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Qiu W, Cai A, Nie Z, Wang J, Ou Y, Feng Y. Cardiometabolic factors and population risks of cardiovascular disease in community-dwelling adults with varied blood pressure statuses. Diabetes Obes Metab 2024. [PMID: 38738333 DOI: 10.1111/dom.15653] [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: 03/10/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
AIMS To examine the differential associations between cardiometabolic risk factors and cardiovascular disease (CVD), and to evaluate the population-attributable fractions (PAFs) for CVD among community-dwelling adults with varied blood pressure (BP) statuses. METHODS This prospective cohort study included participants without prevalent CVD from a subcohort of the China Patient-Centred Evaluative Assessment of Cardiac Events Million Persons Project. Participants were divided into four BP groups according to the American College of Cardiology/American Heart Association guidelines. The study exposure comprised the selected cardiometabolic risk factors, including waist circumference (WC), body mass index, (BMI) heart rate, fasting blood glucose (FBG), low-density lipoprotein cholesterol, and remnant cholesterol. The outcome was hospitalizations for CVD. Cox proportional hazard models were conducted, and the PAFs were calculated in the analysis. RESULTS Among the 94 183 participants (39.0% were men, mean age: 54.2 years), 26.6% had Stage 1 hypertension and 30.8% had Stage 2 hypertension. A total of 6065 hospitalizations for CVD were captured after a median follow-up of 3.5 years. BP (per 1-standard deviation [SD]: hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.29, 1.40), FBG (per 1-SD: HR 1.16, 95% CI 1.14, 1.19) and WC (per 1-SD: HR 1.41, 95% CI 1.36, 1.47) were three major contributors to CVD events. BP status significantly modified the associations of abdominal obesity, suboptimal BMI, suboptimal heart rate and abnormal FBG with CVD, with stronger associations with CVD observed in optimal BP groups compared to hypertensive groups (p for risk factor-by-BP group interaction <0.05). Participants with all cardiometabolic risk factors were at the highest risk for CVD, accounting for 35.6% (95% CI 30.0, 40.8) of the PAF for CVD. Among the risk factors, BP control explained the highest PAF for CVD (15.1%, 95% CI 8.2, 21.4) The overall PAFs of cardiometabolic risk factors for CVD were higher among the normotensive participants compared to the hypertensive participants. CONCLUSIONS The awareness and control rates of hypertension were extremely low among Southern Chinese adults. BP status significantly modified the associations between cardiometabolic risk factors and CVD, and the overall PAFs for CVD were higher among people with normal BP. Dedicated efforts are needed to improve the management of cardiometabolic factors.
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Affiliation(s)
- Weida Qiu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jiabin Wang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Felippe ISA, Río RD, Schultz H, Machado BH, Paton JFR. Commonalities and differences in carotid body dysfunction in hypertension and heart failure. J Physiol 2023; 601:5527-5551. [PMID: 37747109 PMCID: PMC10873039 DOI: 10.1113/jp284114] [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: 03/31/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Carotid body pathophysiology is associated with many cardiovascular-respiratory-metabolic diseases. This pathophysiology reflects both hyper-sensitivity and hyper-tonicity. From both animal models and human patients, evidence indicates that amelioration of this pathophysiological signalling improves disease states such as a lowering of blood pressure in hypertension, a reduction of breathing disturbances with improved cardiac function in heart failure (HF) and a re-balancing of autonomic activity with lowered sympathetic discharge. Given this, we have reviewed the mechanisms of carotid body hyper-sensitivity and hyper-tonicity across disease models asking whether there is uniqueness related to specific disease states. Our analysis indicates some commonalities and some potential differences, although not all mechanisms have been fully explored across all disease models. One potential commonality is that of hypoperfusion of the carotid body across hypertension and HF, where the excessive sympathetic drive may reduce blood flow in both models and, in addition, lowered cardiac output in HF may potentiate the hypoperfusion state of the carotid body. Other mechanisms are explored that focus on neurotransmitter and signalling pathways intrinsic to the carotid body (e.g. ATP, carbon monoxide) as well as extrinsic molecules carried in the blood (e.g. leptin); there are also transcription factors found in the carotid body endothelium that modulate its activity (Krüppel-like factor 2). The evidence to date fully supports that a better understanding of the mechanisms of carotid body pathophysiology is a fruitful strategy for informing potential new treatment strategies for many cardiovascular, respiratory and metabolic diseases, and this is highly relevant clinically.
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Affiliation(s)
- Igor S. A. Felippe
- Manaaki Manawa – The Centre for Heart Research, Department of Physiology, Faculty of Health & Medical Sciences, University of Auckland, Grafton, Auckland, 1023, New Zealand
| | - Rodrigo Del Río
- Department of Physiology, Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
- Mechanisms of Myelin Formation and Repair Laboratory, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
- Centro de Envejecimiento y Regeneración (CARE), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Harold Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Benedito H. Machado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julian F. R. Paton
- Manaaki Manawa – The Centre for Heart Research, Department of Physiology, Faculty of Health & Medical Sciences, University of Auckland, Grafton, Auckland, 1023, New Zealand
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Boudreaux BD, Romero EK, Diaz KM. Sedentary behavior and risk of cardiovascular disease and all-cause mortality in United States adults with hypertension. J Hypertens 2023; 41:1793-1801. [PMID: 37605821 DOI: 10.1097/hjh.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Growing evidence has implicated sedentary behavior is associated with cardiovascular and all-cause mortality, independent of moderate to vigorous physical activity (MVPA). Contrary to national physical activity guidelines, reductions in sedentary behavior are not promoted as a lifestyle modification in hypertensive adults. This may be in part because of a paucity of evidence demonstrating that sedentary behavior confers morbidity and mortality risk in hypertensive adults. PURPOSE To examine the association between device-measured sedentary behavior and risk of cardiovascular and all-cause mortality and in hypertensive adults. METHODS Data for this analysis come from the 2003 to 2006 National Health and Nutrition Examination Survey, a nationally representative survey of US adults. Sedentary behavior and MVPA were assessed with an ActiGraph 7164 accelerometer. Hypertension was classified as blood pressure at least 140/≥90 mmHg or antihypertensive medication use. RESULTS Median follow-up was 14.5 years. After adjusting for covariates and MVPA, greater time spent in sedentary behavior was associated with an increased risk of cardiovascular mortality [quartile 1: REF, quartile 2: hazard ratio = 1.41 [95% confidence interval (95% CI) 0.83-2.38], quartile 3: hazard ratio = 1.25 (95% CI 0.81-1.94), quartile 4: hazard ratio = 2.14 (95% CI 1.41-3.24); P trend <0.001]. Greater sedentary behavior was also associated with an increased risk of all-cause mortality [quartile 1: REF: quartile 2: hazard ratio = 1.13 (95% CI 0.83-1.52), quartile 3: hazard ratio = 1.33 (95% CI 1.00-1.78), quartile 4: hazard ratio = 2.06 (95% CI 1.60, 2.64); P trend <0.001]. CONCLUSION Greater sedentary behavior is associated with increased risk of cardiovascular mortality and all-cause mortality among US adults with hypertension. These findings suggest reductions in sedentary behavior should be considered to reduce mortality risk in hypertensive adults.
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Martín-Fernández J, Alonso-Safont T, Polentinos-Castro E, Esteban-Vasallo MD, Ariza-Cardiel G, González-Anglada MI, Sánchez-Perruca L, Rodríguez-Martínez G, Rotaeche-del-Campo R, Bilbao-González A. Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care. BMC PRIMARY CARE 2023; 24:79. [PMID: 36959558 PMCID: PMC10037862 DOI: 10.1186/s12875-023-02036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. METHODS Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. RESULTS The median follow-up was 138.61 months (IQR: 124.68-143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80-5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64-210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90-3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02-1.28 for ages 45 to 54). CONCLUSION The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.
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Affiliation(s)
- Jesus Martín-Fernández
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Tamara Alonso-Safont
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Elena Polentinos-Castro
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | | | - Gloria Ariza-Cardiel
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mª Isabel González-Anglada
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Internal Medicine Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Luis Sánchez-Perruca
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Gemma Rodríguez-Martínez
- Don Luis Infant Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Rafael Rotaeche-del-Campo
- Alza Health Center, Osakidetza, OSI Donostia, Research Group in AP IIS Biodonostia, San Sebastián, Spain
| | - Amaia Bilbao-González
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Osakidetza, Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
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Jones S, Schultz MG, Park C, Tillin T, Chaturvedi N, Hughes AD. Antihypertensive treatment effect on exercise blood pressure and exercise capacity in older adults. J Hypertens 2022; 40:1682-1691. [PMID: 35881442 DOI: 10.1097/hjh.0000000000003201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An exaggerated blood pressure (BP) response to exercise and low exercise capacity are risk factors for cardiovascular disease (CVD). The effect of pharmacological antihypertensive treatment on exercise BP in older adults is largely unknown. This study investigates these effects accounting for differences in exercise capacity. METHODS Participants enrolled in the Southall and Brent Revisited (SABRE) study undertook a 6-min stepper test with expired gas analysis and BP measured throughout exercise. Participants were stratified by antihypertensive treatment status and resting BP control. Exercise systolic and diastolic BP (exSBP and exDBP) were compared between groups using potential outcome means [95% confidence intervals (CIs)] adjusted for exercise capacity. Exercise capacity was also compared by group. RESULTS In total, 659 participants were included (mean age ± SD: 73 ± 6.6 years, 57% male). 31% of normotensive and 23% of hypertensive older adults with controlled resting BP had an exaggerated exercise BP. ExSBP was similar between normotensive and treated/controlled individuals [mean (95%CI): 180 (176 184) mmHg vs. 177 (173 181) mmHg, respectively] but was higher in treated/uncontrolled and untreated/uncontrolled individuals [mean (95% CI): 194 (190 197) mmHg, P < 0.001 and 199 (194 204) mmHg, P < 0.001, respectively]; these differences persisted after adjustment for exercise capacity and other confounders. Exercise capacity was lower in treated vs. normotensive individuals [mean (95% CI) normotensive: 16.7 (16.0,17.4) ml/kg/min]; treated/controlled: 15.5 (14.8,16.1) ml/kg/min, P = 0.009; treated/uncontrolled: [15.1 (14.5,15.7) ml/kg per min, P = 0.001] but was not reduced in untreated/uncontrolled individuals [mean (95% CI): 17.0 (16.1,17.8) ml/kg per min, P = 0.621]. CONCLUSION Irrespective of resting BP control and despite performing less exercise, antihypertensive treatment does not fully mitigate an exaggerated BP response to exercise suggesting residual CVD risk in older adults.
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Affiliation(s)
- Siana Jones
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Chloe Park
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science & Experimental Medicine, Institute for Cardiovascular Science, University College London, UK
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Cardiovascular risk in patients receiving antihypertensive drug treatment from the perspective of endothelial function. Hypertens Res 2022; 45:1322-1333. [PMID: 35595983 DOI: 10.1038/s41440-022-00936-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
Abstract
Blood-pressure-lowering therapy with antihypertensive drugs can reduce the risk of cardiovascular morbidity and mortality in patients with hypertension. However, patients treated with antihypertensive drugs generally have a worse prognosis than untreated individuals. Consistent with the results obtained from epidemiological studies, a clinical study showed that endothelial function was impaired more in treated patients with hypertension than in untreated individuals with the same blood pressure level, suggesting that blood-pressure-lowering therapy with currently available antihypertensive drugs cannot restore endothelial function to the level of that in untreated individuals. Several mechanisms of endothelial dysfunction in treated patients are postulated: irreversible damage to the endothelium caused by higher cumulative elevated blood pressure exposure over time; the persistence of the primary causes of hypertension even after the initiation of antihypertensive drug treatment, including an activated renin-angiotensin-aldosterone system, oxidative stress, and inflammation; and higher global cardiovascular risk related not only to conventional cardiovascular risk factors but also to undetectable nonconventional risk factors. Lifestyle modifications/nonpharmacological interventions should be strongly recommended for both untreated and treated individuals with hypertension. Lifestyle modifications/nonpharmacological interventions may directly correct the primary causes of hypertension, which can improve endothelial function and consequently reduce cardiovascular risk regardless of the use or nonuse of antihypertensive drugs.
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Gan L, Sun D, Cheng Y, Wang D, Wang F, Wang L, Li W, Shen D, Guo D, Zhang Z, Wang H, Li J, Yang Y, Liang T. Post-operative blood pressure and 3-year major adverse cardiac events in Chinese patients undergoing PCI. BMC Cardiovasc Disord 2021; 21:623. [PMID: 34969370 PMCID: PMC8717657 DOI: 10.1186/s12872-021-02435-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no clear evidence for the target value of blood pressure control after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure after PCI and major adverse cardiac events (MACE) during 3-year follow-up. METHODS This study is a prospective study. We included the patients who were diagnosed with acute coronary syndrome and underwent PCI stent implantation operation. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. MACE is defined as acute myocardial infarction, recurring chest pain, heart failure, stroke, revascularization and cardiac death. RESULTS A total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure of patients after PCI and MACE events within 3 years and the inflection point is 121. On the left side of the inflection point, the effect size and 95% CI are 1.09 and 1.01-1.18, respectively (P = 0.029). The impact size and 95% CI at the right inflection point were 1.00 and 0.98-1.02(P = 0.604), respectively. CONCLUSION There is a curvilinear relationship between systolic blood pressure and prognosis of patients after PCI. Under the premise of ensuring the safety of patients, maintaining lower blood pressure after surgery is beneficial to improve the prognosis of patients.
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Affiliation(s)
- Lijun Gan
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Sun
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yuntao Cheng
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Deyang Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Fen Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Lin Wang
- Catheterization Room, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Wei Li
- Department of Nursing, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Shen
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Daotong Guo
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zonglei Zhang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Haiyan Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Jinli Li
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yong Yang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Tao Liang
- School of Nursing, Peking Union Medical College, Beijing, China.
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Arafa A, Kokubo Y, Sheerah HA, Sakai Y, Watanabe E, Li J, Honda-Kohmo K, Teramoto M, Kashima R, Nakao YM, Koga M. Developing a Stroke Risk Prediction Model Using Cardiovascular Risk Factors: The Suita Study. Cerebrovasc Dis 2021; 51:323-330. [PMID: 34844243 DOI: 10.1159/000520100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Stroke remains a major cause of death and disability in Japan and worldwide. Detecting individuals at high risk for stroke to apply preventive approaches is recommended. This study aimed to develop a stroke risk prediction model among urban Japanese using cardiovascular risk factors. METHODS We followed 6,641 participants aged 30-79 years with neither a history of stroke nor coronary heart disease. The Cox proportional hazard model estimated the risk of stroke incidence adjusted for potential confounders at the baseline survey. The model's performance was assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow statistics. The internal validity of the risk model was tested using derivation and validation samples. Regression coefficients were used for score calculation. RESULTS During a median follow-up duration of 17.1 years, 372 participants developed stroke. A risk model including older age, current smoking, increased blood pressure, impaired fasting blood glucose and diabetes, chronic kidney disease, and atrial fibrillation predicted stroke incidence with an area under the curve = 0.76 and p value of the goodness of fit = 0.21. This risk model was shown to be internally valid (p value of the goodness of fit in the validation sample = 0.64). On a risk score from 0 to 26, the incidence of stroke for the categories 0-5, 6-7, 8-9, 10-11, 12-13, 14-15, and 16-26 was 1.1%, 2.1%, 5.4%, 8.2%, 9.0%, 13.5%, and 18.6%, respectively. CONCLUSION We developed a new stroke risk model for the urban general population in Japan. Further research to determine the clinical practicality of this model is required.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Haytham A Sheerah
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Emi Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jiaqi Li
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kyoko Honda-Kohmo
- Division of Preventive Healthcare, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government, Osaka, Japan
| | - Yoko M Nakao
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Center for Cerebral and Cardiovascular Disease Information, Open Innovative Center, National Cerebral and Cardiovascular Center, Suita, Japan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Masatoshi Koga
- Division of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Utility of urinary albumin excretion as an index for stratifying the residual cardiovascular risk in patients undergoing antihypertensive agents treatment. J Hypertens 2021; 39:2431-2438. [PMID: 34261952 DOI: 10.1097/hjh.0000000000002947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients treated with antihypertensive medication, even those with well controlled blood pressure (BP), are at higher risk for the development of atherosclerotic cardiovascular disease (ASCVD) in comparison to nonhypertensive individuals with optimal risk levels. We hypothesized that this residual risk could be stratified based on urinary albumin excretion (UAE). METHODS A total of 13 082 middle-aged and older individuals with SBP/DBP of less than 160/100 mmHg and urinary albumin-to-creatinine ratios (UACRs) of less than 300 mg/g, and who were free from ASCVD events, were followed to investigate the incidence of ASCVD. The baseline BP was classified into four categories: normal BP (BP1), high normal BP (BP2), elevated BP (BP3), and grade 1 hypertension (BP4) based on the 2019 Japanese Society of Hypertension guidelines. RESULTS After an average 10.6 ± 2.6 years of follow-up, the multivariable hazard ratio for the development of ASCVD (n = 994) was already increased in medicated hypertensive patients with BP1 in comparison with untreated individuals with BP1; however, among medicated hypertensive patients, this risk was separated between the UAE groups, which were classified according to the median UACR (male, 15.4 mg/g; female, 19.0 mg/g). In medicated hypertensive patients with any category of BP1-BP3, the adjusted risk of the development of ASCVD in those with lower and higher UACRs was comparable to that observed in untreated individuals in the BP1 and BP4 categories, respectively. CONCLUSION In medicated patients with well controlled hypertension, UAE is useful for stratifying the residual risk of developing ASCVD in comparison to nonhypertensive individuals with optimal risk levels.
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Yang Q, Chang A, Tong X, Merritt R. Herpes Zoster Vaccine Live and Risk of Stroke Among Medicare Beneficiaries: A Population-Based Cohort Study. Stroke 2021; 52:1712-1721. [PMID: 33874749 DOI: 10.1161/strokeaha.120.032788] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anping Chang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Maruhashi T, Kihara Y, Higashi Y. Perspectives on the management of hypertension in Japan. Expert Opin Pharmacother 2020; 21:1179-1187. [DOI: 10.1080/14656566.2020.1724958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tatsuya Maruhashi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan
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Nagai K, Yamagata K, Iseki K, Moriyama T, Tsuruya K, Fujimoto S, Narita I, Konta T, Kondo M, Kasahara M, Shibagaki Y, Asahi K, Watanabe T. Antihypertensive treatment and risk of cardiovascular mortality in patients with chronic kidney disease diagnosed based on the presence of proteinuria and renal function: A large longitudinal study in Japan. PLoS One 2019; 14:e0225812. [PMID: 31800605 PMCID: PMC6892527 DOI: 10.1371/journal.pone.0225812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
Several recent clinical trials and meta-analyses have shown that lowering blood pressure reduces the risk of cardiovascular disease. However, current evidence that describes general demographics in blood pressure and mortality with chronic kidney disease is sparse in Japan. Using a population-based longitudinal cohort that received annual health checkups in Japan in 2008, hypertensive status, self-reported use of antihypertensive drugs, and prognosis were examined through 2012. Chronic kidney disease was defined as positive proteinuria or estimated glomerular filtration rate <60 ml/min/1.73 m2. Subjects were 40 to 74 years old (n = 227,204) with median 3.6 years follow-up period, and patients with and without chronic kidney disease were analyzed separately (n = 183,586 and n = 43,618, respectively). Cardiovascular disease mortality, comprising coronary heart diseases and stroke as entered in the national death registry using ICD-10 coding, was examined. Among all subjects, 346 deaths (96 in chronic kidney disease and 250 in non-chronic kidney disease) due to cardiovascular disease occurred. Compared with cardiovascular disease mortality in chronic kidney disease patients with untreated normal blood pressure, the multivariable adjusted hazard ratio was 3.08 (95% confidence interval: 1.75–5.41) for those with untreated hypertension, 2.30 (1.31–4.03) for those who became normotensive after treatment, and 3.28 (1.91–5.64) for those who remained hypertensive despite treatment. In non-chronic kidney disease subjects, the ratios were 1.90 (1.33–5.41), 1.95 (1.35–2.80), and 1.77 (1.18–2.66), respectively. These results from a nationwide cohort could be one of representative demographics of controlling blood pressure and cardiovascular disease deaths when treating patients with chronic kidney disease in Japan in recent years. Even after development and spread of anti-hypertensive drugs, preventing development of hypertension is preferable, because any hypertension treatment status comparing untreated normal blood pressure was a risk of cardiovascular mortality at baseline year.
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Affiliation(s)
- Kei Nagai
- University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- University of Tsukuba, Tsukuba, Ibaraki, Japan
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Kunitoshi Iseki
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Okinawa Heart and Renal Association, Okinawa, Japan
| | - Toshiki Moriyama
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Health Care Center, Osaka University, Suita, Japan
| | - Kazuhiko Tsuruya
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Nara Medical University, Nara, Japan
| | - Shouichi Fujimoto
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- University of Miyazaki, Miyazaki, Japan
| | - Ichiei Narita
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tsuneo Konta
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Masahide Kondo
- University of Tsukuba, Tsukuba, Ibaraki, Japan
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
| | - Masato Kasahara
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan
| | - Yugo Shibagaki
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Koichi Asahi
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Iwate Medical University, Morioka, Japan
| | - Tsuyoshi Watanabe
- The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan
- Fukushima Rosai Hospital, Iwaki, Japan
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Effects of Physical Exercise on Endothelial Function and DNA Methylation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142530. [PMID: 31315170 PMCID: PMC6678332 DOI: 10.3390/ijerph16142530] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 12/22/2022]
Abstract
Essential hypertension is the leading preventable cause of death in the world. Epidemiological studies have shown that physical training can reduce blood pressure (BP), both in hypertensive and healthy individuals. Increasing evidence is emerging that DNA methylation is involved in alteration of the phenotype and of vascular function in response to environmental stimuli. We evaluated repetitive element and gene-specific DNA methylation in peripheral blood leukocytes of 68 volunteers, taken before (T0) and after (T1) a three-month intervention protocol of continuative aerobic physical exercise. DNA methylation was assessed by bisulfite-PCR and pyrosequencing. Comparing T0 and T1 measurements, we found an increase in oxygen consumption at peak of exercise (VO2peak) and a decrease in diastolic BP at rest. Exercise increased the levels of ALU and Long Interspersed Nuclear Element 1 (LINE-1) repetitive elements methylation, and of Endothelin-1 (EDN1), Inducible Nitric Oxide Synthase (NOS2), and Tumour Necrosis Factor Alpha (TNF) gene-specific methylation. VO2peak was positively associated with methylation of ALU, EDN1, NOS2, and TNF; systolic BP at rest was inversely associated with LINE-1, EDN1, and NOS2 methylation; diastolic BP was inversely associated with EDN1 and NOS2 methylation. Our findings suggest a possible role of DNA methylation for lowering systemic BP induced by the continuative aerobic physical training program.
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Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK, Bell DSH, Mechanick JI, Pessah-Pollack R, Wyne K, Smith D, Brinton EA, Fazio S, Davidson M. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE. Endocr Pract 2019; 23:1-87. [PMID: 28437620 DOI: 10.4158/ep171764.appgl] [Citation(s) in RCA: 620] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. RESULTS The Executive Summary of this document contains 87 recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 203 (29.2 %) are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence). CONCLUSION This CPG is a practical tool that endocrinologists, other health care professionals, health-related organizations, and regulatory bodies can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of individuals with various lipid disorders. The recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously endorsed and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to individuals with diabetes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. ABBREVIATIONS 4S = Scandinavian Simvastatin Survival Study A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists AAP = American Academy of Pediatrics ACC = American College of Cardiology ACE = American College of Endocrinology ACS = acute coronary syndrome ADMIT = Arterial Disease Multiple Intervention Trial ADVENT = Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study AHA = American Heart Association AHRQ = Agency for Healthcare Research and Quality AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides trial ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level BIP = Bezafibrate Infarction Prevention trial BMI = body mass index CABG = coronary artery bypass graft CAC = coronary artery calcification CARDS = Collaborative Atorvastatin Diabetes Study CDP = Coronary Drug Project trial CI = confidence interval CIMT = carotid intimal media thickness CKD = chronic kidney disease CPG(s) = clinical practice guideline(s) CRP = C-reactive protein CTT = Cholesterol Treatment Trialists CV = cerebrovascular CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia FIELD = Secondary Endpoints from the Fenofibrate Intervention and Event Lowering in Diabetes trial FOURIER = Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects With Elevated Risk trial HATS = HDL-Atherosclerosis Treatment Study HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HHS = Helsinki Heart Study HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia HPS = Heart Protection Study HPS2-THRIVE = Treatment of HDL to Reduce the Incidence of Vascular Events trial HR = hazard ratio HRT = hormone replacement therapy hsCRP = high-sensitivity CRP IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial IRAS = Insulin Resistance Atherosclerosis Study JUPITER = Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin LDL-C = low-density lipoprotein cholesterol Lp-PLA2 = lipoprotein-associated phospholipase A2 MACE = major cardiovascular events MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction MRFIT = Multiple Risk Factor Intervention Trial NCEP = National Cholesterol Education Program NHLBI = National Heart, Lung, and Blood Institute PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 Post CABG = Post Coronary Artery Bypass Graft trial PROSPER = Prospective Study of Pravastatin in the Elderly at Risk trial QALY = quality-adjusted life-year ROC = receiver-operator characteristic SOC = standard of care SHARP = Study of Heart and Renal Protection T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides TNT = Treating to New Targets trial VA-HIT = Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial VLDL-C = very low-density lipoprotein cholesterol WHI = Women's Health Initiative.
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Chant B, Bakali M, Hinton T, Burchell AE, Nightingale AK, Paton JF, Hart EC. Antihypertensive Treatment Fails to Control Blood Pressure During Exercise. Hypertension 2018; 72:102-109. [DOI: 10.1161/hypertensionaha.118.11076] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/03/2018] [Accepted: 04/06/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Benjamin Chant
- From the Bristol Heart Institute (BHI) CardioNomics Research Group, Clinical Research and Imaging Centre, School of Physiology, Pharmacology, Neuroscience (B.C., M.B., T.H., J.F.R.P., E.C.H.)
| | - Majda Bakali
- From the Bristol Heart Institute (BHI) CardioNomics Research Group, Clinical Research and Imaging Centre, School of Physiology, Pharmacology, Neuroscience (B.C., M.B., T.H., J.F.R.P., E.C.H.)
| | - Thomas Hinton
- From the Bristol Heart Institute (BHI) CardioNomics Research Group, Clinical Research and Imaging Centre, School of Physiology, Pharmacology, Neuroscience (B.C., M.B., T.H., J.F.R.P., E.C.H.)
| | - Amy E. Burchell
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol National Health Service (NHS) Foundation Trust, United Kingdom (A.E.B., A.K.N.)
| | - Angus K. Nightingale
- Bristol Medical School, Translational Health Sciences (A.K.N.), University of Bristol, United Kingdom
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol National Health Service (NHS) Foundation Trust, United Kingdom (A.E.B., A.K.N.)
| | - Julian F.R. Paton
- From the Bristol Heart Institute (BHI) CardioNomics Research Group, Clinical Research and Imaging Centre, School of Physiology, Pharmacology, Neuroscience (B.C., M.B., T.H., J.F.R.P., E.C.H.)
- Department of Physiology, University of Auckland, Grafton, New Zealand (J.F.R.P.)
| | - Emma C. Hart
- From the Bristol Heart Institute (BHI) CardioNomics Research Group, Clinical Research and Imaging Centre, School of Physiology, Pharmacology, Neuroscience (B.C., M.B., T.H., J.F.R.P., E.C.H.)
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Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study. Int J Hypertens 2017; 2017:2637051. [PMID: 28695006 PMCID: PMC5485479 DOI: 10.1155/2017/2637051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 (p = 0.01)]. Conclusion More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.
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Samson R, Qi A, Jaiswal A, Le Jemtel TH, Oparil S. Obesity-Associated Hypertension: the Upcoming Phenotype in African-American Women. Curr Hypertens Rep 2017; 19:41. [DOI: 10.1007/s11906-017-0738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Walsh KB, Woo D, Sekar P, Osborne J, Moomaw CJ, Langefeld CD, Adeoye O. Untreated Hypertension: A Powerful Risk Factor for Lobar and Nonlobar Intracerebral Hemorrhage in Whites, Blacks, and Hispanics. Circulation 2016; 134:1444-1452. [PMID: 27737957 DOI: 10.1161/circulationaha.116.024073] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). Although ethnic/racial disparities related to hypertension and ICH have been reported, these previous studies were limited by a lack of Hispanics and inadequate power to analyze by ICH location. In the current study, while overcoming these prior limitations, we investigated whether there was variation by ethnicity/race of treated and untreated hypertension as risk factors for ICH. METHODS The ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment sites. Controls matched to cases 1:1 by age (±5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Subjects were interviewed to determine history of hypertension and use of antihypertensive medications. Cases and controls within ethnic groups were compared by using conditional logistic regression. Multivariable conditional logistic regression models were computed for ICH as an overall group and separately for the location subcategories deep, lobar, and infratentorial (brainstem/cerebellar). RESULTS Nine hundred fifty-eight white, 880 black, and 766 Hispanic ICH patients were enrolled. For ICH cases, untreated hypertension was higher in blacks (43.6%, P<0.0001) and Hispanics (46.9%, P<0.0001) versus whites (32.7%). In multivariable analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and medical insurance status, treated hypertension was a significant risk factor across all locations of ICH in whites (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.24-1.98; P<0.0001), blacks (OR, 3.02; 95% CI, 2.16-4.22; P<0.0001), and Hispanics (OR, 2.50; 95% CI, 1.73-3.62; P<0.0001). Untreated hypertension was a substantially greater risk factor for all 3 racial/ethnic groups across all locations of ICH: whites (OR, 8.79; 95% CI, 5.66-13.66; P<0.0001), blacks (OR, 12.46; 95% CI, 8.08-19.20; P<0.0001), and Hispanics (OR, 10.95; 95% CI, 6.58-18.23; P<0.0001). There was an interaction between race/ethnicity and ICH risk (P<0.0001). CONCLUSIONS Untreated hypertension confers a greater ICH risk in blacks and Hispanics relative to whites across all anatomic locations of ICH. Accelerated research efforts are needed to improve overall hypertension treatment rates and to monitor the impact of such efforts on racial/ethnic disparities in stroke. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01202864.
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Affiliation(s)
- Kyle B Walsh
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.).
| | - Daniel Woo
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
| | - Padmini Sekar
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
| | - Jennifer Osborne
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
| | - Charles J Moomaw
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
| | - Carl D Langefeld
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
| | - Opeolu Adeoye
- From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.)
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Hypertension phenotypes and incident cardiovascular disease and mortality events in a decade follow-up of a Middle East cohort. J Hypertens 2016; 33:1153-61. [PMID: 25699976 DOI: 10.1097/hjh.0000000000000540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association of hypertension phenotypes, with the risk of cardiovascular disease (CVD) and mortality. METHODS We examined the risk of hypertension phenotypes, that is, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), controlled blood pressure (CBP), and uncontrolled blood pressure (UBP) among 6974 middle-aged and 882 elderly participants. Cox regression analysis was used to estimate the hazard ratio for hypertension phenotypes, considering those with normotension as the reference. RESULTS During more than 10 years of follow-up, in the middle-aged group, 490 CVD events and 152 deaths occurred; corresponding rates for the elderly group were 194 and 183, respectively. In middle-aged patients, ISH, SDH, and UBP increased the risk of CVD, whereas UBP increased the risk of mortality due to CVD and any cause (hazard ratio 5.67 and 2.95, respectively) and IDH increased only the risk of total mortality in the middle-aged group (hazard ratio 2.01; all P values <0.05). In elderly patients, ISH, SDH, and UBP significantly increased the risks of CVD. IDH (hazard ratio 3.20 and 2.01), SDH (hazard ratio 3.80 and 3.23) and CBP (hazard ratio 2.86 and 1.87) increased the risks of CVD and all-cause mortality in this group, respectively (all P values <0.05). CONCLUSION In both middle-aged and elderly population, ISH, SDH, and UBP increase the risk of CVD. Controlling of BP to less than 140/90 mmHg decreases the risk of mortality events among the middle-aged population; however, it is not suitable for the elderly as it was associated with higher risk of mortality.
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Bakris GL, Weir MR. Comparison of Dual RAAS Blockade and Higher-Dose RAAS Inhibition on Nephropathy Progression. Postgrad Med 2015; 120:33-42. [DOI: 10.3810/pgm.2008.04.1758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Howard G, Banach M, Cushman M, Goff DC, Howard VJ, Lackland DT, McVay J, Meschia JF, Muntner P, Oparil S, Rightmyer M, Taylor HA. Is blood pressure control for stroke prevention the correct goal? The lost opportunity of preventing hypertension. Stroke 2015; 46:1595-600. [PMID: 25953369 DOI: 10.1161/strokeaha.115.009128] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/13/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension. METHODS A total of 26 875 black and white participants aged 45+ years were assessed and followed for incident stroke events. The association was assessed between incident stroke and: (1) systolic blood pressure (SBP)categorized as normal (<120 mm Hg), prehypertension (120-139 mm Hg), stage 1 hypertension (140-159 mm Hg), and stage 2 hypertension (160 mm Hg+), and (2) number of classes of antihypertensive medications, classified as none, 1, 2, or 3 or more. RESULTS During 6.3 years of follow-up, 823 stroke events occurred. Nearly half (46%) of the population were successfully treated (SBP<140 mm Hg) hypertensives. Within blood pressure strata, the risk of stroke increased with each additional class of required antihypertensive medication, with hazard ratio [HR], 1.33; 95% confidence interval, 1.16 to 1.52 for normotensive, HR, 1.15; 95% confidence interval, 1.05 to 1.26 for prehypertension, and HR, 1.22; 95% confidence interval, 1.06 to 1.39 for stage 1 hypertension. A successfully treated (SBP<120 mm Hg) hypertensive person on 3+ antihypertensive medication classes was at marginally higher stroke risk than a person with untreated stage 1 hypertension (HR, 2.48 versus HR=2.19; relative to those with SBP <120 on no antihypertensive medications). CONCLUSIONS Maintaining the normotensive status solely through pharmacological treatment has a profound impact, as nearly half of this general population cohort were treated to guideline (SBP<140 mm Hg) but failed to return to risk levels similar to normotensive individuals. Even with successful treatment, there is a substantial potential gain by prevention or delay of hypertension.
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Affiliation(s)
- George Howard
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.).
| | - Maciej Banach
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Mary Cushman
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - David C Goff
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Virginia J Howard
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Daniel T Lackland
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Jim McVay
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - James F Meschia
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Paul Muntner
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Suzanne Oparil
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Melanie Rightmyer
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
| | - Herman A Taylor
- From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.)
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Makridakis S, DiNicolantonio JJ. Hypertension: empirical evidence and implications in 2014. Open Heart 2014; 1:e000048. [PMID: 25332797 PMCID: PMC4195935 DOI: 10.1136/openhrt-2014-000048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/06/2014] [Accepted: 05/28/2014] [Indexed: 01/13/2023] Open
Abstract
High blood pressure (HBP) or hypertension (HTN) is one of the leading causes of cardiovascular (CV) morbidity and mortality throughout the world. Despite this fact, there is widespread agreement that the treatment of HBP, over the last half century, has been a great achievement. However, after the release of the new Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure-8 (JNC-8) guidelines, there have been heated debates with regard to what are the most evidence-based blood pressure goals. While JNC-8 claims that the goal blood pressure for otherwise healthy patients with mild hypertension (systolic blood pressure ≥140-159 mm Hg and diastolic blood pressure ≥90-99 mm Hg) should be <140/90 mm Hg; a recent Cochrane meta-analysis is in direct conflict with these recommendations. Indeed, a 2012 Cochrane meta-analysis indicated that there is no evidence that treating otherwise healthy mild hypertension patients with antihypertensive therapy will reduce CV events or mortality. Additionally, the Cochrane meta-analysis showed that antihypertensive therapy was associated with a significant increase in withdrawal due to adverse events. Thus, the current evidence in the literature does not support the goals set by the JNC-8 guidelines. In this review we discussed the strengths and limitations of both lines of evidence and why it takes an evidence-based medication to reduce CV events/mortality (eg, how a goal blood pressure is achieved is more important than getting to the goal). As medications inherently cause side effects and come at a cost to the patient, the practice of evidence-based medicine becomes exceedingly important. Although the majority of HTN studies claim great advantages by lowering HBP, this review finds severe conflicts in the findings among the various HTN studies, as well as serious epistemological, methodological and statistical problems that cast doubt to such claims.
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Asayama K, Satoh M, Murakami Y, Ohkubo T, Nagasawa SY, Tsuji I, Nakayama T, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T, Ueshima H, Okamura T, Imai Y, Ohkubo T, Irie F, Iso H, Kiyohara Y, Miura K, Murakami Y, Nakagawa H, Nakayama T, Okayama A, Sairenchi T, Saitoh S, Sakata K, Tamakoshi A, Tsuji I, Yamada M, Kitamura A, Miyamoto Y. Cardiovascular Risk With and Without Antihypertensive Drug Treatment in the Japanese General Population. Hypertension 2014; 63:1189-97. [DOI: 10.1161/hypertensionaha.113.03206] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kei Asayama
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Michihiro Satoh
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Yoshitaka Murakami
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Takayoshi Ohkubo
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Sin-ya Nagasawa
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Ichiro Tsuji
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Takeo Nakayama
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Akira Okayama
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Katsuyuki Miura
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Yutaka Imai
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Hirotsugu Ueshima
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | - Tomonori Okamura
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.S., T. Ohkubo, Y.I.); Department of Pharmacy, Tohoku University Hospital, Sendai, Japan (M.S.); Medical Statistics, Shiga University of Medical Science, Otsu
| | | | | | - Yutaka Imai
- Tohoku University Graduate School of Pharmaceutical Sciences
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Brown RE, Riddell MC, Macpherson AK, Canning KL, Kuk JL. The joint association of physical activity, blood-pressure control, and pharmacologic treatment of hypertension for all-cause mortality risk. Am J Hypertens 2013; 26:1005-10. [PMID: 23690165 DOI: 10.1093/ajh/hpt063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We conducted a study to determine the joint association of physical activity, pharmacologic treatment for hypertension, and the control of blood pressure (BP) on all-cause mortality risk. METHODS The study subjects were 10,665 adults from the Third National Health and Nutrition Examination Survey (NHANES III) and the Continuous NHANES survey (1999-2000 and 2000-2001). Cox proportional hazards analyses were used to estimate differences in mortality risk according to physical activity, pharmacologic treatment for hypertension, and BP control, with physically active, treated, and controlled as the referent category. RESULTS The average follow-up time in the study was 8.6±4.8 years. The main effect of physical activity was significant independently of pharmacologic treatment and BP control (P < 0.001). Physically inactive adults with hypertension had a higher risk of mortality than did physically active adults with treated and controlled hypertension (inactive, treated and controlled hypertension: HR, 1.42; 95% CI, 1.17-1.72; P < 0.01; inactive, treated, and uncontrolled hypertension: HR, 1.55; 95% CI, 1.30-1.84; P < 0.01; inactive, untreated, and uncontrolled hypertension: HR, 1.27; 95% CI, 1.07-1.52, P < 0.01). However, the risk of mortality for physically active adults with hypertension did not differ significantly with or without treatment for hypertension if their hypertension remained uncontrolled (active, treated and uncontrolled hypertension: HR, 1.17; 95% CI 0.98-1.40; P = 0.08; active, untreated and uncontrolled hypertension: HR, 0.90; 95% CI, 0.76-1.08; P = 0.25). Physically active, normotensive individuals had a lower all-cause mortality risk than did the referent group of physically active individuals being treated with antihypertensive medication and who had controlled hypertension (HR, 0.72; 95% CI, 0.60-0.86; P < 0.01), whereas physically inactive, normotensive individuals had a risk of mortality similar to that of the referent group (HR, 1.08; 95% CI, 0.90-1.30; P = 0.42). CONCLUSION Physical activity may be as or even more important than pharmacotherapy for reducing the risk of mortality in adults with hypertension. However, the risk of mortality remained higher for physically active adults with treated and controlled hypertension than did the risk of mortality for physically active normotensive populations. Prevention of hypertension is therefore imperative for reducing the all-cause risk of premature mortality in adults.
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Affiliation(s)
- Ruth E Brown
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, Canada, M3J 1P3
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Viigimaa M, Talvik A, Wojciechowska W, Kawecka-Jaszcz K, Toft I, Stergiou GS, Nasothimiou EG, Kotsis V, Agabiti Rosei E, Salvetti M, Dorobantu M, Martell-Claros N, Abad-Cardiel M, Hernández-Hernández R, Doménech M, Coca A. Identification of the hemodynamic modulators and hemodynamic status in uncontrolled hypertensive patients. Blood Press 2013; 22:362-70. [DOI: 10.3109/08037051.2013.782900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Belov VV, Menshchikov AA. SURVIVAL OF THE COHORTS OF CARDIAC PATIENTS AND HEALTHY MEN AGED 40–59 YEARS: THE 30-YEAR FOLLOW-UP DATA. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-2-74-79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - A. A. Menshchikov
- South Ural State University (National Research Institute), Chelyabinsk
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The effects of control of systolic and diastolic hypertension on cardiovascular and all-cause mortality in a community-based population cohort. J Hum Hypertens 2013; 27:693-7. [PMID: 23514844 DOI: 10.1038/jhh.2013.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/20/2013] [Accepted: 02/14/2013] [Indexed: 11/08/2022]
Abstract
The objective of this study (follow-up of 26,113 people) was to investigate differences in the risk of cardiovascular disease (CVD) and all-cause mortality among hypertensive people according to the control of systolic blood pressure (SBP) and diastolic blood pressure (DBP). People with a history of coronary heart disease, heart failure, cancer or incomplete data at baseline (n=1113) were excluded from the study. The participants were classified into six groups according to their blood pressure status. Treated hypertensive individuals with controlled SBP and DBP did not experience an increase in all-cause mortality compared with normotensive people. The increase in all-cause mortality was 1.48-fold (95% confidence interval (CI) 1.09-2.01) among those who were treated with antihypertensive drugs and had only their DBP controlled and 1.45-fold (95% CI 1.04-2.02) among those who were treated and had only their SBP controlled. Treated patients with both SBP and DBP controlled did not have an increased risk of CVD mortality when compared with normotensive people. The risk of CVD mortality was statistically significantly higher in treated hypertensive people with SBP alone, DBP alone or both SBP and DBP uncontrolled. Our study indicates that uncontrolled SBP alone and DBP alone are risk factors of all-cause and CVD mortality.
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Hermida RC, Ayala DE, Mojón A, Fernández JR. Cardiovascular Risk of Essential Hypertension: Influence of Class, Number, and Treatment-Time Regimen of Hypertension Medications. Chronobiol Int 2012. [DOI: 10.3109/07420528.2012.701534] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle Factors and Antihypertensive Treatment on the Risks of Ischemic and Hemorrhagic Stroke. Hypertension 2012; 60:906-12. [DOI: 10.1161/hypertensionaha.112.193961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yurong Zhang
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
| | - Jaakko Tuomilehto
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
| | - Pekka Jousilahti
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
| | - Yujie Wang
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
| | - Riitta Antikainen
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
| | - Gang Hu
- From the First Affiliated Hospital of Medical School (Y.Z.), Xi’an Jiaotong University, Xi’an, Shaanxi, China; Pennington Biomedical Research Center (Y.Z., Y.W., G.H.), Baton Rouge, LA; South Ostrobothnia Central Hospital (J.T.), Seinäjoki, Finland; Department of Chronic Diseases Prevention (J.T., P.J.), National Institute for Health and Welfare, Helsinki, Finland; School of Human Ecology (Y.W.), Louisiana State University AgCenter, Baton Rouge, LA; Oulu City Hospital and Institute of Health
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Jellinger PS, Smith DA, Mehta AE, Ganda O, Handelsman Y, Rodbard HW, Shepherd MD, Seibel JA. American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis. Endocr Pract 2012; 18 Suppl 1:1-78. [PMID: 22522068 DOI: 10.4158/ep.18.s1.1] [Citation(s) in RCA: 296] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Christensen KL, Buus NH. Dissociation of Blood Pressure and Resistance Artery Structure: Potential Clinical Implications. Basic Clin Pharmacol Toxicol 2011; 110:73-9. [DOI: 10.1111/j.1742-7843.2011.00799.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2010; 27:2121-58. [PMID: 19838131 DOI: 10.1097/hjh.0b013e328333146d] [Citation(s) in RCA: 999] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Grassi G, Cifkova R, Laurent S, Narkiewicz K, Redon J, Farsang C, Viigimaa M, Erdine S, Brambilla G, Bombelli M, Dell'Oro R, Notari M, Mancia G. Blood pressure control and cardiovascular risk profile in hypertensive patients from central and eastern European countries: results of the BP-CARE study. Eur Heart J 2010; 32:218-25. [PMID: 21047877 DOI: 10.1093/eurheartj/ehq394] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Limited information is available on office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients living in central and eastern European countries. METHODS AND RESULTS In 2008, a survey on 7860 treated hypertensive patients followed by non-specialist or specialist physicians was carried out in nine central and eastern European countries (Albania, Belarus, Bosnia, Czech Republic, Latvia, Romania, Serbia, Slovakia, and Ukraine). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Patients had a mean (±SD) age of 60.1 ± 11 years, and the majority of them (83.5%) were followed by specialists. Average clinic BP was 149.3 ± 17/88.8 ± 11 mmHg. About 70% of patients displayed a very high-risk profile. Electrocardiogram was performed in 99% of patients, echocardiography in 65%, carotid ultrasound in 24%, fundoscopy in 68%, and search for microalbuminuria in 10%. Ambulatory BP monitoring was performed in about one-fifth of the recruited patients. Despite the widespread use of combination treatment (87% of the patients), office BP control (<140/90 mmHg) was achieved in 27.1% only, the corresponding control rate for ambulatory BP (<130/80 mmHg) being 35.7%. Blood pressure control was (i) variable among different countries, (ii) worse for systolic than for diastolic BP, (iii) slightly better in patients followed by specialists than by non-specialists, (iv) unrelated to patients' age, and (v) more unsatisfactory in high-risk hypertensives and in patients with coronary heart disease, stroke, or renal failure. CONCLUSION These data provide evidence that in central and eastern European countries office and ambulatory BP control are unsatisfactory, particularly in patients at very high CV risk, and not differ from that seen in Western Europe. They also show that assessment of subclinical organ damage is quite common, except for microalbuminuria, and that combination drug treatment is frequently used.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo dei Tintori, Via Pergolesi 33, Monza, Milan, Italy
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Chien KL, Su TC, Hsu HC, Chang WT, Chen PC, Sung FC, Chen MF, Lee YT. Constructing the Prediction Model for the Risk of Stroke in a Chinese Population. Stroke 2010; 41:1858-64. [DOI: 10.1161/strokeaha.110.586222] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kuo-Liong Chien
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Ta-Chen Su
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Hsiu-Ching Hsu
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Wei-Tien Chang
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Pei-Chun Chen
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Fung-Chang Sung
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Ming-Fong Chen
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
| | - Yuan-Teh Lee
- From the Institute of Preventive Medicine (K.-L.C.), College of Public Health, National Taiwan University, Taiwan; the Departments of Internal Medicine (T.-C.S., H.-C.H., P.-C.C., M.-F.C., Y.-T.L.) and Emergency Medicine (W.-T.C.), National Taiwan University Hospital, Taiwan; and China Medical University Hospital (F.C.S., Y.-T.L.), Taichung, Taiwan
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Administration–time-dependent effects of blood pressure-lowering medications: basis for the chronotherapy of hypertension. Blood Press Monit 2010; 15:173-80. [PMID: 20571367 DOI: 10.1097/mbp.0b013e32833c7308] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Antihypertensive Treatment, High Triglycerides, and Low High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease Mortality: A 16-Year Follow-Up in the Copenhagen Male Study. Metab Syndr Relat Disord 2010; 8:215-22. [DOI: 10.1089/met.2009.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stroke risk in treated hypertension based on home blood pressure: the Ohasama study. Am J Hypertens 2010; 23:508-14. [PMID: 20186131 DOI: 10.1038/ajh.2010.15] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Several observational studies have shown that treated hypertensives are characterized as having worse prognosis than nonhypertensives. However, there is little evidence based on home blood pressure (home BP) measurement. We compare the risk of stroke between untreated individuals and those taking antihypertensive medication based on home BP and casual-screening BP (casual BP) in the general population. METHODS The study included 1,690 untreated and 700 treated subjects aged >or=35 years. We measured home BP and casual BP at the beginning of the study. The risk of first stroke was examined by using the Cox proportional hazards model. RESULTS During 11.9 years of follow-up, we observed 242 first-time stroke cases. Treated subjects had significantly higher risk for stroke than untreated subjects based on home BP (relative hazard (RH) = 1.48) as well as on casual BP (RH = 1.78), adjusted for systolic BP values and characteristics. When subjects were classified into six categories based on BP (optimal, normal, high normal, and grade 1-3 hypertension), RHs in treated hypertensives linearly increased (trend P < 0.01) based on home BP. However, there was no consistent association for casual BP (trend P: not significant) in treated subjects. Stroke risk was linearly increased regardless of the BP information source in untreated subjects (home BP: trend P < 0.01, casual BP: trend P < 0.01). CONCLUSION The results suggest a strong association between elevated home BP and increased risk of stroke. Home BP is a better tool to assess stroke risk, especially in treated hypertensives.
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Yang SJ, Jung D, Choi AS. Prediction model of blood pressure control in community-dwelling hypertensive adults in Korea. Nurs Health Sci 2010; 12:105-12. [DOI: 10.1111/j.1442-2018.2009.00501.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HAJ, Van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2010; 18:308-47. [PMID: 20001654 DOI: 10.3109/08037050903450468] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, 20052 Monza, Milan, Italy.
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Ojeda NB, Grigore D, Alexander BT. Role of fetal programming in the development of hypertension. Future Cardiol 2009; 4:163-74. [PMID: 19672482 DOI: 10.2217/14796678.4.2.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Epidemiological studies have suggested that size at birth contributes to increased cardiovascular disease (CVD) risk in later life. Findings from experimental studies are providing insight into the mechanisms linking impaired fetal growth and the increased risk of CVD and hypertension in adulthood. This article summarizes potential mechanisms involved in the fetal programming of hypertension and CVD, including alterations in the organs and regulatory systems critical to long-term control of sodium and volume homeostasis.
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Affiliation(s)
- Norma B Ojeda
- University of Mississippi Medical Center, Department of Physiology & Biophysics, The Center for Excellence in Cardiovascular-Renal Research, 2500 North State Street, Jackson, MS 39216-4505, USA.
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Bottom blood pressure or bottom cardiovascular risk? How far can cardiovascular risk be reduced? J Hypertens 2009; 27:1509-20. [DOI: 10.1097/hjh.0b013e32832e9500] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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The effects of awareness, treatment and control of hypertension on future stroke incidence in a community-based population study in Finland. J Hypertens 2009; 27:1459-65. [DOI: 10.1097/hjh.0b013e32832b7d8b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barengo NC, Kastarinen M, Antikainen R, Nissinen A, Tuomilehto J. The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population. J Hum Hypertens 2009; 23:808-16. [DOI: 10.1038/jhh.2009.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Weir MR. Assessing the Blood Pressure-Lowering Efficacy of Antihypertensive Medications: Which Blood Pressures Should We Use? J Clin Hypertens (Greenwich) 2009; 11:155-8. [DOI: 10.1111/j.1751-7176.2009.00087.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antihypertensive treatment and risk of cardiovascular complications: is the cure worse than the disease? J Hypertens 2009; 27:221-3. [DOI: 10.1097/hjh.0b013e32831e9962] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stroke risk and antihypertensive drug treatment in the general population: the Japan arteriosclerosis longitudinal study. J Hypertens 2009; 27:357-64. [DOI: 10.1097/hjh.0b013e32831967ca] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pereira EA, Green AL, Aziz TZ. Deep Brain Stimulation for Blood Pressure Control. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kelly TN, Gu D, Chen J, Huang JF, Chen JC, Duan X, Wu X, Yau CL, Whelton PK, He J. Hypertension subtype and risk of cardiovascular disease in Chinese adults. Circulation 2008; 118:1558-66. [PMID: 18809800 PMCID: PMC2735390 DOI: 10.1161/circulationaha.107.723593] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We examined the relationship between hypertension subtype and cardiovascular disease incidence and mortality in Chinese adults. METHODS AND RESULTS We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged >or=40 years. Data on systolic (SBP) and diastolic blood pressure (DBP) and other variables were obtained at a baseline examination in 1991 with the use of standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Hypertension subtypes were defined as combined systolic and diastolic hypertension (SBP >or=140 and DBP >or=90 mm Hg), isolated systolic hypertension (SBP >or=140 and DBP <90 mm Hg), isolated diastolic hypertension (SBP <140 and DBP >or=90 mm Hg), and 2 categories of treated hypertension (SBP <140 and DBP <90 mm Hg or SBP >or=140 and/or DBP >or=90 mm Hg). After participants with missing BP values were excluded, 169 577 adults were included in the analyses. Compared with normotensives, relative risks (95% CIs) of cardiovascular disease incidence and mortality were 2.73 (2.60 to 2.86) and 2.53 (2.39 to 2.68) for combined systolic and diastolic hypertension, 1.78 (1.69 to 1.87) and 1.68 (1.58 to 1.78) for isolated systolic hypertension, 1.59 (1.43 to 1.76) and 1.45 (1.27 to 1.65) for isolated diastolic hypertension, 2.01 (1.64 to 2.48) and 1.61 (1.28 to 2.03) for treated hypertension with SBP <140 and DBP <90 mm Hg, and 3.37 (3.07 to 3.69) and 2.88 (2.60 to 3.19) for treated hypertension with SBP >or=140 and/or DBP >or=90 mm Hg, respectively, after adjustment for important covariables. CONCLUSIONS Our results indicate that all hypertension subtypes are associated with significantly increased risk of cardiovascular disease in Chinese adults. Primary prevention of hypertension should be a public health priority in the Chinese population.
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Affiliation(s)
- Tanika N. Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dongfeng Gu
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jian-feng Huang
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-chun Chen
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiufang Duan
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xigui Wu
- Cardiovascular Institute and Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - C. Lillian Yau
- Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Paul K. Whelton
- President’s Office, Loyola University Medical Center, Maywood, IL, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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The Pleiotropic Effects of Antihypertensive Agents: Do They Account for Additional Cardiovascular Benefit Beyond BP Reduction? South Med J 2008; 101:818-23. [DOI: 10.1097/smj.0b013e31817b6622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deshmukh M, Lee HW, McFarlane SI, Whaley-Connell A. Antihypertensive medications and their effects on lipid metabolism. Curr Diab Rep 2008; 8:214-20. [PMID: 18625119 DOI: 10.1007/s11892-008-0037-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension and hyperlipidemia are interrelated and share common pathophysiologic mechanisms, such as insulin resistance and endothelial dysfunction. Accumulating evidence shows that it is important to regulate hypertension and hyperlipidemia to reduce cardiovascular risk. However, medications such as beta-blockers and thiazide diuretics, which are widely used for blood pressure regulation, are known to have several metabolic side effects. Despite deleterious effects on glucose metabolism and lipid metabolism, these medications have been proven to reduce cardiovascular risk. On the other hand, calcium channel blockers, angiotensin-converting enzyme inhibitors, and alpha-blockers have either no effect or favorable effects on the lipid profile. This review outlines the need to control hypertension, options for several antihypertensive medications, their differing effects on lipid metabolism, and the clinical implications of their effects on lipid parameters.
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Affiliation(s)
- Mrunalini Deshmukh
- Department of Medicine, Box 50, State University of New York Health Science Center at Brooklyn, Kings County Hospital Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
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