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Elbarbary M, Shoeib O, El-Saied SB, Atlm RM, Alkassas A. Prevalence and determinants of resistant hypertension in the delta region of Egypt: A prospective observational study. Health Sci Rep 2023; 6:e1441. [PMID: 37701356 PMCID: PMC10494290 DOI: 10.1002/hsr2.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023] Open
Abstract
Background and Aims Hypertension (HTN) is a leading cause of morbidity and mortality affecting about 30%-40% of the adult population in developed countries. Fewer data were published about the prevalence, sociodemographics, and clinical characteristics of the resistant hypertensive population in Egypt. Hence, our aim is to focus the attention on these determinants especially in the delta region of Egypt. Methods Data belonging to patients visiting our HTN clinic in the Cardiovascular Department, Tanta University Hospital, Gharbeyah Governorate, Egypt, were collected over 12 months, between January 1, 2022, and 31 December 31, 2022, and then carefully analyzed. Results We found that the prevalence of resistant hypertension (RHTN) in the delta region of Egypt was 18%. We noted more RHTN cases in older age, that is, mean ± Std. was 51.5 ± 13.24 and 62.1 ± 7.56 for non-RHTN and RHTN, respectively. Also, the prevalence was higher in women representing about 54.4% of cases. Sixty-two percent of the patients with RH were obese (mean ± Std. of body mass index was 30.7 ± 5.36 in HTN and 47.7 ± 30.3 in RHTN groups with p value <0.001). We found a significant relationship between chronic kidney disease, diabetes, and RHTN. Conclusion Control of HTN among the Egyptian population in the delta region was unsatisfactory and higher than rates published globally. RH was more obvious in women, elderly, obese population, and diabetic and chronic kidney disease patients. Excessive use of nonsteroidal anti-inflammatory drugs, smoking, and high salt intake were clearly observed.
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Affiliation(s)
- Mohammed Elbarbary
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Osama Shoeib
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Shaimaa B El-Saied
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Ramy M Atlm
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
| | - Amr Alkassas
- Department of Cardiovascular Medicine, Faculty of Medicine Tanta University Tanta Egypt
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2
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Dolmatova E, Waheed N, Olson BM, Patel SA, Mandawat A. The Intersection of Prostate Cancer and Hypertension: a Call to Action. Curr Treat Options Oncol 2023:10.1007/s11864-023-01094-z. [PMID: 37191906 DOI: 10.1007/s11864-023-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
OPINION STATEMENT With improvements in treatment and survival from prostate cancer, comorbid cardiac conditions will significantly impact overall morbidity and mortality from prostate cancer. Hypertension is a well-established cardiovascular risk factor that increases the risk of heart failure, myocardial infarction, and stroke. Therapies used in the treatment of prostate cancer, including GnRH agonists, GnRH antagonists, enzalutamide, abiraterone, and others, can directly or indirectly increase the risk of hypertension. In this paper, we review the evidence available on the incidence and mechanism of hypertension in prostate cancer patients. In addition, we provide recommendations on the assessment, treatment, and future directions for hypertension management in the prostate cancer population. We propose an individualized goal for blood pressure in prostate cancer patients, balancing the target goal of 130/80 mmHg with common comorbidities of frailty, orthostatic symptoms, and imbalance in this population. The presence of additional comorbidities (myocardial infarction, heart failure, renal disease, diabetes) can assist in preference of anti-hypertensive drugs.
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Affiliation(s)
| | - Nida Waheed
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sagar A Patel
- Emory University School of Medicine, Atlanta, GA, USA
| | - Anant Mandawat
- Emory University School of Medicine, Atlanta, GA, USA.
- Cardio-Oncology Center of Excellence, Emory University, 1365B Clifton Rd NE Suite 4000, Atlanta, GA, 30322, USA.
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3
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Chatzis DG, Magounaki K, Pantazopoulos I, Beltsios ET, Katsi V, Tsioufis KP. Current Management of Hypertension in Older Adults. Drugs Aging 2023; 40:407-416. [PMID: 36933178 DOI: 10.1007/s40266-023-01013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/19/2023]
Abstract
Hypertension is a major global health issue and it accounts for a big proportion of disability and mortality worldwide even in adults aged 65 years and above. Moreover, advanced age per se is an independent risk factor for adverse cardiovascular events and there is abundant scientific evidence supporting the beneficial effects of blood pressure lowering, within certain limits, in this subset of hypertensive patients. The aim of this review article is to summarize the available evidence regarding the appropriate management of hypertension in this specific subgroup, in an era of a constantly increasing aging population.
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Affiliation(s)
- Dimitrios G Chatzis
- Medical School, European University Cyprus, 76 Siggrou avenue, 11742, Athens, Greece.
| | - Kalliopi Magounaki
- Department of Internal Medicine, KAT General Hospital of Athens, Athens, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West Germany Heart Center, University Clinic Essen, Essen, Germany
| | - Vasiliki Katsi
- Department of Cardiology, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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4
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Li LG, Ma X. Early identification and treatment for peripheral arterial disease in patients with ischemic cerebrovascular disease. Eur J Med Res 2023; 28:93. [PMID: 36823655 PMCID: PMC9948380 DOI: 10.1186/s40001-023-01050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Ischemic cerebrovascular disease (ICVD) is a major cause of mortality and disability worldwide and is often caused by atherosclerosis. As a systemic disease, atherosclerosis usually affects multiple vascular beds, mainly including cerebral, coronary, and peripheral arteries. Therefore, ICVD is easily complicated by lower-extremity peripheral arterial disease (PAD). ICVD patients with PAD have more serious symptoms and a worse prognosis, however, neurologists might neglect the evaluation and management of the coexistent PAD, and there is still a lack of consensuses about the diagnosis and treatment for such patients. By summarizing relevant research progresses, this review showed that duplex ultrasound had more advantages in the early screening and evaluation of PAD in ICVD patients among multiple methods to diagnose PAD. Furthermore, the current evidence seems to support that single-drug antiplatelet can be used as the basic treatment, and new antithrombotic strategies, such as ticagrelor only or aspirin combined with low-dose rivaroxaban are expected to further reduce the incidence of stroke for ICVD patients with PAD. More effective treatments would be explored by large-scale trials to guide the clinical management to prevent secondary stroke for such patients.
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Affiliation(s)
- Lu-guang Li
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053 China ,National Clinical Research Center for Geriatric Disorders, Beijing, China ,grid.24696.3f0000 0004 0369 153XClinical Center for Cardio-Cerebrovascular Disease of Capital Medical University, Beijing, China
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China. .,Clinical Center for Cardio-Cerebrovascular Disease of Capital Medical University, Beijing, China.
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5
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Carter RR, Chum AP, Sanchez R, Guha A, Dey AK, Reinbolt R, Kim L, Otchere P, Oppong‐Nkrumah O, Abraham WT, Lustberg M, Addison D. Hypertensive events after the initiation of contemporary cancer therapies for breast cancer control. Cancer Med 2023; 12:297-305. [PMID: 35633055 PMCID: PMC9844596 DOI: 10.1002/cam4.4862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Contemporary therapies improve breast cancer (BC) outcomes. Yet, many of these therapies have been increasingly linked with serious cardiotoxicity, including reports of profound hypertension. Yet, the incidence, predictors, and impacts of these events are largely unknown. METHODS Leveraging two large U.S.-based registries, the National Inpatient Sample (NIS) and the Food and Drug Administration Adverse Event Reporting System (FAERS) databases, we assessed the incidence, factors, and outcomes of hypertensive events among BC patients from 2007 to 2015. Differences in baseline characteristics, hypertension-related discharges, and complications were examined over time. Further, we performed a disproportionality analysis using reporting-odds-ratios (ROR) to determine the association between individual BC drugs and hypertensive events. Utilizing an ROR cutoff of >1.0, we quantified associations by drug-class, and individual drugs with the likelihood of excess hypertension. RESULTS Overall, there were 5,464,401 BC-admissions, of which 46,989 (0.8%) presented with hypertension. Hypertensive BC patients were older, and saw initially increased in-hospital mortality, which equilibrated over time. The mean incidence of hypertension-related admissions was 732 per 100,000 among BC patients, versus 96 per 100,000 among non-cancer patients (RR 7.71, p < 0.001). Moreover, in FAERS, those with hypertension versus other BC-treatment side-effects were more frequently hospitalized (40.1% vs. 36.7%, p < 0.001), and were most commonly associated with chemotherapy (45.9%). Outside of Eribulin (ROR 3.36; 95% CI 1.37-8.22), no specific drug was associated with a higher reporting of hypertension; however, collectively BC drugs were associated with a higher odds of hypertension (ROR 1.66; 95% CI 1.09-2.53). CONCLUSIONS BC therapies are associated with a substantial increase in limiting hypertension.
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Affiliation(s)
- Rebecca R. Carter
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST)Ohio State UniversityColumbusOhioUSA
| | - Aaron P. Chum
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Reynaldo Sanchez
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Avirup Guha
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- Harrington Heart and Vascular InstituteCase Western Reserve UniversityClevelandOhioUSA
| | - Amit K. Dey
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | - Raquel Reinbolt
- Solove Research InstituteThe Ohio State University Comprehensive Cancer Center – James Cancer HospitalColumbusOhioUSA
| | - Lisa Kim
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Prince Otchere
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Oduro Oppong‐Nkrumah
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - William T. Abraham
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
| | - Maryam Lustberg
- Solove Research InstituteThe Ohio State University Comprehensive Cancer Center – James Cancer HospitalColumbusOhioUSA
| | - Daniel Addison
- Cardio‐Oncology Program, Division of CardiologyOhio State UniversityColumbusOhioUSA
- Cancer Control Program, Department of MedicineOhio State University Comprehensive Cancer CenterColumbusOhioUSA
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Dahel H, Lafrance JP, Patenaude M, Kilpatrick K, Beaubien-Souligny W, Moreau M, Wang HT. Determining Factors Influencing RAS Inhibitors Re-Initiation in ICU: A Modified Delphi Method. Can J Kidney Health Dis 2022; 9:20543581221112266. [PMID: 35860649 PMCID: PMC9290153 DOI: 10.1177/20543581221112266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Renin-angiotensin system inhibitors (RASi) are not re-initiated for almost a quarter of patients who suffered acute kidney injury 6 months after discharge. This discontinuation might be partly explained by the nephrotoxicity of these medications, yet they remain of benefit, especially for patients with heart failure. Objective To determine the factors deemed by clinicians to influence RASi re-initiation and set threshold values for important safety parameters. Design Three-round modified online Delphi survey. Setting The study was conducted in Quebec, Canada. Participants Twenty clinicians from nephrology, intensive care medicine, and internal medicine. Measurements The factors' importance was rated on 4-point Likert-type scale, ranging from "not important" to "very important" by the panelists. Methods We conducted a brief literature review to uncover possible influencing factors followed by a 3-round modified Delphi survey to establish a consensus on the importance of these factors. Results We recruited 20 clinicians (7 nephrologists, 3 internists, and 10 intensive care physicians). We created a list of 25 factors, 15 of which met consensus. Eleven of these factors, including serum creatinine, glomerular filtration rate, and acute kidney injury (AKI) stage, were deemed as important while 4, such as responsibility ambiguity and absence of feedback, were deemed as not important. The majority of the 10 factors which did not meet consensus were related to the clinical setting, such as a pharmacist follow-up and the required time to ensure optimal RASi re-initiation. Limitations Quebec clinicians' agreement might not reflect the opinion of the rest of Canada. The survey measures clinicians' belief rather than their actual practice. Conclusion Renin-angiotensin system inhibitors re-initiation is a rather complex concept which encompasses several factors. Our research uncovered some of these factors which may be used to develop guidelines on optimal RASi re-initiation.
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Affiliation(s)
- Hadjer Dahel
- Faculty of Pharmacy, Université de Montréal, QC, Canada.,Centre hospitalier de l'Université de Montréal Research Center, QC, Canada.,Hôpital du Sacré-Cœur de Montréal Research Center, QC, Canada
| | - Jean-Philippe Lafrance
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont Research Centre, Montreal, QC, Canada
| | - Mathilde Patenaude
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Affiliated with Université de Montréal, QC, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - William Beaubien-Souligny
- Centre hospitalier de l'Université de Montréal Research Center, QC, Canada.,Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada
| | - Mathieu Moreau
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, QC, Canada.,Centre intégré de santé et de services sociaux de Laval, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, QC, Canada.,Bureau de l'éthique clinique, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Han Ting Wang
- Centre hospitalier de l'Université de Montréal Research Center, QC, Canada.,Department of Medicine, Division of Critical Care Medicine, Centre hospitalier de l'Université de Montréal, QC, Canada
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7
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Kabakambira JD, Shumbusho P, Mujawamariya G, Rutagengwa W, Twagirumukiza M. The Role of the Integrated District Hospital Based Non Communicable Diseases' Clinics in Cardiovascular Disease Control: Preliminary Data from Rwanda. Diabetes Metab Syndr Obes 2022; 15:2107-2115. [PMID: 35898444 PMCID: PMC9309289 DOI: 10.2147/dmso.s348031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs), remain the leading cause of death worldwide and represent an emerging global health threat. In Rwanda and elsewhere, the prevalence of cardiovascular diseases is increasing. To address this global health threat, Rwanda launched integrated nurse-led NCD clinics in all the forty-five District Hospitals across the country in 2006, but no evaluation study has been conducted so far for the added value of this program. The main goal of this study was to assess the impact of NCD clinics on disease control in Rwanda. METHODS This was a retrospective ambulatory patient chart review at a rural district hospital and an urban teaching hospital; which enrolled patients with diabetes and/or hypertension who consulted in a period of 1 month with retrospective data of one year. RESULTS A total of 199 patients' electronic health records were reviewed from the University Teaching Hospital of Kigali (CHUK) (53%) and Nyamata District Hospital (47%). Among them, 31% had diabetes, 38% had hypertension and 31% had both diseases. The mean age for the total cohort was 60 years and was predominantly female at 70%. Throughout the year, about 59% patients with hypertension had blood pressure control at the district hospital as opposed to 38% at the referral hospital. The rate of diabetes control was 20% at the referral hospital, but no comparison could be established between the two health facilities as the follow up laboratory markers were not available at the district hospital. CONCLUSION There was a consistent blood pressure control at the district hospital. Diabetes control was not optimal at the referral hospital despite the presence of human resources and logistics required for diabetes care. The situation was even worse at the district hospital where the follow up markers were rarely available.
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Affiliation(s)
- Jean Damascene Kabakambira
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Correspondence: Jean Damascene Kabakambira, Department of Internal Medicine, University Teaching Hospital of Kigali, KN 4th Avenue, P.O Box 655, Kigali, Rwanda, Tel +250 788800966, Email
| | - Patrick Shumbusho
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gisele Mujawamariya
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - William Rutagengwa
- Department of Internal Medicine, Nyamata District Hospital, Bugesera, Rwanda
| | - Marc Twagirumukiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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8
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Cuffee YL, Wang M, Geyer NR, Saxena S, Akuley S, Jones L, Wilson RT. Vitamin D and family history of hypertension in relation to hypertension status among college students. J Hum Hypertens 2022; 36:839-45. [PMID: 34285353 DOI: 10.1038/s41371-021-00577-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Hypertension and vitamin D concentrations have heritable components, although these factors remain uninvestigated in young adults. The objective of this study was to investigate hypertension risk among young adults with respect to family history of hypertension, adjusting for vitamin D status. Resting blood pressure (BP) was measured in 398 individuals aged 18-35 and classified according to the 2017 American Heart Association criteria. Plasma vitamin D metabolite (25(OH)D3; 24,25(OH)2D3; 1,25(OH)2D3) concentrations were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS). Stepwise logistic regression was used to select covariates. Participants' mean age was 21, 30.3% had hypertension, and nearly all unaware of their hypertensive status (90.7%). Compared with no parental history, the adjusted odds ratio (AOR) for hypertension was elevated among participants with two parents having hypertension (AOR = 4.5, 95% CI: 1.70-11.76), adjusting for sex, body mass index, physical activity, and plasma 25(OH)D3. Results for systolic hypertension (SH) were similar but more extreme (two parents AOR = 7.1, 95% CI: 2.82, 17.66), although dihydroxy metabolites (1,25(OH)2D3 and 24,25(OH)2D3) were significant. There was a strong, independent association with dual parental history and hypertension status, regardless of vitamin D status. Hypertension was prevalent in nearly one-third of the sample and underscores the need for targeted prevention for young adults.
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9
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Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S, Maddury SR, Kumar AS, Chandra N, Suryaprakash G, Thomas JM, Juvale NI, Sathe S, Khan A, Bansal S, Kumar V, Reddi R. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J 2021; 73:667-673. [PMID: 34861979 PMCID: PMC8642659 DOI: 10.1016/j.ihj.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN.
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Affiliation(s)
- Jamshed J Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India.
| | | | - Arup Dasbiswas
- Department of Cardiology, NRS Medical College, Kolkata, West Bengal, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | | | | | | | | | - Joy M Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, India.
| | - N I Juvale
- Department of Cardiology, Saifee Hospital, Mumbai, India.
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, India.
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Medical College, Delhi, India.
| | | | - Rajshekhar Reddi
- Department of Neurology, Max Superspecialty Hospital, Saket, New Delhi, India.
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10
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Wright JT, Whelton PK, Johnson KC, Snyder JK, Reboussin DM, Cushman WC, Williamson JD, Pajewski NM, Cheung AK, Lewis CE, Oparil S, Rocco MV, Beddhu S, Fine LJ, Cutler JA, Ambrosius WT, Rahman M, Still CH, Chen Z, Tatsuoka C. SPRINT Revisited: Updated Results and Implications. Hypertension 2021; 78:1701-1710. [PMID: 34757768 PMCID: PMC8824314 DOI: 10.1161/hypertensionaha.121.17682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The SPRINT (Systolic Blood Pressure Intervention Trial) results have influenced clinical practice but have also generated discussion regarding the validity, generalizability, and importance of the findings. Following the SPRINT primary results manuscript in 2015, additional results and analyses of the data have addressed these concerns. The primary objective of this article is to respond to key questions that have been raised.
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Affiliation(s)
- Jackson T Wright
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joni K Snyder
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alfred K Cheung
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne Oparil
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael V Rocco
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Srinivasan Beddhu
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Lawrence J Fine
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Jeffrey A Cutler
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Curtis Tatsuoka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
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Zamora-Kapoor A, Hebert LE, Montañez M, Buchwald D, Sinclair K. Risk Factors in Adolescence for the Development of Elevated Blood Pressure and Hypertension in American Indian and Alaskan Native Adults. J Immigr Minor Health 2021; 23:717-724. [PMID: 33247795 PMCID: PMC8160022 DOI: 10.1007/s10903-020-01130-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
To examine risk factors for elevated blood pressure and hypertension in American Indians and Alaska Natives (AI/ANs), compared to three other ethnic groups in the US. Weighted relative risk regression models, stratified by race/ethnicity, were used to measure the associations between risk factors and elevated blood pressure and hypertension in AI/ANs, compared to non-Hispanic Whites, non-Hispanic Blacks and Hispanics, with data from the National Longitudinal Study of Adolescent to Adult Health. In all groups, females had a lower risk of both elevated blood pressure and hypertension than males. Increasing body mass index raised hypertension risk in all groups. In AI/ANs, financial instability increased the risk of hypertension by 88% (95% CI: 1.27-2.77), but not in other groups. No other statistically significant associations were found. Future interventions should include socio-economic factors in efforts to prevent hypertension in AI/ANs.
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Affiliation(s)
- Anna Zamora-Kapoor
- Departments of Sociology and Medical Education and Clinical Sciences, Washington State University, Pullman, WA, USA.
| | - Luciana E Hebert
- Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
| | - Morgan Montañez
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Department of Medical Education and Clinical Sciences, Washington State University, Spokane, WA, USA
| | - Ka'imi Sinclair
- College of Nursing, Washington State University, Spokane, WA, USA
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Jan YT, Tsai PS, Longenecker CT, Lin DC, Yun CH, Sung KT, Liu CC, Kuo JY, Hung CL, Wu TH, Lin JL, Hou CJY, Tsai CT, Chien CY, So A. Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines. Diagnostics (Basel) 2021; 11:diagnostics11061027. [PMID: 34205037 PMCID: PMC8226485 DOI: 10.3390/diagnostics11061027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.
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Affiliation(s)
- Ya-Ting Jan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Pei-Shan Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | | | - Dao-Chen Lin
- Division of Endocrine and metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Kuo-Tzu Sung
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chuan-Chuan Liu
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
- Health Evaluation Center, MacKay Memorial Hospital, Taipei 104, Taiwan
- Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu City 306, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan;
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Cheng-Ting Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chen-Yen Chien
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104, Taiwan
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Aaron So
- Imaging Program, Lawson Health Research Institute, London, ON N6C 2R5, Canada;
- Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada
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Abstract
According to the last Hypertension guideline recommendations, it may be concluded that intensive BP lowering is only advisable in a subgroup of patients where there is a clear net benefit of targeting to lower BP goals. However, taking into account the relevance of correct BP measurement, estimates of the benefits versus the harm should be based on reliable office BP measurements and home BP measurements. There is still debate about which BP goals are optimal in reducing morbidity and mortality in uncomplicated hypertensives and in those with associated comorbidities. In recent years, trials and meta-analyses have assessed intensive BP lowering, with some success. However, a careful examination of the results shows that current data are not easily applicable to the general hypertensive population. This article reviews the evidence on and controversies about intensive BP lowering in general and in specific clinical situations, and the importance of obtaining reliable BP readings in patients with hypertension and comorbidities.
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Affiliation(s)
- Miguel Camafort
- Department of Internal Medicine-ICMiD. Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. .,Cardiovascular Risk, Nutrition and Aging Research Group. IDIBAPS, Barcelona, Spain. .,Ciber-OBN, Instituto de Salud Carlos III, Madrid, Spain.
| | - Josep Redón
- Ciber-OBN, Instituto de Salud Carlos III, Madrid, Spain.,Hypertension Clinic. Hospital Clinico, University of Valencia, Valencia, Spain
| | - Wook Bum Pyun
- Department of Cardiology, Ewha Womans University. Seoul Hospital, Seoul, South Korea
| | - Antonio Coca
- Department of Internal Medicine-ICMiD. Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Cardiovascular Risk, Nutrition and Aging Research Group. IDIBAPS, Barcelona, Spain
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Botchway A, Buhnerkempe MG, Prakash V, Al-Akchar M, Adekola B, Flack JM. Serious Adverse Events Cluster in Participants Experiencing the Primary Composite Cardiovascular Endpoint: A Post Hoc Analysis of the SPRINT Trial. Am J Hypertens 2020; 33:528-533. [PMID: 31930338 DOI: 10.1093/ajh/hpaa010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/30/2019] [Accepted: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Intensively treated participants in the SPRINT study experienced fewer primary cardiovascular composite study endpoints (CVD events) and lower mortality, although 38% of participants experienced a serious adverse event (SAE). The relationship of SAEs with CVD events is unknown. METHODS CVD events were defined as either myocardial infarction, acute coronary syndrome, decompensated heart failure, stroke, or death from cardiovascular causes. Cox models were utilized to understand the occurrence of SAEs with CVD events according to baseline atherosclerotic cardiovascular disease (ASCVD) risk. RESULTS SAEs occurred in 96% of those experiencing a CVD event but only in 34% (P < 0.001) of those not experiencing a CVD event. Occurrence of SAEs monotonically increased across the range of baseline ASCVD risk being approximately twice as great in the highest compared with the lowest risk category. SAE occurrence was strongly associated with ASCVD risk but was similar within risk groups across treatment arms. In adjusted Cox models, experiencing a CVD event was the strongest predictor of SAEs in all risk groups. By the end of year 1, the hazard ratios for the low, middle, and high ASCVD risk tertiles, and baseline clinical CVD group were 2.56 (95% CI = 1.39-4.71); 2.52 (1.63-3.89); 3.61 (2.79-4.68); 1.86 (1.37-2.54), respectively-a trend observed in subsequent years until study end. Intensive treatment independently predicted SAEs only in the second ASVCD risk tertile. CONCLUSIONS The occurrence of SAEs is multifactorial and mostly related to prerandomization patient characteristics, most prominently ASCVD risk, which, in turn, relates to in-study CVD events.
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Affiliation(s)
- Albert Botchway
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Michael G Buhnerkempe
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Vivek Prakash
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mohammad Al-Akchar
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Bemi Adekola
- Division of General Internal Medicine, Hypertension Section, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Division of Nephrology, Department of Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - John M Flack
- Division of General Internal Medicine, Hypertension Section, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Tata CM, Ndinteh D, Nkeh-Chungag BN, Oyedeji OO, Sewani-Rusike CR. Fractionation and bioassay-guided isolation of antihypertensive components of Senecio serratuloides. Cogent Medicine 2020. [DOI: 10.1080/2331205x.2020.1716447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Charlotte Mungho Tata
- Department of Human Biology, Faculty of Health Sciences, Walter Sisulu University Mthatha 5117 South Africa
- Department of Chemical Sciences, Faculty of Science, University of Johannesburg Johannesburg South Africa
| | - Derek Ndinteh
- Department of Chemical Sciences, Faculty of Science, University of Johannesburg Johannesburg South Africa
| | | | - Opeopluwa Oyehan Oyedeji
- Department of Chemistry, Faculty of Science and Agriculture, University of Fort Hare PBX1314 Alice Eastern Cape Province 5700 South Africa
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Intracranial Atherosclerosis and Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline. Am J Hypertens 2020; 33:92-98. [PMID: 31433051 DOI: 10.1093/ajh/hpz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new, stricter definition of stage 1 hypertension which was previously considered prehypertension. However, impacts of the novel stage 1 hypertension on deleterious target-organ outcomes are still controversial. In this study, we evaluated the relationship between this newly defined stage 1 hypertension and the presence of intracranial atherosclerosis (ICAS) lesions in neurologically healthy participants. METHODS We assessed consecutive participants in routine health checkups between January 2006 and December 2013. Blood pressure (BP) was classified according to the 2017 ACC/AHA hypertension guideline, and ICAS was defined as occlusion or ≥50% stenosis of intracranial vessels on flight magnetic resonance angiography. RESULTS Among 3,111 healthy participants (mean age: 56 years, sex: 54% men), 85 (3%) had ICAS lesions. In multivariate analysis, stage 1 hypertension (adjusted odds ratio: 2.46, 95% confidence interval: 1.10-5.51, P = 0.029) remained an independent predictor of ICAS after adjustment for confounders. Stage 2 hypertension showed a higher odds ratio and a lower P value, indicating a dose-response effect. Age and HbA1c level were also significantly associated with ICAS, independent of the BP categories. The ICAS lesion burden showed a dose-response effect across the BP categories (P for trend <0.001), whereas ICAS lesion location did not (P for trend = 0.699). CONCLUSIONS We demonstrated that stage 1 hypertension, defined according to the 2017 ACC/AHA guideline, was associated with a higher prevalence and burden of ICAS lesions in a neurologically healthy population.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
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Affiliation(s)
- O M P Jolobe
- From the, Manchester Medical Society, Manchester, UK
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18
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1866] [Impact Index Per Article: 373.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
The Systolic Blood Pressure Intervention Trial is the first large prospective randomized controlled trial to demonstrate the benefit of an intensive systolic blood pressure (SBP) treatment target (<120 mm Hg) compared to a standard target (<140 mm Hg) in reducing cardiovascular morbidity and mortality and all-cause mortality in high-risk hypertensive patients. The impact of SPRINT on hypertension treatment has been large, but major questions remain about the feasibility of achieving the SPRINT intensive SBP target in routine practice, the generalizability of the SPRINT findings to hypertensive populations that were excluded from the trial, and the cost effectiveness of adopting the SPRINT intensive treatment goal. In this review, we discuss the generalizability of SPRINT data to the general population of adults with hypertension and with various comorbidities, the cost effectiveness of intensive SBP-lowering therapy, and the implications of SPRINT for future hypertension guideline development and clinical practice.
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Affiliation(s)
- Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455;
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama 35294;
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Rastogi A, Ameen KM, Al-Baghdadi M, Shaffer K, Nobakht N, Kamgar M, Lerma EV. Autosomal dominant polycystic kidney disease: updated perspectives. Ther Clin Risk Manag 2019; 15:1041-1052. [PMID: 31692482 PMCID: PMC6716585 DOI: 10.2147/tcrm.s196244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited multisystem disorder, characterized by renal and extra-renal fluid-filled cyst formation and increased kidney volume that eventually leads to end-stage renal disease. ADPKD is considered the fourth leading cause of end-stage renal disease in the United States and globally. Care of patients with ADPKD was, for a long time, limited to supportive lifestyle measures, due to the lack of therapeutic strategies targeting the main pathways involved in the pathophysiology of ADPKD. As the first FDA approved treatment of ADPKD, Vasopressin (V2) receptor blocking agent, tolvaptan, is an urgently awaited advance for ADPKD patients. In our review, we also shed some lights on what is beyond Tolvaptan as there are other medications in the pipeline and many medications have been or are currently being studied in clinical trials such as Tesevatinib, Metformin and Pravastatin, with the goal of slowing the rate of progression of ADPKD by reducing the increase in total kidney volume or maintaining eGFR. Here, we review updates in the perspectives and management of ADPKD.
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Affiliation(s)
- Anjay Rastogi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Khalid Mohammed Ameen
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Maha Al-Baghdadi
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kelly Shaffer
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Niloofar Nobakht
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mohammad Kamgar
- Department of Medicine, Division of Nephrology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Edgar V Lerma
- Department of Medicine, Divison of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Section of Nephrology, Oak Lawn, IL, USA
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Çoner A, Gençtoy G, Akinci S, Altin C, Müderrisoğlu H. Assessment of vascular inflammation and subclinical nephropathy in exaggerated blood pressure response to exercise test. Blood Press Monit 2019; 24:114-9. [DOI: 10.1097/mbp.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Brandi M Wynne
- 3 Renal Division Department of Medicine School of Medicine Emory University Atlanta GA
| | - Hana A Itani
- 1 Department of Pharmacology and Toxicology Faculty of Medicine American University of Beirut Lebanon.,2 Vanderbilt University Medical Center Nashville TN
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Polonia J, Baptista C, Silva J, Barbosa L. Unattended versus two attended, ambulatory and central blood pressure measurements in hypertensive patients with and without diabetes. Blood Press 2019; 28:99-106. [DOI: 10.1080/08037051.2019.1568184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jorge Polonia
- Department Medicine/Cintesis Faculty Medicine, Porto, Portugal
| | | | - Jose Silva
- Hypertension Unit/ULS Matosinhos EPE, Matosinhos, Portugal
| | - Loide Barbosa
- Hypertension Unit/ULS Matosinhos EPE, Matosinhos, Portugal
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Sackner MA, Patel S, Adams JA. Changes of blood pressure following initiation of physical inactivity and after external addition of pulses to circulation. Eur J Appl Physiol 2018; 119:201-211. [PMID: 30350153 PMCID: PMC6342894 DOI: 10.1007/s00421-018-4016-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine whether an innovative, motorized, wellness device that effortlessly produces physical activity (JD) can mitigate the hypertensive effects of prolonged sitting or lying down. METHODS Twenty-two normotensive and hypertensive adults of both genders gave informed consent to participate in a randomized controlled crossover study of a passive simulated jogging device (JD) in both supine and seated postures. Each study participant was monitored with a continuous non-invasive arterial pressure monitoring device (CNAP) over 60 min. The initial 10 min served as baseline for each posture. The subjects were randomized to begin with either JD or SHAM control for 30 min, and monitoring was continued for an additional 10 min in one posture; three days later posture and order of JD or SHAM were changed. RESULTS In both seated and supine postures, SHAM was associated with a significant rise in blood pressure (BP) which was observed within 5-10 min; it continued to rise or remain elevated for over a 40-min observation period. In contrast, JD produced a significant decrease in both systolic and diastolic blood pressure in both postures. During recovery in seated posture JD decreased systolic and diastolic BP by - 8.1 and - 7.6 mmHg, respectively. In supine posture, a similar decrease in BP occurred. CONCLUSIONS There is rapid onset of increase in systolic and diastolic BP with physical inactivity in both supine and seated postures. Administration of JD significantly decreased BP in both postures. Further studies are needed to assess long-term effectiveness.
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Affiliation(s)
- Marvin A Sackner
- Emeritus Director of Medical Services, Mt Sinai Medical Center of Greater Miami, Miami Beach, FL, USA
| | | | - Jose A Adams
- Division Neonatology, Mt Sinai Medical Center of Greater Miami, Miami Beach, FL, USA.
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Sun X, Guo Y, Nie Z, Cheng J, Zhou H, Zhong X, Zhang S, Du Z, Zhuang X, Liao X. Influence of baseline systolic blood pressure on the relationship between intensive blood pressure control and cardiovascular outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Res Cardiol 2019; 108:273-81. [DOI: 10.1007/s00392-018-1353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Russo G, Liguori I, Aran L, Bulli G, Curcio F, Galizia G, Gargiulo G, Testa G, Ungar A, Cacciatore F, Bonaduce D, Abete P. Impact of SPRINT results on hypertension guidelines: implications for "frail" elderly patients. J Hum Hypertens 2018; 32:633-638. [PMID: 29991704 DOI: 10.1038/s41371-018-0086-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 12/20/2022]
Abstract
In the last years, guidelines for the treatment of hypertension recommended individualized blood pressure goals for geriatric population because of elderly susceptibility to adverse outcomes and higher mortality rate deriving from the excessive blood pressure lowering, especially in "frail" elderly. Recent findings from the SPRINT study, which demonstrated that intensive blood pressure lowering was associated with lower rates of cardiovascular events and mortality in both hypertensive fit and frail elderly subjects compared to standard treatment, heavily influenced the recent US guidelines. In SPRINT sub-study analysis of adults aged ≥75 years, the most controversial issue appears the method of blood pressure measurement, the selection of patients and related-frailty degree that appears to be very light. Accordingly, it has been described that light frailty is related to good outcomes in older adults. SPRINT findings in "frail elderly patients" cannot be applied to the clinical practice because this condition has been clearly under-estimated. Thus, frailty status should be routinely and correctly quantified in order to identify the frailty degree and to find the best harms-benefits balance of antihypertensive drug treatment in frail older adults.
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Affiliation(s)
- Gennaro Russo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luisa Aran
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giulia Bulli
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianluigi Galizia
- Istituti Clinici Scientifici Maugeri- Syncope unit - UOC Cure sub-acute, Milan, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Andrea Ungar
- Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Azienda Ospedaliera dei Colli, Monaldi Hospital, Heart Transplantation Unit, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
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Papadopoulou E, Angeloudi E, Karras S, Sarafidis P. The optimal blood pressure target in diabetes mellitus: a quest coming to an end? J Hum Hypertens 2018; 32:641-50. [DOI: 10.1038/s41371-018-0079-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023]
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Sörelius K, Wanhainen A. Challenging Current Conservative Management of Uncomplicated Acute Type B Aortic Dissections. EJVES Short Rep 2018; 39:37-39. [PMID: 29988823 PMCID: PMC6031758 DOI: 10.1016/j.ejvssr.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Despite weak evidence, current treatment guidelines for uncomplicated acute type B aortic dissection (uATBAD) consistently recommend intensive and rapid lowering of systolic blood pressure and heart rate. Report The case of a 62 year old man with uATBAD, who was treated according to guidelines, is presented. Owing to an unknown chronic occlusion of the left carotid artery combined with intensive hypotensive treatment, the patient developed a cerebral infarct. Discussion The case illustrates a severe complication of the widely accepted management of uATBAD. This case, along with scrutiny of guidelines and the evidence behind these guidelines, provoke questions regarding the rationale of current conservative management, and whether it should be challenged with alternative strategies employing a more cautious blood pressure regimen. It also highlights the importance of evaluating the vessels of the supra-aortic trunk when determining the extent of the dissection.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Abstract
PURPOSE OF REVIEW The optimal blood pressure (BP) goal during treatment of hypertension has been controversial. In this report, recent articles that elaborate on this issue are reviewed. RECENT FINDINGS Results from the Systolic Blood Pressure Intervention Trial (SPRINT) have suggested substantial benefits from more intensive BP lowering than is recommended in current US BP management guidelines. SUMMARY Increasing evidence suggests that intensive BP lowering provides a cost-effective means to improve health in many adults with high BP. SPRINT provides the most convincing confirmation, but experience in other trials, alone and in pooled analyses augments and broadens the evidence base to patient groups who were not included in SPRINT. Implementation trials to document feasibility and effectiveness of SPRINT-like interventions in routine practice, including in resource-constrained settings, are warranted.
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Jones LM, Veinot T, Pressler SJ, Coleman-Burns P, McCall A. Exploring Predictors of Information Use to Self-Manage Blood Pressure in Midwestern African American Women with Hypertension. J Immigr Minor Health 2018; 20:569-576. [PMID: 28382426 PMCID: PMC5628088 DOI: 10.1007/s10903-017-0573-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Self-management of hypertension requires patients to find, understand, and use information to lower their blood pressure. Little is known about information use among African American women with hypertension, therefore the purpose of this study was to examine predictors of self-reported information use to self-manage blood pressure. Ninety-four Midwestern African American women (mean age = 59) completed questionnaires about information behaviors (seeking, sharing, use) and personal beliefs (attitude, social norms) related to self-management of blood pressure. Linear regression was used to identify significant predictors of information use. The total variance explained by the model was 36%, F(7, 79) = 6.29, p < .001. Information sharing was the only significant predictor (beta = .46, p < .001). These results provide evidence that information sharing is a potential health behavior to support intervention strategies for African American women with hypertension.
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Affiliation(s)
- Lenette M Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Foy CG, Lovato LC, Vitolins MZ, Bates JT, Campbell R, Cushman WC, Glasser SP, Gillespie A, Kostis WJ, Krousel-Wood M, Muhlestein JB, Oparil S, Osei K, Pisoni R, Segal MS, Wiggers A, Johnson KC. Gender, blood pressure, and cardiovascular and renal outcomes in adults with hypertension from the Systolic Blood Pressure Intervention Trial. J Hypertens 2018; 36:904-915. [PMID: 29493562 PMCID: PMC7199892 DOI: 10.1097/hjh.0000000000001619] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender. METHODS Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed. RESULTS Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was reduced by 16% [hazard ratio 0.84 (0.61-1.13)] in women, and by 27% in men [hazard ratio 0.73 (0.59-0.89), P value for interaction between treatment and gender is 0.45]. Similarly, the effect of the intensive treatment on individual components of the primary composite outcome, renal outcomes, and overall serious adverse events was not significantly different according to gender. CONCLUSION In adults with hypertension but not with diabetes, treatment to a systolic blood pressure goal of less than 120 mmHg, compared with a goal of less than 140 mmHg, resulted in no heterogeneity of effect between men and women on cardiovascular or renal outcomes, or on rates of serious adverse events.ClinicalTrials.gov number, NCT01206062.
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Affiliation(s)
- Capri G. Foy
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina
| | - Laura C. Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Winston-Salem, North Carolina
| | - Mara Z. Vitolins
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeffrey T. Bates
- Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas
| | - Ruth Campbell
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - William C. Cushman
- Veterans Affairs Medical Center, Preventive Medicine Section, Medical Service, Memphis, Tennessee
| | - Stephen P. Glasser
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - William J. Kostis
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Marie Krousel-Wood
- Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University, New Orleans, Louisiana
| | - Joseph B. Muhlestein
- Intermountain Medical Center Heart Institute, Murray
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Kwame Osei
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Medical Center, Columbus, Ohio
| | - Roberto Pisoni
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainsville, Florida
| | - Alan Wiggers
- Cleveland Medical Center, UH Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Dungan K, Craven TE, Soe K, Wright JT, Basile J, Haley WE, Kressin NR, Rani U, Tamariz L, Whittle J, Wiggers A, Osei K. Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort. Diabetes Obes Metab 2018; 20:629-637. [PMID: 29024310 PMCID: PMC5812782 DOI: 10.1111/dom.13127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 01/06/2023]
Abstract
AIMS To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. METHODS We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120 mm Hg (intensive group, N = 4544) or an SBP target of <140 mm Hg (standard group, N = 4553). The median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. RESULTS Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3 ± 5.6 vs 33.0 ± 5.3 kg/m2 ; P < .01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction = .98). Similarly, there was no evidence of treatment × MetS subgroup interaction for all-cause mortality (adjusted interaction P value = .98). The findings were also similar across race/ethnic subgroups. CONCLUSIONS In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.
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Affiliation(s)
- Kathleen Dungan
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, Ohio
| | - Timothy E Craven
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kyaw Soe
- Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas
- Division of Population Health and Computational Medicine, University of Miami and Geriatric Research and Education Clinical Center, Miami
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jan Basile
- Division of General Internal Medicine, Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Charleston, South Carolina
| | - William E Haley
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida
| | - Nancy R Kressin
- VA Boston Healthcare System; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Uzma Rani
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Leonardo Tamariz
- Division of Population Health and Computational Medicine, University of Miami and Geriatric Research and Education Clinical Center, Miami, Florida
| | - Jeff Whittle
- Division of Primary Care, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Alan Wiggers
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland campus, Cleveland, Ohio
| | - Kwame Osei
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, Ohio
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Dargad RR, Prajapati MR, Dargad RR, Parekh JD. Sacubitril/valsartan: A novel angiotensin receptor-neprilysin inhibitor. Indian Heart J 2018; 70 Suppl 1:S102-10. [PMID: 30122239 DOI: 10.1016/j.ihj.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/18/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe the efficacy, superiority and safety profile of the first-in-class angiotensin receptor-neprilysin inhibitor "Sacubitril/Valsartan" as compared to angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blocker (ARB) in heart failure (HF) patients, reviewing data available from both clinical and pre-clinical studies. Evidences on health care utilization outcomes such as hospitalizations and emergency department visits were also evaluated. MATERIAL (DATA SOURCE) Sources: Medical literature on 'Sacubitril/Valsartan' and 'Angiotensin Receptor-Neprilysin Inhibitor' was identified by searching databases (including, but not limited to, PubMed, Embase and HighWire) for articles published since 1991, bibliographies from published literature, clinical trial registries/databases and websites (including those of regional regulatory agencies and the manufacturer). Additional information (including contributory unpublished data) was also requested from the companies developing the drug. SEARCH STRATEGY We conducted separate searches for each of the interventions of interest. The timeframe for both searches spanned the period from January 1991 to the most recently published data available and focused on PubMed, Embase and HighWire indexed articles. The search strategies included a combination of indexing terms as well as free-text terms included separately in 'Keywords' section. To supplement the above searches and ensure optimal and complete literature retrieval, we performed a manual check of the references of recent relevant reviews and meta-analysis. Searches were last updated on 12th July 2017. SELECTION Studies in patients with hypertension who received sacubitril/valsartan combination drug were included. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well-controlled trials with appropriate statistical methodology was preferred. Relevant pharmacodynamics and pharmacokinetics data was also included. DATA EVALUATION Many clinical trials have been conducted comparing the efficacy of sacubitril/valsartan with other anti-hypertensives. The trials have shown sacubitril/valsartan to be more effective in improving symptoms and physical limitations, reducing the risk of cardiovascular (CV) death, HF hospitalization, and the overall mortality and morbidity compared to its counterparts. CONCLUSION Effective reduction of blood pressure to accepted goals is the key to reduce the risk of CV events and stroke. Dual inhibition of neprilysin and the angiotensin receptor with sacubitril/valsartan may represent an attractive and serendipitous therapeutic approach for a range of CV diseases, including hypertension and HF, in which vasoconstriction, volume overload and neuro-hormonal activation play a part in pathophysiology. Sacubitril/Valsartan appears to be more efficacious in reducing blood pressure than currently available ACEi and ARBs with a similar safety and tolerability profile. Besides, pleiotropic benefits like HbA1c reduction, better eGFR progression and a greater decrease in blood pressure and serum creatinine levels make this drug a novel addition to the current hypertension armamentarium.
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Brunström M, Carlberg B. SPRINT in context: meta-analysis of trials with baseline normotension and low levels of previous cardiovascular disease. J Hypertens 2018; 36:979-86. [PMID: 29300245 DOI: 10.1097/HJH.0000000000001663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of antihypertensive treatment in trials with baseline normotension and low levels of previous cardiovascular disease. To test if the results from SPRINT are compatible with those from other trials, and test the impact of SPRINT results on overall effect estimates. METHODS Systematic review and meta-analysis of randomized controlled trials with at least 1000 patient-years of follow-up, comparing antihypertensive treatment versus placebo, or different blood pressure goals against each other. Trials with at least 50% previous cardiovascular disease were excluded. RESULTS Sixteen trials, including 66 816 participants, were included in the meta-analyses. Mean baseline SBP was 138 mmHg, and mean difference between treatment arms was 5.5 mmHg. Antihypertensive treatment was associated with a neutral effect on all-cause mortality [relative risk 0.98, 95% confidence interval (CI) 0.92-1.05] and major cardiovascular events (0.97, 0.91-1.03). Results from SPRINT differed significantly from those of other trials (P = 0.012 for all-cause mortality; P = 0.016 for major cardiovascular events), but overall effect estimates were similar when SPRINT was excluded (1.01, 0.95-1.06 for all-cause mortality; 0.98, 0.93-1.03 for major cardiovascular events). Treatment was associated with reduced risk of secondary outcomes stroke (0.84, 0.71-1.00) and heart failure (0.88, 0.78-0.98), although heterogeneity was high in the stroke analysis (I = 54%). CONCLUSION SPRINT results are not representative for trials with baseline normotension and low levels of previous cardiovascular disease. Antihypertensive treatment does not protect against death or major cardiovascular events in this setting.
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Tilea I, Petra D, Voidazan S, Ardeleanu E, Varga A. Treatment adherence among adult hypertensive patients: a cross-sectional retrospective study in primary care in Romania. Patient Prefer Adherence 2018; 12:625-635. [PMID: 29731610 PMCID: PMC5923249 DOI: 10.2147/ppa.s162965] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. PATIENTS AND METHODS A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. RESULTS The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found (p = 0.01) between low adherence and male gender. A significant positive association (p = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated with high adherence to therapy (p = 0.03). Antihypertensive regimens administered as fixed-dose combinations were positively associated with high adherence (p = 0.001). Subjects who had their antihypertensive regimen adjusted to a new drug class during the study period showed enhanced adherence compared to subjects treated with an unchanged regimen (p = 0.001). CONCLUSION This is the first published study assessing adherence to antihypertensive therapy in family medicine practice in Romania. It presented data derived from a primarily urban setting and targeted a geographical area where the prevalence of hypertension has increased continuously. Female gender, age, presence of cardiovascular risk factors, defined cardiovascular disease, chronic renal impairment, and good control of hypertension were positively associated with high adherence. The results provide insights to guide further strategies to improve adherence and indirect methods for blood pressure management strategies.
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Affiliation(s)
- Ioan Tilea
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Dorina Petra
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
- Correspondence: Dorina Petra, Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, 38, Gheorghe Marinescu Street, Tirgu Mures 540319, Mures, Romania, Tel +40 740 19 4122, Fax +40 265 21 1011, Email
| | - Septimiu Voidazan
- Department M2-Functional and Complementary Sciences, Epidemiology Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
| | - Elena Ardeleanu
- Department XVI-Balneology, Medical Rehabilitation and Rheumatology, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Timisoara, Timis, Romania
| | - Andreea Varga
- Department M3-Internal Medicine, Family Medicine Discipline, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Mures, Romania
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Abstract
OBJECTIVES To assess the incremental effects of adding extra antihypertensive drugs from a new class to a patient's regimen. DESIGN Instrumental variable analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). To account for confounding by indication-when treatments seem less effective if they are administered to sicker patients-randomization status was used as the instrumental variable. Patients' randomization status was either intensive (systolic blood pressure target <120 mm Hg) or standard (systolic blood pressure target <140 mm Hg) treatment. Results from instrumental variable models were compared with those from standard multivariable models. SETTING Secondary data analysis of a randomized clinical trial conducted at 102 sites in 2010-15. PARTICIPANTS 9092 SPRINT participants with hypertension and increased cardiovascular risk but no history of diabetes or stroke. MAIN OUTCOMES MEASURES Systolic blood pressure, major cardiovascular events, and serious adverse events. RESULTS In standard multivariable models not adjusted for confounding by indication, addition of an antihypertensive drug from a new class was associated with modestly lower systolic blood pressure (-1.3 mm Hg, 95% confidence interval -1.6 to -1.0) and no change in major cardiovascular events (absolute risk of events per 1000 patient years, 0.5, 95% confidence interval -1.5 to 2.3). In instrumental variable models, the addition of an antihypertensive drug from a new class led to clinically important reductions in systolic blood pressure (-14.4 mm Hg, -15.6 to -13.3) and fewer major cardiovascular events (absolute risk -6.2, -10.9 to -1.3). Incremental reductions in systolic blood pressure remained large and similar in magnitude for patients already taking drugs from zero, one, two, or three or more drug classes. This finding was consistent across all subgroups of patients. The addition of another antihypertensive drug class was not associated with adverse events in either standard or instrumental variable models. CONCLUSIONS After adjustment for confounding by indication, the addition of a new antihypertensive drug class led to large reductions in systolic blood pressure and major cardiovascular events among patients at high risk for cardiovascular events but without diabetes. Effects on systolic blood pressure persisted across all levels of baseline drug use and all subgroups of patients.
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Affiliation(s)
- Adam A Markovitz
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Center for Evaluating Health Reform, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jacob A Mack
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John Z Ayanian
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Gerald R Ford School of Public Policy, Ann Arbor, MI, USA
| | - Andrew M Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan Center for Evaluating Health Reform, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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Jones LM, Rosemberg MAS, Wright KD. Opportunities for the Advanced Practice Nurse to Enhance Hypertension Knowledge and Self-management Among African American Women. CLIN NURSE SPEC 2017; 31:311-318. [PMID: 28991014 PMCID: PMC5679274 DOI: 10.1097/nur.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women. DESIGN A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge. METHODS African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured. RESULTS Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure. CONCLUSION Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.
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Affiliation(s)
- Lenette M Jones
- Author Affiliations: Assistant Professor (Dr Jones), Department of Health Behavior and Biological Sciences and Assistant Professor (Dr Rosemberg), Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor; and Assistant Professor (Dr Wright), the Ohio State University College of Nursing, Columbus
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39
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Abstract
Hypertension management is one of the most common clinical tasks in the care of patients with chronic kidney disease (CKD). Elevated blood pressure (BP) is associated with greater risk of all-cause mortality, cardiovascular (CV) disease, and CKD progression in this population. However, it is still debated, to what target(s) BP should be lowered in patients with signs of kidney damage. The Systolic Blood Pressure Intervention Trial (SPRINT) provided new and important information about the effects of lowering systolic BP to a target of <120 mmHg, which is lower than the levels currently recommended by the most guidelines (<140/90 mmHg). The SPRINT results were not only exciting but also surprising for many clinicians because evidence from well-conducted observational studies in CKD patient showed increased mortality in patients with CKD whose office systolic BP levels were <120 mmHg, as compared with systolic BP in 120-139 mmHg range. In the present review, we will discuss whether a systolic BP goal of <120 mmHg that was found to be beneficial for CV and all-cause mortality outcomes in the SPRINT can be generalized to the entire CKD population.
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Affiliation(s)
- Elvira O Gosmanova
- Nephrology Division, Department of Medicine, Albany Medical College, Albany, NY, USA.,Nephrology Section, Stratton VA Medical Center, Albany, NY, USA
| | - Csaba P Kovesdy
- Nephrology Division, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. .,Nephrology Section, Memphis VA Medical Center, 1030 Jefferson Ave., Memphis, TN, 38104, USA.
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Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, Document Reviewers, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tuñón J, Vega de Ceniga M, Windecker S, Zamorano JL. Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:305-68. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 645] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension-related organ damage. In an era of precision medicine, additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review, we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension-associated vascular dementia.
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Affiliation(s)
- Gemma Currie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK.
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43
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Abstract
In patients with diabetes mellitus, the presence of hypertension substantially increases the risk of cardiovascular events, and reductions in blood pressure (BP) can reduce cardiovascular morbidity and mortality. Following evidence from trials randomizing patients to diastolic BP levels, previous guidelines recommended an office BP target of <130/80 mmHg in individuals with diabetes mellitus. However, the evidence for this systolic BP (SBP) target was derived from observational studies. When the results of the ACCORD-BP study showed that those individuals with diabetes mellitus and a target BP of <120 mmHg had a cardiovascular risk that is similar to those with <140 mmHg, all guidelines returned to a recommended SBP of <140 mmHg. However, the ACCORD-BP trial was limited by the low number of cardiovascular events observed, whereas the mean SBP in the 'conventional' arm was 133 mmHg. The SPRINT study, showing cardiovascular benefits in hypertensive patients without diabetes mellitus randomized to SBP <120 mmHg versus those randomized to <140 mmHg, came in contrast with the ACCORD-BP, but a detailed evaluation reveals many similarities between the two trials. Finally, the EMPA-REG OUTCOME study, with impressive cardiovascular mortality reduction with empagliflozin, suggested that reduction of SBP to around 130 mmHg is safe and might explain part of these beneficial results. In this Review, we evaluate the implications of the ACCORD-BP, SPRINT and EMPA-REG OUTCOME trials and previous studies for the optimal BP target in diabetes mellitus.
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Affiliation(s)
- Pantelis A Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital
| | - Antonios A Lazaridis
- 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
- Department of Internal Medicine, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Gema Ruiz-Hurtado
- Institute of Investigation and Hypertension Unit, Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Luis M Ruilope
- Institute of Investigation and Hypertension Unit, Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Autonoma, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
- School of Doctoral Studies and Research, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Madrid, Spain
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Tyson CC, Coffman TM. In the Wake of Systolic Blood Pressure Intervention Trial: New Targets for Improving Hypertension Management in Chronic Kidney Disease? Nephron Clin Pract 2017; 135:287-290. [PMID: 28161697 DOI: 10.1159/000455130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/12/2016] [Indexed: 01/13/2023] Open
Abstract
Systolic Blood Pressure Intervention Trial (SPRINT) was a multicenter randomized controlled trial showing the significant benefit of intensive reduction of blood pressure to a target of 120 mm Hg in individuals with hypertension and elevated cardiovascular risk. Because SPRINT includes the largest cohort of adults with chronic kidney disease (CKD) to be prospectively studied in a hypertension intervention trial, it has particular relevance to the field of nephrology. Here, we review the findings of SPRINT and assess their potential impact on guidelines for treatment of hypertension in patients with CKD. We believe that the data from SPRINT will support a recommendation for lowering blood pressure targets to 120 mm Hg in a substantial segment of adults with CKD.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Abstract
Hypertension, or high blood pressure, is a prevalent yet modifiable risk factor for cardiovascular disease. While there are many effective treatments available to combat hypertension, patients often require at least two to three medications to control blood pressure, although there are patients who are resistant to such therapies. This short review will briefly update on recent clinical advances and potential emerging therapies and is intended for a cross-disciplinary readership.
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Affiliation(s)
- Andrew J. Freeman
- Department of Pharmacology and Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Antony Vinh
- Department of Pharmacology and Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Robert E. Widdop
- Department of Pharmacology and Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
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Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, New York Medical College, Valhalla, NY, USA
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de la Sierra A, Banegas JR, Divisón JA, Gorostidi M, Vinyoles E, de la Cruz JJ, Segura J, Ruilope LM. Ambulatory blood pressure in hypertensive patients with inclusion criteria for the SPRINT trial. ACTA ACUST UNITED AC 2016; 10:947-953.e5. [PMID: 27865822 DOI: 10.1016/j.jash.2016.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
We aimed to characterize 24-hour blood pressure (BP) values and categories in patients with inclusion/exclusion criteria of the Systolic Blood Pressure Intervention (SPRINT) trial from the Spanish ABPM Registry. We selected patients older than 50 years, with office systolic BP (SBP) above 130 mm Hg and at high cardiovascular risk, but without diabetes, previous stroke, or symptomatic heart failure. Ambulatory BP was compared among BP categories. A total of 39,132 patients (34%) fulfilled inclusion criteria of SPRINT trial. Ambulatory SBP was considerably lower than office BP, with 42% of patients having daytime values below 130 mm Hg and 21% 24-hour values below 120 mm Hg. In conclusion, more than one-third of the hypertensive population included in the Spanish ABPM Registry can be considered as SPRINT candidates, although one out of five have values of 24-hour SBP below 120 mm Hg. These data suggest that knowledge of ABPM values could be helpful when planning a treatment intensification in high-risk patients.
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Affiliation(s)
- Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain.
| | - José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid;IdiPAZ/CIBERESP, Madrid, Spain
| | | | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Juan J de la Cruz
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid;IdiPAZ/CIBERESP, Madrid, Spain
| | - Julián Segura
- Department of Nephrology, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Luis M Ruilope
- Department of Nephrology, Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain
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Abstract
Background Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care. Methods and Results Using the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time. Conclusions US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.
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Affiliation(s)
- Lin Mu
- Yale School of Medicine, New Haven, CT
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA Harvard Medical School, Boston, MA
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Abstract
Blood pressure is a major determinant of cardiovascular risk. Blood pressure target to reach with antihypertensive therapy, and the population to whom it should apply, remain debatted. Blood pressure goals established by scientific societies may be revised after the publication of the US multicenter SPRINT study results (Systolic Blood Pressure Intervention Trial) obtained in 2015. Analysis of the generalizability of the SPRINT results shows that they may not be directly applied to the french population which is at lower risk than the US population and would have major medical and economic implications.
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Affiliation(s)
- Anne-Laure Faucon
- Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris Paris, France ; Centre d'investigation clinique (CIC 1418), Hôpital Européen Georges Pompidou, AP-HP, Paris, 20, rue Leblanc, 75015 Paris France ; Université Paris-Descartes, Paris, France
| | - Anne-Marie Madjalian
- Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris Paris, France ; Centre d'investigation clinique (CIC 1418), Hôpital Européen Georges Pompidou, AP-HP, Paris, 20, rue Leblanc, 75015 Paris France ; Université Paris-Descartes, Paris, France
| | - Guillaume Bobrie
- Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris Paris, France ; Centre d'investigation clinique (CIC 1418), Hôpital Européen Georges Pompidou, AP-HP, Paris, 20, rue Leblanc, 75015 Paris France ; Université Paris-Descartes, Paris, France
| | - Laurence Amar
- Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris Paris, France ; Centre d'investigation clinique (CIC 1418), Hôpital Européen Georges Pompidou, AP-HP, Paris, 20, rue Leblanc, 75015 Paris France ; Université Paris-Descartes, Paris, France
| | - Michel Azizi
- Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris Paris, France ; Centre d'investigation clinique (CIC 1418), Hôpital Européen Georges Pompidou, AP-HP, Paris, 20, rue Leblanc, 75015 Paris France ; Université Paris-Descartes, Paris, France
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Myers MG, Kaczorowski J, Dolovich L, Tu K, Paterson JM. Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement. Hypertension 2016; 68:866-72. [DOI: 10.1161/hypertensionaha.116.07721] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category. Based on 904 fatal and nonfatal cardiovascular events, the nadir of cardiovascular events was at the systolic pressure category of 110 to 119 mm Hg, which was lower than the next highest category of 120 to 129 mm Hg (hazard ratio 1.30 [1.01, 1.66]). The hazard ratio for diastolic pressure was relatively unchanged above 60 mm Hg. Pulse pressure exhibited an increase in hazard ratio (1.33 [1.02, 1.72]) at ≥80 mm Hg. These results using automated office BP measurement in a usual treatment setting extend the finding in SPRINT of an optimum target systolic BP of <120 mm Hg to routine clinical practice.
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Affiliation(s)
- Martin G. Myers
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network–Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM,
| | - Janusz Kaczorowski
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network–Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM,
| | - Lisa Dolovich
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network–Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM,
| | - Karen Tu
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network–Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM,
| | - J. Michael Paterson
- From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network–Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM,
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