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Muehleman DL, Crocini C, Swearingen AR, Ozeroff CD, Leinwand LA. Regression from pathological hypertrophy in mice is sexually dimorphic and stimulus-specific. Am J Physiol Heart Circ Physiol 2022; 322:H785-H797. [PMID: 35302880 PMCID: PMC8993523 DOI: 10.1152/ajpheart.00644.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pathological cardiac hypertrophy is associated with increased morbidity and mortality. Understanding the mechanisms whereby pathological cardiac growth can be reversed could have therapeutic value. Here, we show that pathways leading to regression of pathological cardiac hypertrophy are strongly dependent on the hypertrophic trigger and are significantly modified by sex. Two pathological stimuli causing hypertrophy via distinct pathways were administered to male and female mice: Angiotensin II [Ang II] or Isoproterenol [Iso]. Stimuli were removed after 7 days of treatment, and left ventricles (LV) were studied at 1, 4, and 7 days. Ang II-treated Females did not show regression after stimulus removal. Iso-treated males showed rapid LV hypertrophy regression. Somewhat surprisingly, RNAseq analysis at day 1 after removal of triggers revealed only 45 differentially regulated genes in common among all groups, demonstrating distinct responses. Ingenuity Pathway Analysis predicted strong downregulation of the TGFβ1 pathway in all groups except for Ang II-treated females. Consistently, we found significant downregulation of Smad signaling after stimulus removal including in Ang II-treated females. Additionally, the ERK1/2 pathway was significantly reduced in the groups showing regression. Finally, protein degradation pathways were significantly activated only in Iso-treated males 1 day after stimulus removal. Our data indicate that TGFβ1 downregulation may play a role in the regression of pathological cardiac hypertrophy via downregulation of the ERK1/2 pathway and activation of autophagy and proteasome activity in Iso-treated males. This work highlights that the reversal of pathological hypertrophy does not utilize universal signaling pathways and that sex potently modifies this process.
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Affiliation(s)
- Deanna L Muehleman
- BioFrontiers Institute University of Colorado Boulder; Department of Molecular and Cellular Development, University of Colorado Boulder, Boulder, Colorado, United States
| | - Claudia Crocini
- BioFrontiers Institute University of Colorado Boulder; Department of Molecular and Cellular Development, University of Colorado Boulder; Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Neuromuscular and Cardiovascular Cell Biology; German Center for Cardiovascular Research (DZHK) Partner Site Berlin, Boulder, Colorado
| | - Alison R Swearingen
- Department of Molecular and Cellular Development, University of Colorado Boulder, Boulder, Colorado, United States
| | - Christopher D Ozeroff
- BioFrontiers Institute University of Colorado Boulder; Department of Molecular and Cellular Development, University of Colorado Boulder, Boulder, Colorado, United States
| | - Leslie A Leinwand
- BioFrontiers Institute University of Colorado Boulder; Department of Molecular and Cellular Development, University of Colorado Boulder, Boulder, Colorado, United States
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Ostroumova OD, Polyakova OA, Listratova AI, Logunova NA, Gorohova TV. Thiazide and thiazide-like diuretics: how to make the right choice? KARDIOLOGIIA 2022; 62:89-97. [PMID: 35168538 DOI: 10.18087/cardio.2022.1.n1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Most patients with arterial hypertension (AH) require a combination treatment to achieve the goal blood pressure. According to Russian and international clinical guidelines on the treatment of AH patients, various antihypertensive drugs may be combined; however, not all combinations have similar profiles of safety and clinical efficacy. In this respect, special attention is given to combinations of renin-angiotensin-aldosterone system inhibitors and thiazide (hydrochlorothiazide) or thiazide-like (chlortalidone, indapamide) diuretics. Diuretics also differ in their mechanisms of action, presence of pleiotropic effects and organ-protective properties, effects on the prognosis, and in the evidence base. This review discusses the place of thiazide and thiazide-like diuretics in the treatment of patients with AH and provides an evaluation of major differences in pharmacological and clinical effects of drugs of the diuretic class.
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Affiliation(s)
- O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow
| | - O A Polyakova
- Russian Medical Academy of Continuous Professional Education, Moscow
| | - A I Listratova
- Russian Medical Academy of Continuous Professional Education, Moscow
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Khalid K, Padda J, Ismail D, Abdullah M, Gupta D, Pradeep R, Hameed W, Cooper AC, Jean-Charles G. Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy. Cureus 2021; 13:e17550. [PMID: 34646607 PMCID: PMC8479854 DOI: 10.7759/cureus.17550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
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Affiliation(s)
- Khizer Khalid
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Jaskamal Padda
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Dina Ismail
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Dhriti Gupta
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Roshini Pradeep
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | - Warda Hameed
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.,Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA
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Hosohata K. Biomarkers of high salt intake. Adv Clin Chem 2021; 104:71-106. [PMID: 34462058 DOI: 10.1016/bs.acc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). International Guidelines recommend a large reduction in the consumption of sodium to reduce blood pressure, organ damage, and mortality. In its early stages, the symptoms of CKD are generally not apparent. CKD proceeds in a "silent" manner, necessitating the need for urinary biomarkers to detect kidney damage at an early stage. Since traditional renal biomarkers, such as serum creatinine, are not sufficiently sensitive, difficulties are associated with detecting kidney damage induced by a high salt intake, particularly in normotensive individuals. Several new biomarkers for renal tubular damage, such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), vanin-1, liver-type fatty acid-binding protein (L-FABP), and monocyte chemotactic protein-1 (MCP-1), have recently been identified. However, few studies have investigated early biomarkers for CKD progression associated with a high salt diet. This chapter provides insights into novel biomarkers for CKD in normo- and hypertensive individuals with a high salt intake. Recent studies using spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY) fed a high salt diet identified urinary vanin-1 and NGAL as early biomarkers for renal tubular damage in SHR and WKY, whereas urinary KIM-1 was a useful biomarker for salt-induced renal injury in SHR only. Clinical studies are needed to confirm these findings.
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Affiliation(s)
- Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Osaka, Japan.
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Bourdillon MT, Vasan RS. A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy. Curr Hypertens Rep 2020; 22:85. [DOI: 10.1007/s11906-020-01092-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ostroumova OD, Alautdinova IA, Kochetkov AI, Litvinova SN. Felodipine in Treatment of Arterial Hypertension and Ischemic Heart Disease. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiovascular diseases are the leading cause of death both in the world and in the Russian Federation. The most significant contributors to the increase in mortality are arterial hypertension (AH) and ischemic heart disease (IHD). Dihydropyridine calcium channel blockers (CCBs) are the first line of treatment for these conditions. This is noted in the clinical guidelines for the diagnosis and treatment of AH and in the guidelines for the management of patients with chronic coronary syndromes. CCBs are a heterogeneous group of drugs that have both general and individual pharmacokinetic and pharmacodynamic properties. They are used in patients with AH and/or IHD, including those with concomitant diseases (diabetes mellitus, chronic kidney disease, bronchial asthma, chronic obstructive pulmonary disease, peripheral arterial disease). Felodipine is one of the CCBs. It has a combination of clinical effects, allowing the drug to be prescribed as a first-line therapy for AH, IHD and a combination of these diseases. This is noted in the registered indications for its use. This CCB has a sufficient evidence base of clinical trials demonstrating not only good antihypertensive and antianginal potential of the drug, but also the nephroprotection and cerebroprotection properties. The nephroprotective effect of felodipine is associated with a slowdown in the progression of chronic kidney disease, and the cerebroprotective effect is associated with a decrease in the risk of stroke and an improvement in cognitive functioning. The safety profile of felodipine is favorable: peripheral edema develops much less frequently. This is confirmed by the results of comparative studies. Felodipine is recommended for a wide range of patients with AH, IHD and their combination due to such clinical and pharmacological properties.
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Affiliation(s)
- O. D. Ostroumova
- Russian Medical Academy of Continuous Professional Education;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - A. I. Kochetkov
- Russian Medical Academy of Continuous Professional Education
| | - S. N. Litvinova
- Russian Medical Academy of Continuous Professional Education
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Lau CWZ, Hamers AJP, Rathod KS, Shabbir A, Cooper J, Primus CP, Davies C, Mathur A, Moon JC, Kapil V, Ahluwalia A. Randomised, double-blind, placebo-controlled clinical trial investigating the effects of inorganic nitrate in hypertension-induced target organ damage: protocol of the NITRATE-TOD study in the UK. BMJ Open 2020; 10:e034399. [PMID: 31969369 PMCID: PMC7045137 DOI: 10.1136/bmjopen-2019-034399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Arterial stiffness and left ventricular (LV) hypertrophy are the key markers of hypertensive target organ damage (TOD) associated with increased cardiovascular morbidity and mortality. We have previously shown that dietary inorganic nitrate supplementation lowers blood pressure (BP) in hypertension, however, whether this approach might also improve markers of hypertensive TOD is unknown. In this study, we will investigate whether daily dietary inorganic nitrate administration reduces LV mass and improves measures of arterial stiffness. METHODS AND DESIGN NITRATE-TOD is a double-blind, randomised, single-centre, placebo-controlled phase II trial aiming to enrol 160 patients with suboptimal BP control on one or more antihypertensives. Patients will be randomised to receive 4 months once daily dose of either nitrate-rich beetroot juice or nitrate-deplete beetroot juice (placebo). The primary outcomes are reduction in LV mass and reduction in pulse wave velocity (PWV) and central BP.The study has a power of 95% for detecting a 9 g LV mass change by cardiovascular MRI (~6% change for a mildly hypertrophied heart of 150 g). For PWV, we have a power of >95% for detecting a 0.6 m/s absolute change. For central systolic BP, we have a>90% power to detect a 5.8 mm Hg difference in central systolic BP.Secondary end points include change in ultrasound flow-mediated dilation, change in plasma nitrate and nitrite concentration and change in BP. ETHICS AND DISSEMINATION The study was approved by the London-City and East Research Ethics Committee (10/H0703/98). Trial results will be published according to the Consolidated Standards of Reporting Trials statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03088514.
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Affiliation(s)
- Clement Wai Zhen Lau
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | | | - Krishnaraj Sinhji Rathod
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Asad Shabbir
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
| | - Jackie Cooper
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
| | - Christopher Peter Primus
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - James C Moon
- Department of Cardiology, Barts Health NHS Trust, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Vikas Kapil
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Amrita Ahluwalia
- William Harvey Research Institute, Barts & The London, Queen Mary University of London, London, UK
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Hydrochlorothiazide and alternative diuretics versus renin-angiotensin system inhibitors for the regression of left ventricular hypertrophy: a head-to-head meta-analysis. J Hypertens 2019; 36:1247-1255. [PMID: 29465713 DOI: 10.1097/hjh.0000000000001691] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Found in 36-41% of hypertension, elevated left ventricular mass (LVM) independently predicts cardiovascular events and total mortality. Conversely, drug-induced regression of LVM predicts improved outcomes. Previous studies have favored renin-angiotensin system inhibitors (RASIs) over other antihypertensives for reducing LVM but ignored differences among thiazide-type diuretics. From evidence regarding potency, cardiovascular events, and electrolytes, we hypothesized a priori that 'CHIP' diuretics [CHlorthalidone, Indapamide and Potassium-sparing Diuretic/hydrochlorothiazide (PSD/HCTZ)] would rival RASIs for reducing LVM. METHOD AND RESULTS Systematic review yielded 12 relevant double-blind randomized trials. CHIPs were more closely associated with reduced LVM than HCTZ (P = 0.004), indicating that RASIs must be compared with each diuretic separately. Publication bias favoring RASIs was corrected by cumulative analysis. For reducing LVM, HCTZ tended to be less effective than RASIs. However, the following surpassed RASIs: chlorthalidone Hedge's G: -0.37 (95% CI -0.72 to -0.02), P = 0.036; indapamide -0.20 (-0.39 to -0.01), P = 0.035; all CHIPs combined (with 61% of patients in one trial) -0.25 (-0.41to -0.09), P = 0.002. Statistical significance (P < 0.05) did not depend on any one trial. CHIPs reduction in LVM was 37% greater than that from RASIs. CHIPs superiority tended to increase with trial duration, from a negligible effect at 0.5 year to a maximal effect at 0.9-1.0 years: -0.26 (-0.43 to -0.09), P = 0.003. Fifty-eight percent of patients had information on echocardiographic components of LVM: relative to RASIs, CHIPs significantly reduced end-diastolic LV internal dimension (EDLVID): -0.18 (-0.36 to -0.00), P = 0.046. Strength of evidence favoring CHIPs over RASIs was at least moderate. CONCLUSION In these novel results in patients with hypertension, CHIPs surpassed RASIs for reducing LVM and EDLVID.
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Changes in left ventricular geometry during antihypertensive treatment. Pharmacol Res 2018; 134:193-199. [DOI: 10.1016/j.phrs.2018.06.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/22/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 2973] [Impact Index Per Article: 424.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Soliman EZ, Prineas RJ. Antihypertensive Therapies and Left Ventricular Hypertrophy. Curr Hypertens Rep 2017; 19:79. [DOI: 10.1007/s11906-017-0777-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Aronow WS. Hypertension and left ventricular hypertrophy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:310. [PMID: 28856150 DOI: 10.21037/atm.2017.06.14] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College Valhalla, NY, USA
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Soliman EZ, Ambrosius WT, Cushman WC, Zhang ZM, Bates JT, Neyra JA, Carson TY, Tamariz L, Ghazi L, Cho ME, Shapiro BP, He J, Fine LJ, Lewis CE. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation 2017; 136:440-450. [PMID: 28512184 DOI: 10.1161/circulationaha.117.028441] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP <120 mm Hg) and 4078 assigned to standard BP lowering (target SBP <140 mm Hg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead ECGs recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (versus standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjustment for LVH as a time-varying covariate. RESULTS Among SPRINT participants without baseline LVH (n=7559), intensive (versus standard) BP lowering was associated with a 46% lower risk of developing LVH (hazard ratio=0.54; 95% confidence interval, 0.43-0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (versus standard) BP lowering were 66% more likely to regress/improve their LVH (hazard ratio=1.66; 95% confidence interval, 1.31-2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (hazard ratio of intensive versus standard BP lowering on CVD, 0.76 [95% confidence interval, 0.64-0.90] and 0.77 [95% confidence interval, 0.65-0.91] before and after adjustment for LVH as a time-varying covariate, respectively). CONCLUSIONS Among patients with hypertension but no diabetes mellitus, intensive BP lowering (target systolic BP <120 mm Hg) compared with standard BP lowering (target systolic BP <140 mm Hg) resulted in lower rates of developing new LVH in those without LVH and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Elsayed Z Soliman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.).
| | - Walter T Ambrosius
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - William C Cushman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Zhu-Ming Zhang
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Jeffrey T Bates
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Javier A Neyra
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Thaddeus Y Carson
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Leonardo Tamariz
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Lama Ghazi
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Monique E Cho
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Brian P Shapiro
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Jiang He
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Lawrence J Fine
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Cora E Lewis
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
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16
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Fuchs SC, Poli-de-Figueiredo CE, Figueiredo Neto JA, Scala LCN, Whelton PK, Mosele F, de Mello RB, Vilela-Martin JF, Moreira LB, Chaves H, Mota Gomes M, de Sousa MR, Silva RPE, Castro I, Cesarino EJ, Jardim PC, Alves JG, Steffens AA, Brandão AA, Consolim-Colombo FM, de Alencastro PR, Neto AA, Nóbrega AC, Franco RS, Sobral Filho DC, Bordignon A, Nobre F, Schlatter R, Gus M, Fuchs FC, Berwanger O, Fuchs FD. Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER-Prevention Randomized Clinical Trial. J Am Heart Assoc 2016; 5:e004248. [PMID: 27965209 PMCID: PMC5210423 DOI: 10.1161/jaha.116.004248] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER-Prevention) trial aimed to evaluate the efficacy and safety of a low-dose diuretic for the prevention of hypertension and end-organ damage. METHODS AND RESULTS This randomized, parallel, double-blind, placebo-controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new-onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38-0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow-Lyon voltage and voltage-duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). CONCLUSIONS A combination of low-dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. CLINICAL TRIAL REGISTRATION URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR-74rr6s.
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Affiliation(s)
- Sandra Costa Fuchs
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Luiz César N Scala
- Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Francisca Mosele
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Bandeira de Mello
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José F Vilela-Martin
- Faculdade de Medicina de São José do Rio Preto e Hospital de Base, São José do Rio Preto, Brazil
| | - Leila B Moreira
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Marcos R de Sousa
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Iran Castro
- Instituto de Cardiologia, Porto Alegre, Brazil
| | | | | | | | | | | | | | - Paulo Ricardo de Alencastro
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Antônio C Nóbrega
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niteroi, Brazil
| | | | | | - Alexandro Bordignon
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Nobre
- Faculdade de Medicina de Ribeirão Preto, USP Ribeirão Preto, Ribeirão Preto, Brazil
| | - Rosane Schlatter
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Miguel Gus
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe C Fuchs
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Flávio D Fuchs
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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17
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Meredith PA, Ostergren J. Review: From Hypertension to Heart Failure — Are There Better Primary Prevention Strategies? J Renin Angiotensin Aldosterone Syst 2016; 7:64-73. [PMID: 17083060 DOI: 10.3317/jraas.2006.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although in the developed world the incidence of and mortality from coronary heart disease (CHD) and stroke have been declining over the last 15 years, heart failure is increasing in incidence, prevalence and overall mortality, despite advances in the diagnosis and management of the condition. Hypertension, alone or in combination with CHD, precedes the development of heart failure in the majority of both men and women. Whilst there have been improvements in the overall management of hypertension, as reflected in rates of diagnosis, awareness, treatment and control of blood pressure (BP), there are still many patients with hypertension who remain undiagnosed or untreated and of those who do receive treatment many fail to achieve current targets for BP control. Placebo controlled trials in hypertension, largely based on diuretic and beta-blocker-based regimens, have unequivocally demonstrated that the treatment of hypertension can significantly reduce the incidence of heart failure. Newer treatment strategies offer theoretical and proven practical advantages over established antihypertensive therapy. In particular, AT1-receptor blockers appear to provide benefits beyond BP control and are effective in the treatment of both hypertension and heart failure. Thus, the primary prevention of heart failure in hypertensive patients should be based upon strategies that provide tight and sustained BP control necessitating the use of multiple drugs. However, there is now compelling evidence to suggest that this therapy should include an antihypertensive agent that inhibits the reninangiotensin-aldosterone system (RAAS).
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Affiliation(s)
- Peter A Meredith
- Department of Medicine and Therapeutics, University of Glasgow, Glasgow, Scotland, UK.
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18
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Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2016; 28:727-54. [PMID: 26140936 DOI: 10.1016/j.echo.2015.05.002] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK
| | | | - Jose L Zamorano
- University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
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19
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Soliman EZ, Byington RP, Bigger JT, Evans G, Okin PM, Goff DC, Chen H. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Diabetes Mellitus: Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial. Hypertension 2015; 66:1123-9. [PMID: 26459421 DOI: 10.1161/hypertensionaha.115.06236] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/04/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is a common complication of hypertension. Regression of LVH is achievable by sustained lowering of systolic blood pressure (BP). However, it is unknown whether a strategy aimed at lowering BP beyond that recommended would lower the risk of LVH. We examined the effect of intensive (systolic BP<120 mm Hg), compared with standard (systolic BP<140 mm Hg), BP lowering on the risk of LVH in 4331 patients with diabetes mellitus from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial, a randomized controlled trial. The outcome measures were electrocardiographic LVH defined by Cornell voltage (binary variable) and mean Cornell index (continuous variable). The baseline prevalence of LVH (5.3% versus 5.4%; P=0.91) and the mean Cornell index (1456 versus 1470 µV; P=0.45) were similar in the intensive (n=2154) and standard (n=2177) BP-lowering arms, respectively. However, after median follow-up of 4.4 years, intensive, compared with standard, BP lowering was associated with a 39% lower risk of LVH (odds ratio [95% confidence interval], 0.61[0.43, 0.88]; P=0.008) and a significantly lower adjusted mean Cornell index (1352 versus 1447 µV; P<0.001). The lower risk of LVH associated with intensive BP lowering during follow-up was because of more regression of baseline LVH and lower rate of developing new LVH, compared with standard BP lowering. No interactions by age, sex, or race were observed. These results provide evidence that targeting a systolic BP of <120 mm Hg when compared with <140 mm Hg in patients with hypertension and diabetes mellitus produces a greater reduction in LVH. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620.
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Affiliation(s)
- Elsayed Z Soliman
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.).
| | - Robert P Byington
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
| | - J Thomas Bigger
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
| | - Gregory Evans
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
| | - Peter M Okin
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
| | - David C Goff
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
| | - Haiying Chen
- From the Division of Public Health Sciences, Epidemiological Cardiology Research Center (EPICARE) (E.Z.S.); Section of Cardiology, Department of Medicine (E.Z.S.), Division of Public Health Sciences, Department of Epidemiology (E.Z.S., R.P.B), and Division of Public Health Sciences, Department of Biostatistical Sciences (G.E., H.C.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology, Department of Medicine, Columbia University, New York, NY (J.T.B.); Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O.); and Colorado School of Public Health, Aurora (D.C.G.)
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Georgianos PI, Agarwal R. Relative Importance of Aortic Stiffness and Volume as Predictors of Treatment-Induced Improvement in Left Ventricular Mass Index in Dialysis. PLoS One 2015; 10:e0135457. [PMID: 26356419 PMCID: PMC4565709 DOI: 10.1371/journal.pone.0135457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/23/2015] [Indexed: 01/20/2023] Open
Abstract
This study aimed to explore the relative contribution of aortic stiffness and volume in treatment-induced change of left ventricular mass in dialysis. Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril trial compared the effect of lisinopril versus atenolol in reducing left ventricular mass index; 179 patients with echo measurements of aortic pulse wave velocity and left ventricular mass at baseline were included. In unadjusted analysis, overall reductions of 26.24 g/m2 (95% CI: -49.20, -3.29) and 35.67 g/m2 (95% CI: -63.70, -7.64) in left ventricular mass index were noted from baseline to 6 and 12 months respectively. Volume control emerged as an important determinant of regression of left ventricular mass index due to the following reasons: (i) additional control for change in ambulatory systolic blood pressure mitigated the reduction in left ventricular mass index in the statistical model above [6-month visit: -18.6 g/m2 (95% CI: -43.7, 6.5); 12-month visit: -22.1 g/m2 (95% CI: -52.2, 8.0)] (ii) regression of left ventricular hypertrophy was primarily due to reduction in left ventricular chamber and not wall thickness and (iii) adjustment for inferior vena cava diameter (as a proxy for volume) removed the effect of time on left ventricular mass index reduction [6-month visit: -6.6 g/m2 (95% CI: (-41.6, 28.4); 12-month visit: 0.6 g/m2 (95% CI: -39.5, 40.7)]. In contrast, aortic pulse wave velocity was neither a determinant of baseline left ventricular mass index nor predictor of its reduction. Among dialysis patients, ambulatory systolic pressure, a proxy for volume expansion, but not aortic stiffness is more important predictor of reduction in left ventricular mass index. Improving blood pressure control via adequate volume management appears as an effective strategy to improve left ventricular hypertrophy in dialysis.
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Affiliation(s)
- Panagiotis I. Georgianos
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, United States of America
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, United States of America
- * E-mail:
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Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 2014:CD003824. [PMID: 24869750 PMCID: PMC10612990 DOI: 10.1002/14651858.cd003824.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertension is a modifiable cardiovascular risk factor. Although it is established that low-dose thiazides reduce mortality as well as cardiovascular morbidity, the dose-related effect of thiazides in decreasing blood pressure has not been subject to a rigorous systematic review. It is not known whether individual drugs within the thiazide diuretic class differ in their blood pressure-lowering effects and adverse effects. OBJECTIVES To determine the dose-related decrease in systolic and/or diastolic blood pressure due to thiazide diuretics compared with placebo control in the treatment of patients with primary hypertension. Secondary outcomes included the dose-related adverse events leading to patient withdrawal and adverse biochemical effects on serum potassium, uric acid, creatinine, glucose and lipids. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 1), Ovid MEDLINE (1946 to February 2014), Ovid EMBASE (1974 to February 2014) and ClinicalTrials.gov. SELECTION CRITERIA We included double-blind, randomized controlled trials (RCTs) comparing fixed-dose thiazide diuretic monotherapy with placebo for a duration of 3 to 12 weeks in the treatment of adult patients with primary hypertension. DATA COLLECTION AND ANALYSIS Two authors independently screened articles, assessed trial eligibility, extracted data and determined risk of bias. We combined data for continuous variables using a mean difference (MD) and for dichotomous outcomes we calculated the relative risk ratio (RR) with 95% confidence interval (CI). MAIN RESULTS We included 60 randomized, double-blind trials that evaluated the dose-related trough blood pressure-lowering efficacy of six different thiazide diuretics in 11,282 participants treated for a mean duration of eight weeks. The mean age of the participants was 55 years and baseline blood pressure was 158/99 mmHg. Adequate blood pressure-lowering efficacy data were available for hydrochlorothiazide, chlorthalidone and indapamide. We judged 54 (90%) included trials to have unclear or high risk of bias, which impacted on our confidence in the results for some of our outcomes.In 33 trials with a baseline blood pressure of 155/100 mmHg, hydrochlorothiazide lowered blood pressure based on dose, with doses of 6.25 mg, 12.5 mg, 25 mg and 50 mg/day lowering blood pressure compared to placebo by 4 mmHg (95% CI 2 to 6, moderate-quality evidence)/2 mmHg (95% CI 1 to 4, moderate-quality evidence), 6 mmHg (95% CI 5 to 7, high-quality evidence)/3 mmHg (95% CI 3 to 4, high-quality evidence), 8 mmHg (95% CI 7 to 9, high-quality evidence)/3 mmHg (95% CI 3 to 4, high-quality evidence) and 11 mmHg (95% CI 6 to 15, low-quality evidence)/5 mmHg (95% CI 3 to 7, low-quality evidence), respectively.Direct comparison of doses did not show evidence of dose dependence for blood pressure-lowering for any of the other thiazides for which RCT data were available: bendrofluazide, chlorthalidone, cyclopenthiazide, metolazone or indapamide.In seven trials with a baseline blood pressure of 163/88 mmHg, chlorthalidone at doses of 12.5 mg to 75 mg/day reduced average blood pressure compared to placebo by 12.0 mmHg (95% CI 10 to 14, low-quality evidence)/4 mmHg (95% CI 3 to 5, low-quality evidence).In 10 trials with a baseline blood pressure of 161/98 mmHg, indapamide at doses of 1.0 mg to 5.0 mg/day reduced blood pressure compared to placebo by 9 mmHg (95% CI 7 to 10, low-quality evidence)/4 (95% CI 3 to 5, low-quality evidence).We judged the maximal blood pressure-lowering effect of the different thiazides to be similar. Overall, thiazides reduced average blood pressure compared to placebo by 9 mmHg (95% CI 9 to 10, high-quality evidence)/4 mmHg (95% CI 3 to 4, high-quality evidence).Thiazides as a class have a greater effect on systolic than on diastolic blood pressure, therefore thiazides lower pulse pressure by 4 mmHg to 6 mmHg, an amount that is greater than the 3 mmHg seen with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and renin inhibitors, and the 2 mmHg seen with non-selective beta-blockers. This is based on an informal indirect comparison of results observed in other Cochrane reviews on ACE inhibitors, ARBs and renin inhibitors compared with placebo, which used similar inclusion/exclusion criteria to the present review.Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides. These effects were dose-related and were least for hydrochlorothiazide. Chlorthalidone increased serum glucose but the evidence was unclear for other thiazides. There is a high risk of bias in the metabolic data. This review does not provide a good assessment of the adverse effects of these drugs because there was a high risk of bias in the reporting of withdrawals due to adverse effects. AUTHORS' CONCLUSIONS This systematic review shows that hydrochlorothiazide has a dose-related blood pressure-lowering effect. The mean blood pressure-lowering effect over the dose range 6.25 mg, 12.5 mg, 25 mg and 50 mg/day is 4/2 mmHg, 6/3 mmHg, 8/3 mmHg and 11/5 mmHg, respectively. For other thiazide drugs, the lowest doses studied lowered blood pressure maximally and higher doses did not lower it more. Due to the greater effect on systolic than on diastolic blood pressure, thiazides lower pulse pressure by 4 mmHg to 6 mmHg. This exceeds the mean 3 mmHg pulse pressure reduction achieved by ACE inhibitors, ARBs and renin inhibitors, and the 2 mmHg pulse pressure reduction with non-selective beta-blockers as shown in other Cochrane reviews, which compared these antihypertensive drug classes with placebo and used similar inclusion/exclusion criteria.Thiazides did not increase withdrawals due to adverse effects in these short-term trials but there is a high risk of bias for that outcome. Thiazides reduced potassium, increased uric acid and increased total cholesterol and triglycerides.
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Affiliation(s)
- Vijaya M Musini
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | | | - Ken Bassett
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Science MallVancouverBCCanadaV6T 1Z3
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Bu SY, Kang MH, Kim EJ, Choi MK. Dietary Intake Ratios of Calcium-to-Phosphorus and Sodium-to-Potassium Are Associated with Serum Lipid Levels in Healthy Korean Adults. Prev Nutr Food Sci 2014; 17:93-100. [PMID: 24471069 PMCID: PMC3866749 DOI: 10.3746/pnf.2012.17.2.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/23/2012] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to identify food sources for major minerals such as calcium (Ca), phosphorus (P), sodium (Na) and potassium (K), and to evaluate the relationship between dietary intake of these minerals and serum lipids in healthy Korean adults. A total of 132 healthy men and women completed a physical examination and dietary record and provided blood samples for lipid profile analysis. Results showed the following daily average mineral intakes: 373.4 mg of calcium, 806.0 mg of phosphorous, 3685.8 mg of sodium, and 1938.3 mg of potassium. The calcium-to-phosphorus and sodium-to-potassium ratio was about 0.5 and 2.0, respectively. The primary sources for each mineral were: vegetables (24.9%) and fishes (19.0%) for calcium, grains (31.4%) for phosphorus, seasonings (41.6%) and vegetables (27.0%) for sodium, and vegetables (30.6%) and grains (18.5%) for potassium. The correlation analysis, which has been adjusted for age, gender, total food consumption, and energy intake, showed significantly positive correlations between Ca/P and serum HDL cholesterol levels, between Na intake and the level of serum total cholesterol, and between Na/K and the level of serum cholesterol and LDL cholesterol. Our data indicates that the level of mineral consumption partially contributes to serum lipid profiles and that a diet consisting of a low Ca/P ratio and a high Na/K ratio may have negative impacts on lipid metabolism.
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Affiliation(s)
- So-Young Bu
- Division of Food Science, Kyungil University, Gyeongbuk 712-701, Korea
| | - Myung-Hwa Kang
- Department of Food Science and Nutrition, Hoseo University, Chungnam 336-795, Korea
| | - Eun-Jin Kim
- Division of Food Science, Kongju National University, Chungnam 340-702, Korea
| | - Mi-Kyeong Choi
- Division of Food Science, Kongju National University, Chungnam 340-702, Korea
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Garg B, Yadav N, Vardhan H, De AK. Asymptomatic obese hypertensives and need of routine echocardiography for left ventricular mass assessment and treatment. J Clin Diagn Res 2013; 7:1599-603. [PMID: 24086850 DOI: 10.7860/jcdr/2013/6227.3235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/23/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Echocardiographic determination of Left Ventricle Mass (LVM) - an important marker of cardiovascular disease, has been given a lot of importance in clinical diagnosis and in planning of treatment. Clinically asymptomatic compensated hypertensives show some pathological findings which are indicative of left ventricular dysfunction. METHODS The study population of 106 males, after a detailed clinical examination, were evaluated by echocardiography and were classified as per the body mass index classification of WHO Western Pacific Region in 2000 for Asian population. Fasting blood samples were taken to estimate blood sugar and lipid profile. RESULTS It was observed that subjects in normal range of body mass index <45 years (23.68%) and >45 years (16.1%), subjects of overweight <45 years (15.7%) and >45 years (10.29%) and obese I and II<45 years (60.52%) and >45 years (73.52%). The comparison between left ventricular mass which was indexed to height(2.7) in subjects who were <45 years and >45years was observed to be statistically significant (p<0.03). On comparing LVM/ht(2.7) of normal BMI group with that of those with higher BMIs, it was noted to be significantly different (p<0.009), which was suggestive of adverse effects of increasing BMI on LVM. It was also observed that persons with increased BMIs showed changes in left ventricular geometry - 30.13% had concentric hypertrophy, 17.80% had concentric remodeling, 8.21% had eccentric hypertrophy and that 38.35% had normal left ventricle geometry. CONCLUSION The present study therefore, indicated that it was better to do an echocardiographic screening of asymptomatic subjects who had even a marginal increase in blood pressure and BMI, to diagnose potential cardiac dysfunction.
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Affiliation(s)
- Bindu Garg
- Assistant Professor, Department of Physiology, Shri Ram Murti Smarak Institute of Medical Sciences , Bhojipura, Bareilly- 243202, Uttar Pradesh, India
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Misra KH, Das MC, Ramani YR. Effect of telmisartan on the regression of the left ventricular hypertrophy in the patients of essential hypertension. J Clin Diagn Res 2013; 7:1352-5. [PMID: 23998064 DOI: 10.7860/jcdr/2013/5416.3127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/28/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An increase in the Left Ventricular Mass as a result of muscle hypertrophy, has emerged as a powerful pressure independent risk factor for the cardiovascular mortality and morbidity. It is associated with a risk of death that is 3 times greater than the risk which is associated with hypertension alone. For the development of Left Ventricular Hypertrophy (LVH), in addition to a chronic increase in the pressure and/or volume overload, an elevation in the plasma ACE activity, plasma aldosterone levels, and the angiotensin-II concentrations play a major role .In this study, the effect of Telmisartan, a selective angiotension-II receptor blocker, was compared with that of Atenolol, a selective β1adrenergic receptor blocker, on the regression of LVH in the patients of essential hypertension. MATERIAL AND METHOD Essential hypertensive patients with LVH were selected for this study, as per the inclusion and exclusion criteria. This study was carried out on two groups of hypertensive patients with LVH: Group-1: The patients who were taking telmisartan 80 mg OD. Group-2: The patients who were taking atenolol 50 mg OD. The blood pressure was measured and echocardiography was done in both the groups, prior to the treatment and 6 months after the treatment in the Department of Cardiology, MKCG Medical College Hospital, Brahmapur, India. The data were analysed by using the Student's 't' test. RESULTS In the cases of Left Ventricular Mass Index (LVMI), which is a better indicator of LVH, in the Atenolol group, the mean value changed from 143.93 ± 2.44 gm/m(2) to 130.16 ± 2.88 gm/m(2) (t=5.83,p<0.01versus baseline).In the Telmisartan group, the mean value changed from 184.67 ± 7.14 gm/m(2) to 133.41± 4.24 gm/m(2) (t=12.12, p<0.001versus baseline). On comparing Telmisartan with Atenolol, Telmisartan was found to produce a greater (27.49%) reduction than Atenolol (9.68%). In the Telmisartan group, 13 patients out of 26 patients achieved a target value of LVMI that was <134 gm/m(2) in males and <110 gm/m(2) in females (50%). In the Atenolol group, only 9 patients out of 22patients achieved a target value (40.90%). CONCLUSION Thus, Telmisartan a selective AT1antagonist, possesses pharmacological effects beyond a blood pressure reduction in which the blockade of the AT1receptor may lead to attenuation of the growth promoting action of Ang II. From this study, it is clear that Telmisartan is superior to Atenolol in achieving a regression of LVH, which is a better indicator of the cardiovascular morbidity and mortality.
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Affiliation(s)
- Kumar Haraprasad Misra
- Assistant Professor, Department of Pharmacology, MIMS , Vizianagaram, Andhra Pradesh, India
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Matteucci MC, Chinali M, Rinelli G, Wühl E, Zurowska A, Charbit M, Pongiglione G, Schaefer F. Change in cardiac geometry and function in CKD children during strict BP control: a randomized study. Clin J Am Soc Nephrol 2012; 8:203-10. [PMID: 23124781 DOI: 10.2215/cjn.08420811] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Left ventricular hypertrophy (LVH) and abnormal systolic function are present in a high proportion of children with CKD. This study evaluated changes in left ventricular (LV) geometry and systolic function in children with mild to moderate CKD as an ancillary project of the Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of Chronic Renal Failure in Pediatric Patients trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Echocardiograms and ambulatory BP monitoring were performed at baseline and at 1- or 2-year follow-up in 84 patients with CKD and 24-hour mean BP above the 50th percentile and/or receiving fixed high-dose angiotensin converting enzyme inhibition and randomized to conventional or intensified BP control. RESULTS LVH prevalence decreased from 38% to 25% (P<0.05). Changes in LV mass index (LVMI) were restricted to patients with LVH at baseline (-7.9 g/m(2.7); P<0.02). Changes in LVMI were independent of randomization, reduction in BP, hemoglobin, and estimated GFR. A significant increase in midwall fractional shortening was observed in the total cohort (P<0.05), and was greater in the intensified group compared with the conventional BP control group (12%±1.9% versus 8%±1.5%; P=0.05). In multivariate analysis, improvement in myocardial function was associated with reduction in BP (r=-0.4; P<0.05), independently of LVMI reduction. CONCLUSIONS In children with CKD, angiotensin converting enzyme inhibition with improved BP control, LVH regression, and improved systolic function was observed within 12 months. Lowering BP to the low-normal range led to a slightly more marked improvement in myocardial function but not in LVMI.
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Affiliation(s)
- Maria Chiara Matteucci
- Departments of Pediatric Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Hipertrofia ventricular izquierda como factor de riesgo cardiovascular en el paciente hipertenso. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Tishina EV, Mychka VB, Saidova MA. Moxonidine-based combination antihypertensive therapy in patients with metabolic syndrome. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-3-36-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim.To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS).Material and methods.In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured.Results.In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p<0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p<0,05) and 1,4 cm/s (p<0,05), respectively, while E/Em av ratio decreased by 0,8 (p<0,05), and PWV decreased by 1,6 ms (p<0,05). The BMI decrease reached 0,7 kg/m2 (p<0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p<0,05). DT was reduced by 9,4 ms (p<0,05), E/A ratio increased by 0,1 (p<0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p<0,05), 0,8 kg/m2 (p<0,05), and 5,6 ml/min/1,73 m2 (p<0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p<0,05). LVMMI decreased by 5,1 g/m2 (p<0,05), Em av increased by 0,3 cm/s (p<0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p<0,05), 1,8 cm (p<0,05), and 0,5 kg/m2 (p<0,05). All three groups demonstrated a significant reduction in urine albumin levels.Conclusion.The moxonidine-based combination therapy effectively reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity.
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Affiliation(s)
- E. V. Tishina
- A. L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Moscow
| | - V. B. Mychka
- A. L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Moscow
| | - M. A. Saidova
- A. L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Moscow
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Abstract
High salt intake over long term is associated with increased incidence of arterial, predominantly systolic, hypertension and increased risk of cardiovascular diseases, e.g., stroke, heart failure, and renal insufficiency. High salt consumption is a vascular risk factor generating aortic stiffness and decreased vascular compliance leading to central blood pressure augmentation, higher cardiac load, and diminished diastolic perfusion. The development of heart failure can be a consequence of this sequelae. Randomized trials show a reduction in blood pressure with lower sodium intake. In long-term clinical trials, a reduction in cardiovascular morbidity and mortality has been demonstrated. Recommendations should emphasize the simultaneous reduction in sodium intake and increase in potassium intake.
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Affiliation(s)
- M Middeke
- Hypertoniezentrum München, München, Deutschland.
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Abstract
Hypertension in African Americans is a major clinical and public health problem because of the high prevalence and premature onset of elevated blood pressure (BP) as well as the high burden of co-morbid factors that lead to pharmacological treatment resistance (obesity, diabetes mellitus, depressed glomerular filtration rate, and albuminuria). BP control rates are lower in African Americans, especially men, than in other major race/ethnicity-sex groups; overall control rates are 29.9% for non-Hispanic Black men. Optimal antihypertensive treatment requires a comprehensive approach that encompasses multifactorial lifestyle modifications (weight loss, salt and alcohol restriction, and increased physical activity) plus drug therapy. The most important initial step in the evaluation of patients with elevated BP is to appropriately risk stratify them to allow determination of whether they are truly hypertensive and also to determine their goal BP levels. The overwhelming majority of African American hypertensive patients will require combination antihypertensive drug therapy to maintain BP consistently below target levels. The emphasis is now appropriately on utilizing the most effective drug combinations for the control of BP and protection of target-organs in this high-risk population. When BP is >15/10 mmHg above goal levels, combination drug therapy is recommended. The preferred combination is a calcium antagonist/angiotensin-converting enzyme inhibitor or, alternatively, in edematous and/or volume overload states, a thiazide diuretic/angiotensin-converting inhibitor.
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Affiliation(s)
- John M Flack
- Department of Medicine, Division of Translational Research and Clinical Epidemiology, Wayne State University and the Detroit Medical Center, Detroit, Michigan, USA.
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Okin PM, Kjeldsen SE, Lindholm LH, Dahlöf B, Devereux RB. The relationship of electrocardiographic left ventricular hypertrophy to decreased serum potassium. Blood Press 2012; 21:146-52. [DOI: 10.3109/08037051.2011.649537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leonova MV. Modern views on amlodipine and new S-amlodipine medications. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-4-117-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review presents the latest evidence on the calcium antagonist amlodipine, summarizing its mechanisms of action, its pleiotropic, endothelial function-related effects, and its anti-atherogenic activity. Amlodipine suppresses the proliferation of vascular smooth myocytes and extracellular matrix and improves endothelial vasodilatation, despite the absence of L-type calcium channels in these cells. This mechanism is related to an increase in endothelial nitric oxide (NO) release. The results of experimental studies on the role of S and R amlodipine isomers in its hemodynamic and pleiotropic activity are presented. While S-amlodipine is a pharmacologically active blocker of L-type calcium channels, R-amlodipine increases endothelial NO release. New medications have been developed, based on S-amlodipine. It has been shown that S-amlodipine 5 mg/d is bioequivalent to amlodipine 10 mg/d. The pharmacodynamics analysis demonstrated that S-amlodipine 5 mg/d and amlodipine 10 mg/d did not differ significantly in terms of mean levels of systolic and diastolic blood pressure, or mean heart rate. S-amlodipine was better tolerated and characterised by a lower incidence of peripheral edema than amlodipine. However, the effects of S-amlodipine on hard end-points should be investigated in the long-term prospective studies.
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Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens 2011; 2011:495349. [PMID: 21755036 PMCID: PMC3132610 DOI: 10.4061/2011/495349] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/19/2011] [Indexed: 01/17/2023] Open
Abstract
Left ventricular hypertrophy is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic heart failure, systolic heart failure, and sudden death in patients with hypertension. Since not all patients with hypertension develop left ventricular hypertrophy, there are clinical findings that should be kept in mind that may alert the physician to the presence of left ventricular hypertrophy so a more definitive evaluation can be performed using an echocardiogram or cardiovascular magnetic resonance. Controlling arterial pressure, sodium restriction, and weight loss independently facilitate the regression of left ventricular hypertrophy. Choice of antihypertensive agents may be important when treating a patient with hypertensive left ventricular hypertrophy. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers followed by calcium channel antagonists most rapidly facilitate the regression of left ventricular hypertrophy. With the regression of left ventricular hypertrophy, diastolic function and coronary flow reserve usually improve, and cardiovascular risk decreases.
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Affiliation(s)
- Richard E Katholi
- Prairie Cardiovascular Consultants, Ltd., 619 E. Mason Street, Ste. 4P57, Springfield, IL 62701, USA
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He FJ, Burnier M, MacGregor GA. Nutrition in cardiovascular disease: salt in hypertension and heart failure. Eur Heart J 2011; 32:3073-80. [DOI: 10.1093/eurheartj/ehr194] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Strazzullo P. Benefit assessment of dietary salt reduction: while the doctors study, should more people die? J Hypertens 2011; 29:829-31. [DOI: 10.1097/hjh.0b013e3283459568] [Citation(s) in RCA: 10] [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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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, Smith SC, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Nishimura R, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 56:e50-103. [PMID: 21144964 DOI: 10.1016/j.jacc.2010.09.001] [Citation(s) in RCA: 1001] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kotsis V, Stabouli S, Toumanidis S, Tsivgoulis G, Rizos Z, Trakateli C, Zakopoulos N, Sion M. Obesity and daytime pulse pressure are predictors of left ventricular hypertrophy in true normotensive individuals. J Hypertens 2010; 28:1065-73. [PMID: 20411600 DOI: 10.1097/hjh.0b013e3283370e5e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate predictors of left ventricular mass corrected for height2.7 (LVMI) and left ventricular hypertrophy in patients who were found to be normotensive with both office and 24-h ambulatory blood pressure (BP) measurements. METHODS A total of 805 consecutive patients were analyzed. All patients underwent office BP measurements, 24-h ambulatory BP monitoring, laboratory measurements for cardiovascular risk factors and echocardiography. Individuals with both office and ambulatory normotension were characterized as true normotensive. RESULTS LVMI was found to be 34.5 +/- 10.9 g/m2.7 in normal-weight patients and 48.7 +/- 13.0 g/m2.7 in obese patients (P < 0.0001). LVMI was found to be 41.7 +/- 10 g/m2.7 in overweight patients, significantly lower than the values of obese patients (P < 0.005) and higher than the values of normal-weight patients (P < 0.001). These results remained significant even after adjustment for age, sex, daytime and nighttime SBP, daytime and nighttime DBP, daytime and nighttime BP variability and daytime and nighttime pulse pressure (PP). In a multivariate analysis model, in which LVMI was the dependent variable and office SBP, office DBP, daytime and nighttime SBP and DBP, daytime and nighttime PPs and variabilities, day-night SBP ratio, fasting serum glucose, triglycerides, total cholesterol, age and BMI were inserted as independent variables with weighted least squares regression by sex, the predictors of LVMI were age, BMI and daytime PP (r2 = 0.31). Left ventricular hypertrophy was 17.67 times more likely in obese patients as compared with normal-weight true normotensive individuals. CONCLUSION Obesity may represent a significant cardiovascular risk factor even in normotensive individuals. Other predictors of LVMI were ageing and daytime PP.
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Affiliation(s)
- Vasilios Kotsis
- Hypertension Center, Third Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
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Greater regression of electrocardiographic left ventricular hypertrophy during hydrochlorothiazide therapy in hypertensive patients. Am J Hypertens 2010; 23:786-93. [PMID: 20395941 DOI: 10.1038/ajh.2010.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Treatment of hypertensive patients with a losartan-based regimen was associated with greater regression of electrocardiographic (ECG) left ventricular hypertrophy (LVH) than atenolol-based therapy in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, independent of blood pressure (BP) changes. However, whether concomitant hydrochlorothiazide (HCTZ) therapy in >70% of LIFE patients was associated with greater regression of LVH independent of BP changes and whether this effect differed between treatment arms has not been examined. METHODS Changes in Cornell product and Sokolow-Lyon voltage LVH were assessed in 9,193 hypertensive patients randomly assigned to treatment with losartan or atenolol, with additional HCTZ therapy added as necessary to achieve target BP goal per study protocol. RESULTS After controlling for baseline and change in systolic and diastolic pressure, age, sex, race, prior antihypertensive treatment, baseline and year-4 body mass index and baseline LVH by either Cornell product or Sokolow-Lyon voltage, at year-4 follow-up HCTZ therapy was associated with greater regression of Cornell product LVH (-244 +/- 788 vs. -172 +/- 771 mm.msec, P < 0.05) and Sokolow-Lyon voltage (-4.2 +/- 6.7 vs. -3.0 +/- 7.0 mm, P < 0.001) and this effect was significantly greater in patients on losartan (-341 +/- 743 vs. -189 +/- 775 mm.msec and -5.2 +/- 6.6 vs. -3.3 +/- 6.6 mm) than in patients on atenolol (-142 +/- 822 vs. -158 +/- 765 mm.msec and -3.1 +/- 6.6 vs. -2.7 +/- 7.4 mm; both P < 0.001 for interaction of HCTZ with losartan vs. atenolol therapy). CONCLUSIONS HCTZ use was associated with greater regression of ECG LVH and this effect was greater in patients on losartan- than atenolol-based therapy, independent of baseline severity of ECG LVH and hypertension and changes in BP.
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He FJ, MacGregor GA. Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 2010; 52:363-82. [PMID: 20226955 DOI: 10.1016/j.pcad.2009.12.006] [Citation(s) in RCA: 361] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Raised blood pressure is a major cause of cardiovascular disease, responsible for 62% of stroke and 49% of coronary heart disease. There is overwhelming evidence that dietary salt is the major cause of raised blood pressure and that a reduction in salt intake lowers blood pressure, thereby, reducing blood pressure-related diseases. Several lines of evidence including ecological, population, and prospective cohort studies, as well as outcome trials, demonstrate that a reduction in salt intake is related to a lower risk of cardiovascular disease. Increasing evidence also suggests that a high salt intake may directly increase the risk of stroke, left ventricular hypertrophy, and renal disease; is associated with obesity through soft drink consumption; is related to renal stones and osteoporosis; is linked to the severity of asthma; and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to foods by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake. The challenge now is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.
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Affiliation(s)
- Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Chrysant SG. Stopping the cardiovascular disease continuum: Focus on prevention. World J Cardiol 2010; 2:43-9. [PMID: 21160754 PMCID: PMC2999025 DOI: 10.4330/wjc.v2.i3.43] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 03/08/2010] [Accepted: 03/15/2010] [Indexed: 02/06/2023] Open
Abstract
The cardiovascular disease continuum (CVDC) is a sequence of events, which begins from a host of cardiovascular risk factors that consists of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If it is not intervened with early, it inexorably progresses to atherosclerosis, coronary artery disease, myocardial infarction, left ventricular hypertrophy, and left ventricular dilatation, which lead to left ventricular diastolic or systolic dysfunction and eventually end-stage heart failure and death. Treatment intervention at any stage during its course will either arrest or delay its progress. In this editorial, the cardiovascular risk factors that initiate and perpetuate the CVDC are briefly discussed, with an emphasis on their early prevention or aggressive treatment.
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Affiliation(s)
- Steven G Chrysant
- Steven G Chrysant, University of Oklahoma and Director of the Oklahoma Cardiovascular and Hypertension Center, Oklahoma City, OK 73132-4904, United States
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Søraas CL, Wachtell K, Okin PM, Dahlöf B, Devereux RB, Tønnessen T, Kjeldsen SE, Olsen MH. Lack of regression of left ventricular hypertrophy is associated with higher incidence of revascularization in hypertension: The LIFE Study. Blood Press 2010; 19:145-51. [DOI: 10.3109/08037051.2010.481812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Weir MR, Townsend RR. What is left ventricular hypertrophy and is there a reason to regress left ventricular hypertrophy? J Clin Hypertens (Greenwich) 2009; 11:407-10. [PMID: 19695027 DOI: 10.1111/j.1751-7176.2009.00156.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21202, USA.
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Nadour W, Biederman RWW. Is left ventricular hypertrophy regression important? Does the tool used to detect it matter? J Clin Hypertens (Greenwich) 2009; 11:441-7. [PMID: 19695032 PMCID: PMC8673408 DOI: 10.1111/j.1751-7176.2009.00137.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 04/30/2009] [Accepted: 04/30/2009] [Indexed: 11/27/2022]
Abstract
Left ventricular hypertrophy (LVH) has been demonstrated to define an adverse cardiovascular prognosis. However, due to poor noninvasive tools in which to accurately define LVH, the clinical manifestations dictate an inexact manner in which to either initiate therapy or to gauge the success of LVH regression. Herein, the authors define the current state of imaging modalities available to interrogate LVH and its regression, but concentrating chiefly on the "gold standard" of cardiovascular magnetic resonance imaging (CMR). The authors review the data demonstrating the importance of LVH regression. Additionally, they highlight the strengths and weaknesses of CMR via several pinnacle studies that demonstrate the ease, efficiency, and accuracy of this new noninvasive reproducible and available tool to relatively inexpensively delineate LVH. Finally, upon pharmacologic administration of an antihypertensive regimen, the authors, for the first time, define a goal of left ventricular mass reduction (in grams) for echocardiography and CMR based in part on Framingham data aiming at improving cardiovascular risk.
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Affiliation(s)
- Wadih Nadour
- Division of Internal Medicine and Cardiology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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FRANK W. BELTMAN, WILFRED F. HEESEN. Effects of Amlodipine and Lisinopril on Left Ventricular Mass and Diastolic Function in Previously Untreated Patients with Mild to Moderate Diastolic Hypertension. Blood Press 2009. [DOI: 10.1080/080370598437484] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2008; 23:363-84. [PMID: 19110538 DOI: 10.1038/jhh.2008.144] [Citation(s) in RCA: 627] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure (BP), cholesterol and smoking, are the major risk factors. Among these, raised BP is the most important cause, accounting for 62% of strokes and 49% of coronary heart disease. Importantly, the risk is throughout the range of BP, starting at systolic 115 mm Hg. There is strong evidence that our current consumption of salt is the major factor increasing BP and thereby CVD. Furthermore, a high salt diet may have direct harmful effects independent of its effect on BP, for example, increasing the risk of stroke, left ventricular hypertrophy and renal disease. Increasing evidence also suggests that salt intake is related to obesity through soft drink consumption, associated with renal stones and osteoporosis and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake, for example, Japan (1960-1970), Finland (1975 onwards) and now the United Kingdom. The challenge is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.
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Affiliation(s)
- F J He
- Blood Pressure Unit, Cardiac and Vascular Sciences, St George's, University of London, London, UK.
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47
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Cuspidi C, Sala C, Zanchetti A. Management of hypertension in patients with left ventricular hypertrophy. Curr Hypertens Rep 2008; 9:498-505. [PMID: 18367014 DOI: 10.1007/s11906-007-0091-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left ventricular hypertrophy (LVH) is a cardinal manifestation of organ damage in patients with arterial hypertension. Identifying LVH is a fundamental step in evaluating hypertensive patients, because clinical and epidemiologic studies have shown this condition has a strong independent adverse prognostic significance. LVH is an integrated marker of cardiovascular risk, reflecting hypertension's hemodynamic and nonhemodynamic effects on the heart. Reversing LVH is an intermediate goal of antihypertensive therapy. Pharmacologic strategies to reverse LVH should be based on combining two or more drugs: a renin-angiotensin system blocker (ie, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist), and a calcium antagonist or low-dose diuretic. Successful therapeutic plans should also include nonpharmacologic interventions to promote LVH regression.
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Affiliation(s)
- Cesare Cuspidi
- Policlinico di Monza, Via Amati 111, 20052 Monza, Italy.
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Treatment of heart failure with preserved systolic function. Arch Cardiovasc Dis 2008; 101:361-72. [PMID: 18656095 DOI: 10.1016/j.acvd.2008.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 04/25/2008] [Indexed: 11/22/2022]
Abstract
Heart failure is a major public health problem. Heart failure with preserved systolic function (HF-PSF) is a common form, which is difficult to diagnose. Results of recent studies show that HF-PSF has a poor prognosis, with an annual survival rate similar to that of heart failure with left ventricular systolic dysfunction. Despite these findings, the therapeutic management of HF-PSF is not clearly defined. We will discuss in this review of the literature the current therapeutic management of HF-PSF, including the role of precipitating factors such as hypertension, myocardial ischaemia and supraventricular arrhythmias, and the main results of epidemiological registries and randomized controlled clinical trials in this disease. Only four large therapeutic trials have assessed the impact of different classes of drugs (digoxin, angiotensin II converting enzyme inhibitors, angiotensin II receptors type I blockers and beta-blockers) on morbidity and mortality in HF-PSF. Results of these trials are disappointing. Apart from the beta-blockers, the other three classes of drugs did not show benefit on the outcome of the disease. Moreover, the results of the beta-blocker trial are controversial as a mixed population of heart failure with and without preserved systolic function was studied. Finally, the current therapeutic management of patients with HF-PSF is still based on our pathophysiological knowledge: education, low salt diet, diuretics, slowing heart rate and controlling triggering factors. Other large randomized controlled multicenter trials, which may help us in the understanding of HF-PSP and its therapeutic management, are ongoing.
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Effect of doxazosin on the left ventricular structure and function in morning hypertensive patients: the Japan Morning Surge 1 study. J Hypertens 2008; 26:1463-71. [DOI: 10.1097/hjh.0b013e3283013b44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Simone G, D'Addeo G. Sibutramine: balancing weight loss benefit and possible cardiovascular risk. Nutr Metab Cardiovasc Dis 2008; 18:337-341. [PMID: 18502626 DOI: 10.1016/j.numecd.2008.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 03/19/2008] [Accepted: 03/21/2008] [Indexed: 11/28/2022]
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