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Polónia J, Marques Pereira R. Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study. Blood Press 2024; 33:2345887. [PMID: 38680045 DOI: 10.1080/08037051.2024.2345887] [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: 02/08/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure. MATERIALS AND METHODS A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg). RESULTS Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex. CONCLUSION In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.
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Affiliation(s)
- Jorge Polónia
- RISE & Department of Medicine, Faculty of Medicine of Porto, Porto, Portugal
- Blood Pressure Unit & CV Risk, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Raul Marques Pereira
- School of Medicine, University of Minho, Braga, Portugal
- Association P5 Digital Medical Center (ACMP5), School of Medicine, University of Minho, Braga, Portugal
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2
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McCarthy CP, Jackson R, McEvoy JW, Rahimi K. From Treating Hypertension to Lowering Cardiovascular Disease Risk. Hypertension 2024; 81:1655-1658. [PMID: 38887943 DOI: 10.1161/hypertensionaha.124.21722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston (C.P.M.)
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand (R.J.)
| | - John W McEvoy
- Cardiology Department, University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Ireland (J.W.M.)
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Reproductive and Women's Health, University of Oxford, United Kingdom (K.R.)
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3
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Zhang X, Li G, Wu W, Li B. Causal role of immune cells in hypertension: a bidirectional Mendelian randomization study. Front Cardiovasc Med 2024; 11:1375704. [PMID: 38859818 PMCID: PMC11163045 DOI: 10.3389/fcvm.2024.1375704] [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] [Received: 01/24/2024] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
Background Although Hypertension (HTN) is considered to be a cardiovascular disease caused by multiple factors, the cause of it is still unknown. In this study, we aim to find out whether circulating immune cell characteristics have an impact on susceptibility to HTN. Methods This study employed a comprehensive two-sample Mendelian randomization (MR) analysis to investigate the causal association between immune cell characteristics and HTN. Utilizing publicly accessible genetic data, we examined the causal relationship between HTN and the susceptibility to 731 immune cell signatures. To ensure the reliability and validity of the findings, a comprehensive sensitivity analysis was conducted to assess heterogeneity, confirm the robustness of the results and evaluate the presence of horizontal pleiotropy. Results After FDR correction, immune phenotype had an effect on HTN. In our study, one immunophenotype was identified as being positively associated with HTN risk significance: HLA DR on CD33- HLA DR+. In addition, we examined 8 immune phenotype with no statistically significant effect of HTN, but it is worth mentioning that they had an unadjusted low P-value phenotype. Conclusions Our MR study by genetic means demonstrated the close relationship between HTN and immune cells, thus providing guidance for future clinical prediction and subsequent treatment of HTN.
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Affiliation(s)
- Xinhe Zhang
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guanying Li
- Jinan Foreign Language School International Center, Jinan, China
| | - Wei Wu
- Department of Cardiology, Hekou District People Hospital, Dongying, China
| | - Bin Li
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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Canepa M, De Marzo V, Ameri P, Ferrari R, Tavazzi L, Rapezzi C, Porto I, Maggioni AP. Temporal trends in evidence supporting therapeutic interventions in heart failure and other European Society of Cardiology guidelines. ESC Heart Fail 2023; 10:3019-3027. [PMID: 37550897 PMCID: PMC10567640 DOI: 10.1002/ehf2.14459] [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: 12/07/2022] [Revised: 05/20/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS This study aimed to determine whether any change occurred over time in level of evidence (LoE) of therapeutic interventions supporting heart failure (HF) and other European Society of Cardiology guideline recommendations. METHODS AND RESULTS We selected topics with at least three documents released between 2008 and April 2022. Classes of recommendations (CoR) and supporting LoE related to therapeutic interventions within each document were collected and compared over time. A total of 1822 recommendations from 18 documents on 6 topics [median number per document = 112, 867 (48%) CoR I] were included in the analysis. There was a trend towards a reduction over time in the percentage of CoR I in HF (46-36-34%), non-ST elevation myocardial infarction (NSTEMI; 78-58-54%), and pulmonary embolism (PE; 65-50-39%) guidelines, with a decrease in the total number of recommendations for HF only. Percentage of CoR I was stable over time around 40% for valvular heart disease (VHD) and atrial fibrillation (AF), and around 60% for cardiovascular prevention (CVP), with an increase in the total number of recommendations for VHD and CVP and a decrease for AF. Among CoR I, 319 (37%) were supported by LoE A, with a decrease over time for HF (56-46-42%), an increase for NSTEMI (29-38-48%) and AF (28-31-36%), a bimodal distribution for PE and CVP, and a lack for VHD. CONCLUSIONS LoE supporting therapeutic recommendations in contemporary European guidelines is generally low. Physicians should be aware of these limitations, and scientific societies promote a greater understanding of their significance and drive future research directions.
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Affiliation(s)
- Marco Canepa
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | | | - Pietro Ameri
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Roberto Ferrari
- Scientific DepartmentMTA GroupLuganoSwitzerland
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Claudio Rapezzi
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Italo Porto
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Aldo Pietro Maggioni
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
- Centro Studi ANMCO, Heart Care FoundationFlorenceItaly
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Louca P, Tran TQB, Toit CD, Christofidou P, Spector TD, Mangino M, Suhre K, Padmanabhan S, Menni C. Machine learning integration of multimodal data identifies key features of blood pressure regulation. EBioMedicine 2022; 84:104243. [PMID: 36084617 PMCID: PMC9463529 DOI: 10.1016/j.ebiom.2022.104243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Association studies have identified several biomarkers for blood pressure and hypertension, but a thorough understanding of their mutual dependencies is lacking. By integrating two different high-throughput datasets, biochemical and dietary data, we aim to understand the multifactorial contributors of blood pressure (BP). METHODS We included 4,863 participants from TwinsUK with concurrent BP, metabolomics, genomics, biochemical measures, and dietary data. We used 5-fold cross-validation with the machine learning XGBoost algorithm to identify features of importance in context of one another in TwinsUK (80% training, 20% test). The features tested in TwinsUK were then probed using the same algorithm in an independent dataset of 2,807 individuals from the Qatari Biobank (QBB). FINDINGS Our model explained 39·2% [4·5%, MAE:11·32 mmHg (95%CI, +/- 0·65)] of the variance in systolic BP (SBP) in TwinsUK. Of the top 50 features, the most influential non-demographic variables were dihomo-linolenate, cis-4-decenoyl carnitine, lactate, chloride, urate, and creatinine along with dietary intakes of total, trans and saturated fat. We also highlight the incremental value of each included dimension. Furthermore, we replicated our model in the QBB [SBP variance explained = 45·2% (13·39%)] cohort and 30 of the top 50 features overlapped between cohorts. INTERPRETATION We show that an integrated analysis of omics, biochemical and dietary data improves our understanding of their in-between relationships and expands the range of potential biomarkers for blood pressure. Our results point to potentially key biological pathways to be prioritised for mechanistic studies. FUNDING Chronic Disease Research Foundation, Medical Research Council, Wellcome Trust, Qatar Foundation.
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Affiliation(s)
- Panayiotis Louca
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Tran Quoc Bao Tran
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Clea du Toit
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Paraskevi Christofidou
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, London, SE1 9RT, United Kingdom
| | - Karsten Suhre
- Bioinformatics Core, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Sandosh Padmanabhan
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom.
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, England, SE1 7EH, United Kingdom.
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Gosse P, Doublet J, Gaudissard J, Boulestreau R, Cremer A. Long-term evolution of ambulatory blood pressure and cardiovascular events in hypertensive patients. J Hum Hypertens 2021; 36:517-523. [PMID: 33931738 DOI: 10.1038/s41371-021-00538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/09/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) is now considered the gold standard to evaluate BP, and predicts related cardiovascular risk. However, no study has reported the association of long-term changes in ABPM with the incidence of cardiovascular events, therefore the objective of this work. We included patients from the Bordeaux cohort of hypertensive patients, who had undergone at least two ABPM; the first was performed before or after antihypertensive treatment was started, and the second was the last recording available before any cardiovascular event. We included 591 patients (mean age, 54 years) with a 7-year average interval between the first and last ABPM, a 10-year average follow-up, and a total of 111 cardiovascular events. The patients were divided into four groups: G0, first and last 24 h systolic blood pressure (SBP) < 130; G1, first 24 h SBP ≥ 130, last 24 h SBP < 130; G2, first 24 h SBP < 130, last 24 h SBP ≥ 130; and G3, first 24 h SBP ≥ 130, last 24 h SBP ≥ 130 mmHg. Baseline ABPM better predicted future events than the last ABPM. G0 and G2 had similar survival. G1 and G3 had a worse prognosis than G0 and G2, while G1 had an intermediate risk between G0 and G3, indicating some benefit of treatment. In conclusion, our study showed the prognostic value of the first ABPM recorded in hypertensive patients and the persistence of risk when 24 h BP is controlled by antihypertensive treatment.
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Affiliation(s)
- Philippe Gosse
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France.
| | - Julien Doublet
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Julie Gaudissard
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Romain Boulestreau
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
| | - Antoine Cremer
- Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France
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Affiliation(s)
- Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow (R.M.T.)
| | - Ernesto L Schiffrin
- Lady Davis Institute for Medical Research, Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, QC, Canada (E.L.S.)
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8
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Htet M, Ursitti JA, Chen L, Fisher SA. Editing of the myosin phosphatase regulatory subunit suppresses angiotensin II induced hypertension via sensitization to nitric oxide mediated vasodilation. Pflugers Arch 2021; 473:611-622. [PMID: 33145641 DOI: 10.1007/s00424-020-02488-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Alternative splicing of exon 24 (E24) of the myosin phosphatase regulatory subunit (Mypt1) tunes smooth muscle sensitivity to NO/cGMP-mediated vasorelaxation and thereby controls blood pressure (BP) in otherwise normal mice. This occurs via the toggling in or out of a C-terminal leucine zipper (LZ) motif required for hetero-dimerization with and activation by cGMP-dependent protein kinase cGK1α. Here we tested the hypothesis that editing (deletion) of E24, by shifting to the LZ positive isoform of Mypt1, would suppress the hypertensive response to angiotensin II (AngII). To test this, mice underwent tamoxifen-inducible and smooth muscle-specific deletion of E24 (E24 cKO) at age 6 weeks followed by a chronic slow-pressor dose of AngII (400 ng/kg/min) plus additional stressors. E24 cKO suppressed the hypertensive response to AngII alone or with the addition of a high salt diet. This effect was not a function of altered salt balance as there were no differences in intake or renal excretion of sodium. This effect was NO dependent as L-NAME in the drinking water caused an exaggerated hypertensive response in the E24cKO mice. E24cKO mouse mesenteric arteries were more sensitive to DEA/NO-induced vasorelaxation and less responsive to AngII- and α-adrenergic-induced vasoconstriction at baseline. Only the latter two effects were still present after 2 weeks of chronic AngII treatment. We conclude that editing of Mypt1 E24, by shifting the expression of naturally occurring isoforms and sensitizing to NO-mediated vasodilation, could be a novel approach to the treatment of human hypertension.
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Affiliation(s)
- Myo Htet
- Department of Medicine (Cardiology) and Physiology and Biophysics, University of Maryland-Baltimore, Baltimore, MD, 21201, USA
| | - Jeanine A Ursitti
- Department of Medicine (Cardiology) and Physiology and Biophysics, University of Maryland-Baltimore, Baltimore, MD, 21201, USA
| | - Ling Chen
- Department of Medicine (Cardiology) and Physiology and Biophysics, University of Maryland-Baltimore, Baltimore, MD, 21201, USA
- Department of Physiology , University of Maryland- Baltimore , MD, 21201, Baltimore, USA
| | - Steven A Fisher
- Department of Medicine (Cardiology) and Physiology and Biophysics, University of Maryland-Baltimore, Baltimore, MD, 21201, USA.
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland-Baltimore, Baltimore, MD, 21201, USA.
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9
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McGrath BP, McEvoy JW. Did the 2017 ACC/AHA blood pressure guideline get it wrong in reducing the diastolic threshold to define hypertension from 90 to 80 mmHg? J Clin Hypertens (Greenwich) 2020; 22:1200-1201. [DOI: 10.1111/jch.13899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Brian P. McGrath
- School of Medicine National University of Ireland Galway National Institute for Prevention and Cardiovascular Health Galway Ireland
| | - John W. McEvoy
- School of Medicine National University of Ireland Galway National Institute for Prevention and Cardiovascular Health Galway Ireland
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10
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Impact of cumulative SBP and serious adverse events on efficacy of intensive blood pressure treatment: a randomized clinical trial. J Hypertens 2020; 37:1058-1069. [PMID: 30444838 DOI: 10.1097/hjh.0000000000002001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive blood pressure lowering is increasingly gaining attention. In addition to higher baseline blood pressure, cumulative SBP, visit-to-visit variability, and treatment-induced serious adverse events (SAEs) could impact treatment efficacy over time. Our aim was to assess the impact of cumulative SBP and SAEs on intensive hypertension treatment efficacy in the Systolic Blood Pressure Intervention Trial (SPRINT) population during follow-up. METHODS Secondary analysis of the SPRINT study: a randomized, controlled, open-label trial including 102 clinical sites in the United States. We included 9068 SPRINT participants with 128 139 repeated SBP measurements. Participants were randomly assigned to intensive (target SBP < 120 mmHg) versus standard treatment (target SBP between 135 and 139 mmHg). We used cumulative joint models for longitudinal and survival data analysis. Primary outcome was a composite outcome of myocardial infarction, other acute coronary syndromes, acute decompensated heart failure, stroke, and cardiovascular mortality. RESULTS Although intensive treatment decreased the risk for the primary SPRINT outcome at the start of follow-up, its effect lost significance after 3.4 years of follow-up in the total SPRINT population and after 1.3, 1.3, 1.1, 1.8, 2.1, 1.8, and 3.4 years among participants with prevalent chronic kidney disease, prevalent cardiovascular disease, women, black individuals, participants less than 75 years, those with baseline SBP more than 132 mmHg, and individuals who suffered SAEs during follow-up, respectively. CONCLUSION The initial beneficial impact of intensive hypertension treatment might be offset by cumulative SBP and development of SAEs during follow-up.
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11
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Brunström M, Carlberg B. Benefits and harms of lower blood pressure treatment targets: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open 2019; 9:e026686. [PMID: 31575567 PMCID: PMC6773352 DOI: 10.1136/bmjopen-2018-026686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 06/10/2019] [Accepted: 09/03/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess the effect of antihypertensive treatment in the 130-140 mm Hg systolic blood pressure range. DESIGN Systematic review and meta-analysis. INFORMATION SOURCES PubMed, CDSR and DARE were searched for the systematic reviews, which were manually browsed for clinical trials. PubMed and Cochrane Central Register of Controlled Trials were searched for trials directly in February 2018. ELIGIBILITY CRITERIA Randomised double-blind trials with ≥1000 patient-years of follow-up, comparing any antihypertensive agent against placebo. DATA EXTRACTION AND RISK OF BIAS Two reviewers extracted study-level data, and assessed risk of bias using Cochrane Collaborations risk of bias assessment tool, independently. MAIN OUTCOMES AND MEASURES Primary outcomes were all-cause mortality, major cardiovascular events and discontinuation due to adverse events. Secondary outcomes were cardiovascular mortality, myocardial infarction, stroke, heart failure, hypotension-related adverse events and renal impairment. RESULTS Eighteen trials, including 92 567 participants (34% women, mean age 63 years), fulfilled the inclusion criteria. Primary preventive antihypertensive treatment was associated with a neutral effect on all-cause mortality (relative risk 1.00, 95% CI 0.95 to 1.06) and major cardiovascular events (1.01, 0.96 to 1.06), but an increased risk of discontinuation due to adverse events (1.23, 1.03 to 1.47). None of the secondary efficacy outcomes were significantly reduced, but the risk of hypotension-related adverse events increased with treatment (1.71, 1.32 to 2.22). In coronary artery disease secondary prevention, antihypertensive treatment was associated with reduced risk of all-cause mortality (0.91, 0.83 to 0.99) and major cardiovascular events (0.85, 0.77 to 0.94), but doubled the risk of adverse events leading to discontinuation (2.05, 1.62 to 2.61). CONCLUSION Primary preventive blood pressure lowering in the 130-140 mm Hg systolic blood pressure range adds no cardiovascular benefit, but increases the risk of adverse events. In the secondary prevention, benefits should be weighed against harms. PROSPERO REGISTRATION NUMBER CRD42018088642.
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Affiliation(s)
- Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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12
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Satish P, Khetan A, Raithatha S, Bhende P, Josephson R. Standardizing hypertension management in a primary care setting in India through a protocol based model. Indian Heart J 2019; 71:375-380. [PMID: 32035519 PMCID: PMC7013193 DOI: 10.1016/j.ihj.2019.11.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/26/2019] [Accepted: 11/16/2019] [Indexed: 01/13/2023] Open
Abstract
Hypertension is a leading cause of death in India. Control rates of hypertension are abysmal, even for people on treatment. There are a number of barriers to adequate control of hypertension in India, including therapeutic inertia and the lack of a systematic, simplified approach. Standardizing hypertension management through an evidence based model that sets thresholds for diagnosis, treatment goals, follow up intervals and choice of drugs can lead to improved management of hypertension in an individual hospital or health system. In this paper, we summarize the evidence for such a model, and adapt it to the Indian context, focusing on maximizing effectiveness, safety and ease of use by a non-expert. This model can be utilized by individual practitioners, hospitals, primary health centers (PHCs) and the Health and Wellness Centers (HWCs) under the Ayushman Bharat initiative.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
| | - Shyamsundar Raithatha
- Department of Community Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Punam Bhende
- Department of Internal Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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13
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Abstract
PURPOSE OF REVIEW Recent US guidelines have changed the definition of hypertension to ≥ 130/80 mmHg and recommended more intense blood pressure (BP) targets. We summarize the evidence for intense BP treatment and discuss risks that must be considered when choosing treatment goals for individual patients. RECENT FINDINGS The SPRINT study reported that treating to a systolic BP target of 120 mmHg reduces cardiovascular outcomes in high-risk individuals, supporting more intensive BP reduction than previously recommended. However, recent observational studies have placed emphasis on the BP J-curve phenomenon, where low BPs are associated with adverse cardiovascular outcomes, suggesting that overly aggressive BP targets may sometimes be harmful. We attempt to reconcile these apparent contradictions for the clinician. We also review other potential dangers of aggressive BP targets, including syncope, renal impairment, polypharmacy, drug interactions, subjective drug side-effects, and non-adherence. We suggest a personalized approach to BP drug management considering individual risks, benefits, and preferences when choosing therapeutic targets, recognizing that a goal of 130/80 mmHg should always be considered. Additionally, we recommend an intense focus on lifestyle changes and medication adherence.
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14
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Affiliation(s)
- Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College, London, UK and Center for Molecular Cardiology, Zurich and Zurich Heart House, Zurich, Switzerland
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15
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Krauss A. Why all randomised controlled trials produce biased results. Ann Med 2018; 50:312-322. [PMID: 29616838 DOI: 10.1080/07853890.2018.1453233] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/10/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are commonly viewed as the best research method to inform public health and social policy. Usually they are thought of as providing the most rigorous evidence of a treatment's effectiveness without strong assumptions, biases and limitations. OBJECTIVE This is the first study to examine that hypothesis by assessing the 10 most cited RCT studies worldwide. DATA SOURCES These 10 RCT studies with the highest number of citations in any journal (up to June 2016) were identified by searching Scopus (the largest database of peer-reviewed journals). RESULTS This study shows that these world-leading RCTs that have influenced policy produce biased results by illustrating that participants' background traits that affect outcomes are often poorly distributed between trial groups, that the trials often neglect alternative factors contributing to their main reported outcome and, among many other issues, that the trials are often only partially blinded or unblinded. The study here also identifies a number of novel and important assumptions, biases and limitations not yet thoroughly discussed in existing studies that arise when designing, implementing and analysing trials. CONCLUSIONS Researchers and policymakers need to become better aware of the broader set of assumptions, biases and limitations in trials. Journals need to also begin requiring researchers to outline them in their studies. We need to furthermore better use RCTs together with other research methods. Key messages RCTs face a range of strong assumptions, biases and limitations that have not yet all been thoroughly discussed in the literature. This study assesses the 10 most cited RCTs worldwide and shows that trials inevitably produce bias. Trials involve complex processes - from randomising, blinding and controlling, to implementing treatments, monitoring participants etc. - that require many decisions and steps at different levels that bring their own assumptions and degree of bias to results.
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Affiliation(s)
- Alexander Krauss
- a London School of Economics ; University College London , London , UK
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Jung HH, Park JI, Jeong JS. Blood Pressure-Related Risk Among Users Versus Nonusers of Antihypertensives: A Population-Based Cohort in Korea. Hypertension 2018; 71:1047-1055. [PMID: 29686015 DOI: 10.1161/hypertensionaha.118.11068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/07/2018] [Accepted: 03/20/2018] [Indexed: 11/16/2022]
Abstract
There have been few studies comparing blood pressure (BP)-related outcomes between users and nonusers of antihypertensive drugs. We constructed a population-based cohort of 492 540 Koreans aged 40 to 79 years, who had no preexisting cardiorenal diseases, from the National Health Insurance Service-Health Screening database. The primary composite outcome was death (or critical care unit admission) from cardiorenal causes, revascularization for myocardial infarction or stroke, and new-onset end-stage renal disease. Using time-dependent Cox models, we estimated hazard ratios according to BP and antihypertensive use, which were determined in each year of follow-up. Over 10 years of follow-up, the primary outcome occurred in 26 122 subjects, and 33 550 deaths were noted. Among nonusers of antihypertensives, the risk for the primary outcome increased linearly from a BP of 105/65 mm Hg, and the risk for all-cause mortality increased from a BP of 115/75 mm Hg. Among irregular users, the risk for the primary outcome increased as the BP increased >115/75 mm Hg. Among active users, the risk for the primary outcome increased in systolic BP <115 mm Hg and >135 mm Hg, and in diastolic BP <65 mm Hg and >85 mm Hg, and the risk for all-cause mortality increased in systolic BP <125 mm Hg and >135 or 145 mm Hg. In conclusion, this population-based study demonstrated that the associations between BP and adverse outcomes were J-shaped among active antihypertensive users, but linear or flat and then increasing among nonusers or irregular users.
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Affiliation(s)
- Hae Hyuk Jung
- From the Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea.
| | - Ji In Park
- From the Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, South Korea
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Streit S, Gussekloo J, Burman RA, Collins C, Kitanovska BG, Gintere S, Gómez Bravo R, Hoffmann K, Iftode C, Johansen KL, Kerse N, Koskela TH, Peštić SK, Kurpas D, Mallen CD, Maisonneuve H, Merlo C, Mueller Y, Muth C, Ornelas RH, Šter MP, Petrazzuoli F, Rosemann T, Sattler M, Švadlenková Z, Tatsioni A, Thulesius H, Tkachenko V, Torzsa P, Tsopra R, Tuz C, Verschoor M, Viegas RPA, Vinker S, de Waal MWM, Zeller A, Rodondi N, Poortvliet RKE. Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old. Scand J Prim Health Care 2018; 36:89-98. [PMID: 29366388 PMCID: PMC5901445 DOI: 10.1080/02813432.2018.1426142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. DESIGN This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. SETTING GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS This study included 2543 GPs from 29 countries. MAIN OUTCOME MEASURES GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. RESULTS Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). CONCLUSIONS GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age). • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years. • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60. • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.
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Affiliation(s)
- Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Biljana Gerasimovska Kitanovska
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Sandra Gintere
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņs University, Riga, Latvia
| | - Raquel Gómez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Iftode
- Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tuomas H. Koskela
- Department of General Practice, University of Tampere, Tampere, Finland
| | - Sanda Kreitmayer Peštić
- Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Hubert Maisonneuve
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
| | - Yolanda Mueller
- Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
| | - Christiane Muth
- Institute of General Practice Goethe-University, Frankfurt/Main, Germany
| | | | - Marija Petek Šter
- Department for Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
| | | | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Hans Thulesius
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
- Senior Researcher Region Kronoberg, Växjö, Sweden
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Rosy Tsopra
- LIMICS, INSERM, Paris, France
- Leeds Centre for Respiratory Medicine, St James’s University Hospital, Leeds, UK
| | - Canan Tuz
- Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
| | - Marjolein Verschoor
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita P. A. Viegas
- Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Shlomo Vinker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Margot W. M. de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Andreas Zeller
- Centre for Primary Health Care (uniham-bb), University of Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rosalinde K. E. Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- CONTACT Rosalinde K. E. Poortvliet Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD Leiden, The Netherlands
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Olivo RE, Scialla JJ. Getting Out of the Phosphate Bind: Trials to Guide Treatment Targets. Clin J Am Soc Nephrol 2017; 12:868-870. [PMID: 28550079 PMCID: PMC5460702 DOI: 10.2215/cjn.04380417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Robert E. Olivo
- Department of Medicine and
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Julia J. Scialla
- Department of Medicine and
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Affiliation(s)
- Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK.,Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, ul. Skarbowa 1, 31-101, Krakow, Poland
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Streit S, Verschoor M, Rodondi N, Bonfim D, Burman RA, Collins C, Biljana GK, Gintere S, Gómez Bravo R, Hoffmann K, Iftode C, Johansen KL, Kerse N, Koskela TH, Peštić SK, Kurpas D, Mallen CD, Maisoneuve H, Merlo C, Mueller Y, Muth C, Šter MP, Petrazzuoli F, Rosemann T, Sattler M, Švadlenková Z, Tatsioni A, Thulesius H, Tkachenko V, Torzsa P, Tsopra R, Canan T, Viegas RPA, Vinker S, de Waal MWM, Zeller A, Gussekloo J, Poortvliet RKE. Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries. BMC Geriatr 2017; 17:93. [PMID: 28427345 PMCID: PMC5399328 DOI: 10.1186/s12877-017-0486-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/11/2017] [Indexed: 01/13/2023] Open
Abstract
Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision. Methods Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP. Results The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs’ decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48–0.59; ORs per country 0.11–1.78). Conclusions Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0486-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Marjolein Verschoor
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daiana Bonfim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Gerasimovska Kitanovska Biljana
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Sandra Gintere
- Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia
| | - Raquel Gómez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Iftode
- Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tuomas H Koskela
- Department of General Practice, University of Tampere, Tampere, Finland
| | - Sanda Kreitmayer Peštić
- Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wrocław, Poland
| | - Christian D Mallen
- Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Hubert Maisoneuve
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
| | - Yolanda Mueller
- Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
| | - Christiane Muth
- Institute of General Practice, Goethe-University, Frankfurt / Main, Germany
| | - Marija Petek Šter
- Department for Family Medicine, Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- SNAMID (National Society of Medical Education in General Practice), Prata Sannita, Italy.,Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
| | | | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Hans Thulesius
- Family Medicine, Department of Clinical Sciences, Lund University, Malmö and senior researcher Region Kronoberg, Växjö, Sweden
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Rosy Tsopra
- LIMICS, INSERM, U1142, F-75006 Paris, Université Paris 13, Sorbonne Paris Cité, UMR_S 1142, F93000 Bobigny, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1142, F75006 Paris, Paris, France.,Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Tuz Canan
- Family Medicine Specialist, Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
| | - Rita P A Viegas
- Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Shlomo Vinker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands
| | - Andreas Zeller
- Centre for Primary Health Care (uniham-bb), Basel, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.
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Spin. Obstet Gynecol 2017; 129:237-238. [DOI: 10.1097/aog.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This article discusses the role of hypertension in heart failure. Elevated blood pressure has the greatest population attributable risk for the development of heart failure. The mortality rates following the clinical recognition of heart failure is increased multifold. The treatment of hypertension with antihypertensive agents is particularly effective in preventing heart failure, which makes it the most effective therapy for heart failure.
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Affiliation(s)
- Marc A Pfeffer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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