard endpoints, more research is needed on the utility of intermediate endpoints identified noninvasively such as subclinical coronary atherosclerosis as a surrogate endpoint. For now, clinical outcomes trials with hard endpoints will more likely change clinical practice. Trial efficiency depends on accurate identification of high-risk young adults, which can potentially be done using traditional risk equations, coronary artery calcium screening, computerized tomography coronary angiography, and polygenic risk scores. Trials in young adults should include enhanced recruitment strategies with intense community engagement to enroll a trial population that is racially, ethnically, geographically, and socially diverse. Despite the challenges in conducting large prevention trials in young adults, recent advances including innovation in clinical trial conduct, new therapies and successful interventions in older populations, and an increasing recognition of a lifespan approach to risk assessment have made such trials more feasible than ever. Disclosures The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
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Affiliation(s)
| | | | | | | | | | | | - Amit V. Khera
- Center for Genomic Medicine, Massachusetts General Hospital, USA
- Verve Therapeutics, USA
| | | | | | | | | | | | | | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, USA
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Kim Y, Kim W, Kim JK, Moon JY, Park S, Park CW, Park HS, Song SH, Yoo TH, Lee SY, Lee EY, Lee J, Jin K, Cha DR, Cha JJ, Han SY. Blood Pressure Control in Patients with Diabetic Kidney Disease. Electrolyte Blood Press 2022; 20:39-48. [PMID: 36688208 PMCID: PMC9827046 DOI: 10.5049/ebp.2022.20.2.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease. Blood pressure (BP) control can reduce the risks of cardiovascular (CV) morbidity, mortality, and kidney disease progression. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines have suggested the implementation of a more intensive BP control with a target systolic BP (SBP) of <120 mmHg based on the evidence that the CV benefits obtained is outweighed by the kidney injury risk associated with a lower BP target. However, an extremely low BP level may paradoxically aggravate renal function and CV outcomes. Herein, we aimed to review the existing literature regarding optimal BP control using medications for DKD.
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Affiliation(s)
- Yaeni Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University, Seoul, Republic of Korea
| | - Won Kim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ju Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Cheol Whee Park
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University, Seoul, Republic of Korea
| | - Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University, Seoul, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine & Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - So-Young Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Kidney Institute, Daegu, Republic of Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Republic of Korea
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Nugroho P, Andrew H, Kohar K, Noor CA, Sutranto AL. Comparison between the world health organization (WHO) and international society of hypertension (ISH) guidelines for hypertension. Ann Med 2022; 54:837-845. [PMID: 35291891 PMCID: PMC8933011 DOI: 10.1080/07853890.2022.2044510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
The global burden of hypertension remains an unsolved problem, especially in low- and middle-income countries (LMICs). For this reason, clinical practice guidelines containing the latest evidence-based recommendations are crucial in the management of hypertension. It is noteworthy that guidelines simply translated from those of high-income countries (HICs) are not the solution to the problem of hypertension in LMICs. Among the numerous guidelines available, those of the World Health Organisation and the International Society of Hypertension are the latest to be published as of the writing of this article. In this review, we conducted both general and specific comparisons between the recommendations supplied by both guidelines. Differences in aspects of hypertension management such as the timing of antihypertensive initiation, assessment of comorbidities and cardiovascular risk factors, pharmacological therapy selection, and blood pressure target and reassessment are explored. Lastly, the implications of the differences found between the two guidelines in both LMICs and HICs are discussed.Key messagesCurrently, with low treatment and control rates, hypertension remains a burden in low- and middle-income countries (LMICs).The lack of customised guidelines for LMICs cannot be solved simply by adopting guidelines from high-income countries.The World Health Organisation (WHO) recently published a clinical guideline for the pharmacological management of hypertension in LMICs. We compare select recommendations from the guidelines to those published by the International Society of Hypertension.
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Affiliation(s)
- Pringgodigdo Nugroho
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hubert Andrew
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kelvin Kohar
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Chairina Azkya Noor
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aida Lydia Sutranto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Affiliation(s)
- Giovanna Liuzzo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University, School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
| | - Carlo Patrono
- Department of Pharmacology, Catholic University School of Medicine, Largo F. Vito 1, 00168 Rome, Italy
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Ciardullo S, Rea F, Cannistraci R, Muraca E, Perra S, Zerbini F, Mortara A, Perseghin G. NT-ProBNP and mortality across the spectrum of glucose tolerance in the general US population. Cardiovasc Diabetol 2022; 21:236. [DOI: 10.1186/s12933-022-01671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Even though hyperglycemia is a well-known cardiovascular risk factor, the absolute risk of cardiovascular events varies to a great extent within each glycemic category. The aim of this study is to evaluate whether N-terminal pro-B natriuretic peptide (NT-ProBNP) could help identify subjects at higher cardiovascular risk, independently of blood glucose levels.
Methods
Serum NT-ProBNP levels were measured in 5502 people aged 45–79 years without heart failure from the general population (3380 with normoglycemia, 1125 with pre-diabetes and 997 with diabetes) that participated in the 1999–2004 cycles of the National Health and Nutrition Examination Survey. We applied Cox and Fine Gray models adjusted for cardiovascular risk factors to evaluate the association between NT-ProBNP levels and all-cause and cardiovascular mortality through December 2015.
Results
After a median follow-up of 13 years, 1509 participants died, 330 of cardiovascular causes. In the multivariable-adjusted models, compared with participants with NT-ProBNP < 100 pg/ml, those with levels 100–300 pg/ml and ≥ 300 pg/ml had a higher incidence of both all-cause mortality (HR 1.61, 95% CI 1.12–2.32, p = 0.012 and HR 2.96, 95% CI 1.75–5.00, p < 0.001, respectively) and cardiovascular mortality (HR 1.57, 95% CI 1.17–2.10, p = 0.011 and HR 2.08, 95% CI 1.47–2.93, p < 0.001, respectively). The association was consistent in subgroup analyses based on glycemic status, obesity, age and sex.
Conclusions
Elevated NT-ProBNP is independently associated with all-cause and cardiovascular mortality in the general population and could help identify patients at the highest risk. Further studies are needed to evaluate whether intensification of treatment based on biomarker data might lead to improvements in cardiovascular risk reduction.
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Desbiens L, Khelifi N, Wang Y, Lavigne F, Beaulieu V, Sidibé A, Mac‐Way F. Thiazide Diuretics and Fracture Risk: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JBMR Plus 2022; 6:e10683. [PMID: 36398110 PMCID: PMC9664541 DOI: 10.1002/jbm4.10683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
Thiazide diuretics are commonly used antihypertensive agents. Until today, whether their use reduces fracture risk remains unclear. Our objective was to conduct a systematic review of thiazide diuretics' effects on fractures and bone mineral density (BMD) in randomized clinical trials (RCT) of adults. MEDLINE, EMBASE, CENTRAL, and the WHO's ICTRP registry were searched from inception to July 31, 2019. Two reviewers assessed studies for eligibility criteria: (i) RCTs; (ii) including adults; (iii) comparing thiazides, alone or in combination; (iv) to placebo or another medication; and (v) reporting fractures or BMD. Conference abstracts and studies comparing thiazides to antiresorptive or anabolic bone therapy were excluded. Bias was assessed using Cochrane Collaboration's Risk of Bias Tool-2. The primary outcome was fracture at any anatomical site. Secondary outcomes were osteoporotic fractures, hip fractures, and BMD at femoral neck, lumbar spine, and/or total hip. Fractures were pooled as risk ratios (RRs) using random-effect models. Prespecified subgroup analyses and post hoc sensitivity analyses were conducted. From 15,712 unique records screened, 32 trials (68,273 patients) met eligibility criteria. Thiazides were associated with decreased fractures at any site (RR = 0.87, 95% confidence interval [CI] 0.77-0.98; I 2 = 0%) and osteoporotic fractures (RR = 0.80; 95% CI 0.69-0.94; I 2 = 0%). Results were consistent in most subgroups and sensitivity analyses. Few studies reported hip fractures, and no association was found between thiazides and this outcome (RR = 0.84; 95% CI 0.67-1.04; I 2 = 0%). Only four studies reported BMD; a meta-analysis was not conducted because BMD reporting was inconsistent. Trials were deemed at low (3 studies, weight = 3%), some concerns (16 studies; 71%), or high (11 studies; 26%) risk of bias for the primary outcome. In conclusion, thiazide diuretics decreases the risk of fractures at any and at osteoporotic sites in a meta-analysis of RCTs. Additional studies are warranted in patients with high fracture risk. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Louis‐Charles Desbiens
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Nada Khelifi
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Yue‐Pei Wang
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Felix Lavigne
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Véronique Beaulieu
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Aboubacar Sidibé
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
| | - Fabrice Mac‐Way
- CHU de Québec Research CenterL'Hôtel‐Dieu de Québec HospitalQuebecCanada
- Department of Medicine, Faculty of MedicineLaval UniversityQuebecCanada
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Mao Y, Ge S, Qi S, Tian QB. Benefits and risks of antihypertensive medication in adults with different systolic blood pressure: A meta-analysis from the perspective of the number needed to treat. Front Cardiovasc Med 2022; 9:986502. [PMID: 36337902 PMCID: PMC9626501 DOI: 10.3389/fcvm.2022.986502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background The blood pressure (BP) threshold for initial pharmacological treatment remains controversial. The number needed to treat (NNT) is a significant indicator. This study aimed to explore the benefits and risks of antihypertensive medications in participants with different systolic BPs (SBPs), and cardiovascular disease status from the perspective of the NNT. Methods We conducted a meta-analysis of 52 randomized placebo-controlled trials. The data were extracted from published articles and pooled to calculate NNTs. The participants were divided into five groups, based on the mean SBP at entry (120–129.9, 130–139.9, 140–159.9, 160–179.9, and ≥180 mmHg). Furthermore, we stratified patients into those with and without cardiovascular disease. The primary outcomes were the major adverse cardiovascular events (MACEs), and adverse events (AEs) leading to discontinuation. Results Antihypertensive medications were not associated with MACEs, however, it increased AEs, when the SBP was <140 mmHg. For participants with cardiovascular disease or at a high risk of heart failure and stroke, antihypertensive treatment reduced MACEs when SBP was ≥130 mmHg. Despite this, only 2–4 subjects had reduced MACEs per 100 patients receiving antihypertensive medications for 3.50 years. The number of individuals who needed to treat to avoid MACEs declined with an increased cardiovascular risk. Conclusion Pharmacological treatment could be activated when SBP reaches 140 mmHg. For people with cardiovascular disease or at a higher risk of stroke and heart failure, 130 mmHg may be a better therapeutic threshold. It could be more cost-effective to prioritize antihypertensive medications for people with a high risk of developing cardiovascular disease.
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Razo C, Welgan CA, Johnson CO, McLaughlin SA, Iannucci V, Rodgers A, Wang N, LeGrand KE, Sorensen RJD, He J, Zheng P, Aravkin AY, Hay SI, Murray CJL, Roth GA. Effects of elevated systolic blood pressure on ischemic heart disease: a Burden of Proof study. Nat Med 2022; 28:2056-2065. [PMID: 36216934 PMCID: PMC9556328 DOI: 10.1038/s41591-022-01974-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/27/2022] [Indexed: 12/28/2022]
Abstract
High systolic blood pressure (SBP) is a major risk factor for ischemic heart disease (IHD), the leading cause of death worldwide. Using data from published observational studies and controlled trials, we estimated the mean SBP-IHD dose-response function and burden of proof risk function (BPRF), and we calculated a risk outcome score (ROS) and corresponding star rating (one to five). We found a very strong, significant harmful effect of SBP on IHD, with a mean risk-relative to that at 100 mm Hg SBP-of 1.39 (95% uncertainty interval including between-study heterogeneity 1.34-1.44) at 120 mm Hg, 1.81 (1.70-1.93) at 130 mm Hg and 4.48 (3.81-5.26) at 165 mm Hg. The conservative BPRF measure indicated that SBP exposure between 107.5 and 165.0 mm Hg raised risk by 101.36% on average, yielding a ROS of 0.70 and star rating of five. Our analysis shows that IHD risk was already increasing at 120 mm Hg SBP, rising steadily up to 165 mm Hg and increasing less steeply above that point. Our study endorses the need to prioritize and strengthen strategies for screening, to raise awareness of the need for timely diagnosis and treatment of hypertension and to increase the resources allocated for understanding primordial prevention of elevated blood pressure.
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Affiliation(s)
- Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | | | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vincent Iannucci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anthony Rodgers
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nelson Wang
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kate E LeGrand
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jiawei He
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, University of Washington, Seattle, WA, USA
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30
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Orozco-Beltrán D, Brotons Cuixart C, Banegas Banegas JR, Gil Guillén VF, Cebrián Cuenca AM, Martín Rioboó E, Jordá Baldó A, Vicuña J, Navarro Pérez J. [Cardiovascular preventive recommendations. PAPPS 2022 thematic updates. Working groups of the PAPPS]. Aten Primaria 2022; 54 Suppl 1:102444. [PMID: 36435583 PMCID: PMC9705225 DOI: 10.1016/j.aprim.2022.102444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
The recommendations of the semFYC's Program for Preventive Activities and Health Promotion (PAPPS) for the prevention of cardiovascular diseases (CVD) are presented. The following sections are included: epidemiological review, where the current morbidity and mortality of CVD in Spain and its evolution as well as the main risk factors are described; cardiovascular (CV) risk and recommendations for the calculation of CV risk; main risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, describing the method for their diagnosis, therapeutic objectives and recommendations for lifestyle measures and pharmacological treatment; indications for antiplatelet therapy, and recommendations for screening of atrial fibrillation, and recommendations for management of chronic conditions. The quality of testing and the strength of the recommendation are included in the main recommendations.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Medicina Familiar y Comunitaria, Unidad de Investigación Centro de Salud Cabo Huertas, Departamento San Juan de Alicante. Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - Carlos Brotons Cuixart
- Medicina Familiar y Comunitaria. Instituto de Investigación Biomédica (IIB) Sant Pau. Equipo de Atención Primaria Sardenya, Barcelona, España
| | - Jose R Banegas Banegas
- Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Vicente F Gil Guillén
- Medicina Familiar y Comunitaria, Hospital Universitario de Elda. Departamento de Medicina Clínica. Universidad Miguel Hernández, San Juan de Alicante, España
| | - Ana M Cebrián Cuenca
- Medicina Familiar y Comunitaria, Centro de Salud Cartagena Casco Antiguo, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, España
| | - Enrique Martín Rioboó
- Medicina Familiar y Comunitaria, Especialista en Medicina Familiar y Comunitaria, Centro de Salud Poniente, Córdoba, IMIBIC Hospital Reina Sofía Córdoba. Colaborador del grupo PAPPS
| | - Ariana Jordá Baldó
- Medicina Familiar y Comunitaria, Centro de Salud San Miguel, Plasencia, Badajoz, España
| | - Johanna Vicuña
- Medicina Preventiva y Salud Pública, Hospital de la Sant Creu i Sant Pau, Barcelona, España
| | - Jorge Navarro Pérez
- Medicina Familiar y Comunitaria, Hospital Clínico Universitario. Departamento de Medicina. Universidad de Valencia. Instituto de Investigación INCLIVA, Valencia, España
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Haring B, McGinn AP, Kamensky V, Allison M, Stefanick ML, Schnatz PF, Kuller LH, Berger JS, Johnson KC, Saquib N, Garcia L, Richey PA, Manson JE, Alderman M, Wassertheil-Smoller S. Low Diastolic Blood Pressure and Mortality in Older Women. Results From the Women's Health Initiative Long Life Study. Am J Hypertens 2022; 35:795-802. [PMID: 35522983 PMCID: PMC9434234 DOI: 10.1093/ajh/hpac056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recommended systolic blood pressure targets often do not consider the relationship of low diastolic blood pressure (DBP) levels with cardiovascular disease (CVD) and all-cause mortality risk, which is especially relevant for older people with concurrent comorbidities. We examined the relationship of DBP levels to CVD and all-cause mortality in older women in the Women's Health Initiative Long Life Study (WHI-LLS). METHODS The study sample included 7,875 women (mean age: 79 years) who underwent a blood pressure measurement at an in-person home visit conducted in 2012-2013. CVD and all-cause mortality were centrally adjudicated. Hazard ratios (HRs) were obtained from adjusted Cox proportional hazards models. RESULTS After 5 years follow-up, all-cause mortality occurred in 18.4% of women. Compared with a DBP of 80 mm Hg, the fully adjusted HR for mortality was 1.33 (95% confidence interval [CI]: 1.04-1.71) for a DBP of 50 mm Hg and 1.67 (95% CI: 1.29-2.16) for a DBP of 100 mm Hg. The HRs for CVD were 1.14 (95% CI: 0.78-1.67) for a DBP of 50 mm Hg and HR 1.50 (95% CI: 1.03-2.17) for a DBP of 100 mm Hg. The nadir DBP associated with lowest mortality risk was 72 mm Hg overall. CONCLUSIONS In older women, consideration should be given to the potential adverse effects of low and high DBP. Low DBP may serve as a risk marker. DBP target levels between 68 and 75 mm Hg may avoid higher mortality risk.
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Affiliation(s)
- Bernhard Haring
- Department of Medicine III, Saarland University Hospital, Homburg, Germany
- Department of Medicine I, University of Würzburg, Würzburg, Germany
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aileen P McGinn
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Victor Kamensky
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew Allison
- Department of Family Medicine, University of California San Diego, La Jolla, California, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Peter F Schnatz
- Department of Obstetrics/Gynecology and Internal Medicine, Reading Hospital/Tower Health, West Reading, Pennsylvania, USA
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey S Berger
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Lorena Garcia
- Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California, USA
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - JoAnn E Manson
- Department of Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Alderman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Al-Sodany E, Chesnaye NC, Heimbürger O, Jager KJ, Bárány P, Evans M. Blood pressure and kidney outcomes in patients with severely decreased glomerular filtration rate: a nationwide observational cohort study. J Hypertens 2022; 40:1487-1498. [PMID: 35730420 PMCID: PMC9415216 DOI: 10.1097/hjh.0000000000003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To investigate the association between blood pressure (BP) and kidney outcomes in patients with estimated glomerular filtration rate less than 30 ml/min per 1.73 m 2 and different degrees of albuminuria. METHODS National observational cohort study of 18 071 chronic kidney disease (CKD) stage 4-5 patients in routine nephrology care 2010-2017. The association between both baseline and repeated clinic office BP and eGFR slope and kidney replacement therapy (KRT) was explored using multivariable adjusted joint models. The analyses were stratified on albuminuria at baseline. RESULTS The adjusted yearly eGFR slope became increasingly steeper from -0,91 (95% CI -0.83 to -1.05) ml/min per 1.73 m 2 per year in those with SBP less than 120 mmHg at baseline to -2.09 (-1.83 to -2.37) ml/min per 1.73 m 2 in those with BP greater than 160 mmHg. Similarly, eGFR slope was steeper with higher DBP. Lower SBP and DBP was associated with slower eGFR decline in patients with albuminuria grade A3 (>30 mg/mmol) but not consistently in albuminuria A1-A2. Those with diabetes progressed faster and the association between BP and eGFR slope was stronger. In repeated BP measurement analyses, every 10 mmHg higher SBP over time was associated with 39% additional risk of KRT. CONCLUSION In people with eGFR less than 30 ml/min per 1.73 m 2 , lower clinic office BP is associated with more favorable kidney outcomes. Our results support lower BP targets also in people with CKD stage 4-5.
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Affiliation(s)
- Ehab Al-Sodany
- Renal Medicine, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Nicholas C. Chesnaye
- ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olof Heimbürger
- Renal Medicine, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Kitty J. Jager
- ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Peter Bárány
- Renal Medicine, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Renal Medicine, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Abstract
A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, University for Continuing Education Krems, Austria (M.B., Y.T.)
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil (S.M.).,Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (S.M.)
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Hussain A, Virani SS, Zheng L, Gluckman TJ, Borden WB, Masoudi FA, Maddox TM. Potential Impact of 2017 American College of Cardiology/American Heart Association Hypertension Guideline on Contemporary Practice: A Cross-Sectional Analysis From NCDR PINNACLE Registry. J Am Heart Assoc 2022; 11:e024107. [PMID: 35656989 PMCID: PMC9238704 DOI: 10.1161/jaha.121.024107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Background Clinical implications of change in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the diagnosis and management of hypertension, compared with recommendations by 2014 expert panel and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), are not known. Methods and Results Using data from the NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence) Registry (January 2013-Decemver 2016), we compared the proportion and clinical characteristics of patients seen in cardiology practices diagnosed with hypertension, recommended antihypertensive treatment, and achieving blood pressure (BP) goals per each guideline document. In addition, we evaluated the proportion of patients at the level of practices meeting BP targets defined by each guideline. Of 6 042 630 patients evaluated, 5 027 961 (83.2%) were diagnosed with hypertension per the 2017 ACC/AHA guideline, compared with 4 521 272 (74.8%) per the 2014 panel and 4 545 976 (75.2%) per JNC7. The largest increase in hypertension prevalence was seen in younger ages, women, and those with lower cardiovascular risk. Antihypertensive medication was recommended to 70.6% of patients per the ACC/AHA guideline compared with 61.8% and 65.9% per the 2014 panel and JNC7, respectively. Among those on antihypertensive agents, 41.2% achieved BP targets per the ACC/AHA guideline, compared with 79.4% per the 2014 panel and 64.3% per JNC7. Lower proportions of women, non-White (Black and "other") races, and those at higher cardiovascular risk achieved BP goals. Median practice-level proportion of patients meeting BP targets per the 2014 panel but not the ACC/AHA guideline was 37.8% (interquartile range, 34.8%-40.7%) and per JNC7 but not the ACC/AHA guideline was 22.9% (interquartile range, 19.8%-25.9%). Conclusions Following publication of the 2017 guideline, significantly more people, particularly younger people and those with lower cardiovascular risk, will be diagnosed with hypertension and need antihypertensive treatment compared with previous recommendations. Significant practice-level variation in BP control also exists. Efforts are needed to improve guideline-concordant hypertension management in an effort to improve outcomes.
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Affiliation(s)
- Aliza Hussain
- Section of CardiologyDepartment of MedicineBaylor College of MedicineHoustonTX
| | - Salim S. Virani
- Section of CardiologyDepartment of MedicineBaylor College of MedicineHoustonTX
- Section of CardiologyMichael E. DeBakey Veterans Affairs HospitalHoustonTX
| | - Luke Zheng
- BAIM Institute for Clinical ResearchBostonMA
| | - Ty J. Gluckman
- Center for Cardiovascular Analytics, Research and Data ScienceProvidence Heart InstituteProvidence St Joseph HealthPortlandOR
| | | | | | - Thomas M. Maddox
- Division of CardiologyWashington University School of MedicineSt. LouisMO
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Ackland GL, Abbott TEF. Hypotension as a marker or mediator of perioperative organ injury: a narrative review. Br J Anaesth 2022; 128:915-930. [PMID: 35151462 PMCID: PMC9204667 DOI: 10.1016/j.bja.2022.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 12/21/2022] Open
Abstract
Perioperative hypotension has been repeatedly associated with organ injury and worse outcome, yet many interventions to reduce morbidity by attempting to avoid or reverse hypotension have floundered. In part, this reflects uncertainty as to what threshold of hypotension is relevant in the perioperative setting. Shifting population-based definitions for hypertension, plus uncertainty regarding individualised norms before surgery, both present major challenges in constructing useful clinical guidelines that may help improve clinical outcomes. Aside from these major pragmatic challenges, a wealth of biological mechanisms that underpin the development of higher blood pressure, particularly with increasing age, suggest that hypotension (however defined) or lower blood pressure per se does not account solely for developing organ injury after major surgery. The mosaic theory of hypertension, first proposed more than 60 yr ago, incorporates multiple, complementary mechanistic pathways through which clinical (macrovascular) attempts to minimise perioperative organ injury may unintentionally subvert protective or adaptive pathways that are fundamental in shaping the integrative host response to injury and inflammation. Consideration of the mosaic framework is critical for a more complete understanding of the perioperative response to acute sterile and infectious inflammation. The largely arbitrary treatment of perioperative blood pressure remains rudimentary in the context of multiple complex adaptive hypertensive endotypes, defined by distinct functional or pathobiological mechanisms, including the regulation of reactive oxygen species, autonomic dysfunction, and inflammation. Developing coherent strategies for the management of perioperative hypotension requires smarter, mechanistically solid interventions delivered by RCTs where observer bias is minimised.
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Affiliation(s)
- Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Tom E F Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
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Chi NF, Chung CP, Cheng HM, Liu CH, Lin CJ, Hsu LC, Tang SC, Lee JT, Po HL, Jeng JS, Wang TD, Lee IH. 2021 Taiwan Stroke Society Guidelines of blood pressure control for ischemic stroke prevention. J Chin Med Assoc 2022; 85:651-664. [PMID: 35507097 DOI: 10.1097/jcma.0000000000000738] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Since the publication of the 2015 Taiwan Stroke Society Blood Pressure for Treatment and Prevention of Stroke Guideline (2015 TSS BP Guideline), several new clinical studies have addressed whether a stricter blood pressure (BP) target would be effective for stroke prevention. METHODS TSS guideline consensus group provides recommendations on BP targets for stroke prevention based on updated evidences. RESULTS The present guideline covers five topics: (1) diagnosis of hypertension; (2) BP control and primary prevention of ischemic stroke; (3) BP control and secondary prevention of ischemic stroke; (4) BP control and secondary prevention of large artery atherosclerosis ischemic stroke; and (5) BP control and secondary prevention of small vessel occlusion ischemic stroke. CONCLUSION The BP target for most stroke patients with hypertension is <130/80 mm Hg.
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Affiliation(s)
- Nai-Fang Chi
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Hao-Ming Cheng
- Center for Evidence-based Medicine & Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chun-Jen Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Li-Chi Hsu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Helen L Po
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tzung-Dau Wang
- Department of Cardiology, National Taiwan University, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
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Prescribing blood pressure lowering drugs irrespective of blood pressure? J Hypertens 2022; 40:1050-1051. [PMID: 35506281 DOI: 10.1097/hjh.0000000000003116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan AA, Siddiqui SA, Yasmin F, Abidi SM, Tariq R, Ahmed H, Murtaza N, Jawed F, Lashkerwala SS, Moin A, Shah SMI, Ullah I, Yousaf Z, Faizan M, Shahid MH. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol 2022:101233. [PMID: 35490770 DOI: 10.1016/j.cpcardiol.2022.101233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular Diseases (CVD) are the leading cause of mortality globally. Wald and Law proposed the idea of a 'polypill'; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, anti-platelet drugs, anti-coagulation drugs, anti-arrhythmic drugs, which are frequently integrated to combat specific CVDs. This 'polypill' holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past physicians are now highly aware of this new strategy.The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.
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Affiliation(s)
- Arsalan Aamir Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Farah Yasmin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Rabbia Tariq
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Hiba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Noor Murtaza
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Fareeha Jawed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Ariba Moin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan.
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muhammad Faizan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
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A novel methodological framework was described for detecting and quantifying overdiagnosis. J Clin Epidemiol 2022; 148:146-159. [PMID: 35483550 DOI: 10.1016/j.jclinepi.2022.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Methods to quantify overdiagnosis of screen detected cancer have been developed, but methods for quantifying overdiagnosis of non-cancer conditions (whether symptomatic or asymptomatic) have been lacking. We aimed to develop a methodological framework for quantifying overdiagnosis that may be used for asymptomatic or symptomatic conditions, and used Gestational Diabetes Mellitus as an example of how it may be applied. STUDY DESIGN AND SETTING We identify two earlier definitions for overdiagnosis, a narrower prognosis-based definition, and a wider utility-based definition. Building on the central importance of the concepts of prognostic information and clinical utility of a diagnosis, we consider the following questions: within a target population, do people found to have a disease using one diagnostic strategy but found not to have the disease using another diagnostic strategy (so called 'additional diagnoses'), have an increased risk of adverse clinical outcomes without treatment (prognosis evidence), and/or a decreased risk of adverse outcomes with treatment (utility evidence)? RESULTS Using Causal Directed Acyclic Graphs and Fair Umpires, we illuminate the relationships between diagnostics strategies and the frequency of overdiagnosis. We then use the example of Gestational Diabetes Mellitus to demonstrate how the Fair Umpire framework may be applied to estimate overdiagnosis. CONCLUSION Our framework may be used to quantify overdiagnosis in non-cancer conditions (and in cancer conditions), as well as to guide further studies on this topic.
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Kandil OA, Motawea KR, Aboelenein MM, Shah J. Polypills for Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:880054. [PMID: 35498049 PMCID: PMC9046936 DOI: 10.3389/fcvm.2022.880054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the effect of polypills on the primary prevention of cardiovascular (CV) events using data from clinical trials.MethodsWe searched PubMed, Web of Science, EBSCO, and SCOPUS throughout May 2021. Two authors independently screened articles for the fulfillment of inclusion criteria. The RevMan software (version 5.4) was used to calculate the pooled risk ratios (RRs) and mean differences (MDs), along with their associated confidence intervals (95% CI).ResultsEight trials with a total of 20653 patients were included. There was a significant reduction in the total number of fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P-value < 0.001]. This reduction was observed in both the intermediate-risk [RR (95% CI) = 0.76 (0.65, 0.89); P-value < 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P-value < 0.001] groups of patients. Subgroup analysis was performed based on the follow-up duration of each study, and benefits were only evident in the five-year follow-up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P-value < 0.001]. Benefits were absent in the one-year-or-less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P-value = 0.330]. Additionally, there was a significant reduction in the 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = −3.74 (−5.96, −1.51); P-value < 0.001], as compared to controls.ConclusionA polypill regimen decreases the incidence of fatal and non-fatal CV events in patients with intermediate- and high- cardiovascular risk, and therefore may be an effective treatment for these patients.
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Affiliation(s)
| | | | | | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
- *Correspondence: Jaffer Shah
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Deng Y, Liu Y, Yang L, Bai J, Cai J. Improving outcomes for older hypertensive patients: is more intensive treatment better? Expert Rev Cardiovasc Ther 2022; 20:193-205. [PMID: 35332819 DOI: 10.1080/14779072.2022.2058491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION With population aging, late-life hypertension is becoming an increasingly important issue. Mounting evidence has documented additional cardiovascular benefits induced by a more intensive target, lower than what are recommended in most current guidelines for systolic blood pressure (SBP) reduction in older patients with hypertension. However, the optimal target remains less clear. AREAS COVERED In the present review, we summarized the evolution of the perspective into late-life hypertension and the development of the 'optimal' target for SBP reduction in older patients with hypertension. More importantly, new evidence from latest antihypertensive drug-placebo studies, blood pressure target studies, and high-quality meta-analysis regarding the effect of intensive SBP treatment in older patients were covered and discussed in detail. EXPERT OPINION In summary, robust evidence supports that a SBP target of <130 mmHg is safe and will induce additional cardiovascular benefits in general older patients with hypertension. This benefit seems to be consistent, but less degreed in older patients with comorbidities such as chronic kidney disease or diabetes mellitus. However, such an intensive SBP target should be judiciously applied in older patients under extreme conditions. Collectively, edging down the relaxed SBP targets to <130 mmHg in most of the current guidelines is in imperative need.
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Affiliation(s)
- Yue Deng
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, Hebei, China
| | - Yunlan Liu
- Department of Cardiology, The First Hospital of Kunming, Kunming, Yunnan, China
| | - Li Yang
- Department of Cardiology, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China
| | - Jingjing Bai
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, Hebei, China
| | - Jun Cai
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, Hebei, China
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Sepanlou S, Najafi F, Poustchi H, Parsaeian M, Ahmadi A, Somi M, Moradpour F, Alizadeh-Navaei R, Gohari A, Zamani B, Esmaeilinadimi A, Rezaianzadeh A, Mansour-Ghanaei F, Bahramali E, Ansari-Moghaddam A, Hamzeh B, Zanganeh Yousefabadi E, Zare Sakhvidi MJ, Mohebbi I, Fattahi MR, Nejatizadeh A, Marioryad H, Motamed-Gorji N, Roozafzai F, Eghtesad S, Mohammadi Z, Shayanrad A, Sharafkhah M, Etemadi A, Kamangar F, Juraschek SP, Malekzadeh R. Prevalence, awareness, treatment, and control of hypertension based on ACC/AHA versus JNC7 guidelines in the PERSIAN cohort study. Sci Rep 2022; 12:4057. [PMID: 35260709 PMCID: PMC8904851 DOI: 10.1038/s41598-022-07896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/28/2022] [Indexed: 02/08/2023] Open
Abstract
In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35-70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran.
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Affiliation(s)
- Sadaf Sepanlou
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Department of Epidemiology and Biostatistics, Modeling in Health Research Center, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Gohari
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Bijan Zamani
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Esmaeilinadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elham Zanganeh Yousefabadi
- Department of Internal Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Zare Sakhvidi
- Occupational Health Research Centre, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Roozafzai
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amaneh Shayanrad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, North Kargar Ave., Tehran, 14117-13135, Iran.
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Nienaber CA, Yuan X. Taming Hypertension to Prevent Aortic Dissection: Universal Recognition of a "New Normal" Blood Pressure? Circulation 2022; 145:645-647. [PMID: 35226554 DOI: 10.1161/circulationaha.121.058133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK (C.A.N., X.Y.).,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK. (C.A.N., X.Y.)
| | - Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK (C.A.N., X.Y.).,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK. (C.A.N., X.Y.)
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Do recent meta-analyses truly prove that treatment with blood pressure-lowering drugs is beneficial at any blood pressure value, no matter how low? A critical review. J Hypertens 2022; 40:839-846. [PMID: 35191413 DOI: 10.1097/hjh.0000000000003056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Current European guidelines for the management of hypertension and on cardiovascular disease prevention place the threshold for pharmacological treatment at a SBP level of 140 mmHg or above, with the exception of patients at very high risk (mainly because of coronary heart disease). This is in agreement with the current definition of hypertension, that is, the level of blood pressure at which the benefits of treatment outweigh the risks of treatment, as documented by clinical trials. This rationale and definition was recently challenged by meta-analyses using individual participant-level data from 48 randomized trials by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC). The authors calculated for a fixed 5 mmHg pharmacological reduction of SBP an overall 10% risk reduction for major cardiovascular events. It was concluded that there was no reliable evidence of heterogeneity of treatment effects by baseline SBP categories; that the effect was independent from the presence of cardiovascular disease; applied also to old and very old individuals up to 84 years or beyond; and that BP-lowering was also beneficial in individuals with normal or high-normal SBP down to a baseline SBP less than 120 mmHg. In this report, we identify and discuss a number of shortcomings of the BPLTTC meta-analyses. In our view, the conclusions by the BPLTTC must be - together with accompanying suggestions to abandon the definition of hypertension - strongly rejected as they are not justified and may be harmful for cardiovascular health in individuals without hypertension.
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Application of the 2017 American college of cardiology/American Heart Association Blood Pressure Guidelines for cardiovascular outcomes among Tehranian residents. J Hypertens 2022; 40:924-932. [PMID: 35185119 DOI: 10.1097/hjh.0000000000003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the associations of cardiovascular disease (CVD) outcomes with elevated blood pressure (BP), stage I of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH), defined by 2017 ACC/AHA guidelines among the Tehranian adult population. METHOD We enrolled 7068 residents of Tehran (district No. 13) aged at least 30 years, who were free of CVD and not taking antihypertensive medications at baseline. Participants were categorized into eight categories: normal BP (reference group), elevated BP, stage I IDH, stage I ISH, stage I SDH, and all stage II phenotypes. Significant interactions were found between age groups (<60 versus ≥60 years) and BP categories (P value: 0.017); hence, the analysis was performed in each age group, separately. We used multivariable Cox proportional regression analysis to evaluate the association of different BP categories with incident CVD. RESULTS During 18 years of follow-up, 1053 CVD events occurred. In the younger group, stage I of IDH and SDH were associated with increased CVD risk with hazard ratios of 1.23 (95% confidence interval: 0.99-1.52) and 1.42 (1.04-1.94), respectively. In the older group, stage I of IDH had a lower risk for coronary heart disease (CHD) [hazard ratio 0.53 (0.29-0.96)]. As a sensitivity analysis, among high CVD risk individuals (10-year risk >10%), we found a higher risk for CVD among those with elevated BP and stage I of SDH. For individuals with 10-year risk less than 10%, all BP parameters, except stage I of IDH, were associated with increased CVD risk. Although there was no significant interaction between sex and BP categories, elevated BP and stage I of SDH significantly increased the risk of CVD only among men. CONCLUSION Age is an important potential modifier in the association between stage I of hypertension and CVD/CHD risk. Stage I of IDH was not an alarming status for CVD development, whether the participants had a high CVD risk or not.
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Thadani U. Polypills: Common Garden Variety or Precision Formulated for Improving Cardiovascular Outcomes: An Ongoing Challenge. Trends Cardiovasc Med 2022; 33:190-191. [PMID: 35231614 DOI: 10.1016/j.tcm.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Udho Thadani
- University of Oklahoma Health Sciences Center, and VA Health Care System, 800 Stanton L Young Boulevard, AAT, Suite 5400, Oklahoma City, Oklahoma, USA.
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Deng Y, Zhang G, Wang L, Cai J. Improving outcomes for older hypertensive patients: is more intensive treatment better? Expert Rev Cardiovasc Ther 2022; 20:1-3. [PMID: 35103577 DOI: 10.1080/14779072.2022.2034500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yue Deng
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Guohui Zhang
- Department of Cardiology, Zhenjiang First People’s Hospital, Zhenjiang, Jiangsu, China
| | - Lu Wang
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Cai
- Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Sarkar G, Gaikwad VB, Sharma A, Halder SK, Kumar DA, Anand J, Agrawal S, Kumbhar A, Kinholkar B, Mathur R, Doshi M, Bachani D, Mehta S. Fixed-dose Combination of Metoprolol, Telmisartan, and Chlorthalidone for Essential Hypertension in Adults with Stable Coronary Artery Disease: Phase III Study. Adv Ther 2022; 39:923-942. [PMID: 34918194 DOI: 10.1007/s12325-021-01971-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the efficacy and safety of fixed-dose combination (FDC) of metoprolol, telmisartan, and chlorthalidone in patients with essential hypertension and stable coronary artery disease (CAD) who showed inadequate response to dual therapy. METHODS In this phase III, open-label, multicenter study, 254 adults with stable CAD having uncontrolled hypertension despite being treated with FDC of metoprolol (25/50 mg) and telmisartan (40 mg) were included. Patients received either of the following FDC for 24 weeks: metoprolol (25 mg), telmisartan (40 mg), and chlorthalidone (12.5 mg) (FDC1; n = 139) or metoprolol (50 mg), telmisartan (40 mg), and chlorthalidone (12.5 mg) (FDC2; n = 115) tablets once daily. The FDCs were developed using the novel Wrap Matrix™ platform technology. Primary endpoint assessed the mean change in seated diastolic blood pressure (SeDBP) and seated systolic blood pressure (SeSBP) from baseline to 24 weeks. Secondary efficacy endpoints included proportion of patients achieving < 90 mmHg SeDBP (SeDBP responder) and < 140 mmHg SeSBP (SeSBP responder) at weeks 12, 16, 20, and 24. Safety was assessed throughout the study. RESULTS A total of 243 (95.70%) patients completed study. The mean change in BP from baseline (FDC1, 155/96 mmHg; FDC2, 165/98 mmHg) to week 24 (FDC1, 128/82 mmHg; FDC2, 131/83 mmHg) was statistically significant (both groups p < 0.0001). Within FDC1 and FDC2, the mean change from baseline to week 24 in SeDBP (82.60 mmHg and 83.09 mmHg) and SeSBP (128.07 mmHg and 131.29 mmHg) was statistically significant (both groups p < 0.0001). At week 24, in FDC1, 80.15% and 84.73% were SeDBP and SeSBP responders, respectively; in FDC2, 79.46% and 74.11% were SeDBP and SeSBP responders, respectively. No serious adverse events or deaths were reported. CONCLUSION Triple FDCs of metoprolol, telmisartan, and chlorthalidone were considered effective and well tolerated in patients with hypertension who respond inadequately to dual therapy. CLINICAL TRIAL REGISTRATION CTRI/2016/11/007491.
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Should a Statin be Given to All Hypertensive Patients? Curr Hypertens Rep 2022; 24:21-27. [DOI: 10.1007/s11906-022-01167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
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