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Sundström J, Lind L, Nowrouzi S, Hagström E, Held C, Lytsy P, Neal B, Marttala K, Östlund O. Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A Randomized Clinical Trial. JAMA 2023; 329:1160-1169. [PMID: 37039792 PMCID: PMC10091169 DOI: 10.1001/jama.2023.3322] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
Importance Hypertension is the leading risk factor for premature death worldwide. Multiple blood pressure-lowering therapies are available but the potential for maximizing benefit by personalized targeting of drug classes is unknown. Objective To investigate and quantify the potential for targeting specific drugs to specific individuals to maximize blood pressure effects. Design, Setting, and Participants A randomized, double-blind, repeated crossover trial in men and women with grade 1 hypertension at low risk for cardiovascular events at an outpatient research clinic in Sweden. Mixed-effects models were used to assess the extent to which individuals responded better to one treatment than another and to estimate the additional blood pressure lowering achievable by personalized treatment. Interventions Each participant was scheduled for treatment in random order with 4 different classes of blood pressure-lowering drugs (lisinopril [angiotensin-converting enzyme inhibitor], candesartan [angiotensin-receptor blocker], hydrochlorothiazide [thiazide], and amlodipine [calcium channel blocker]), with repeated treatments for 2 classes. Main Outcomes and Measures Ambulatory daytime systolic blood pressure, measured at the end of each treatment period. Results There were 1468 completed treatment periods (median length, 56 days) recorded in 270 of the 280 randomized participants (54% men; mean age, 64 years). The blood pressure response to different treatments varied considerably between individuals (P < .001), specifically for the choices of lisinopril vs hydrochlorothiazide, lisinopril vs amlodipine, candesartan vs hydrochlorothiazide, and candesartan vs amlodipine. Large differences were excluded for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine. On average, personalized treatment had the potential to provide an additional 4.4 mm Hg-lower systolic blood pressure. Conclusions and Relevance These data reveal substantial heterogeneity in blood pressure response to drug therapy for hypertension, findings that may have implications for personalized therapy. Trial Registration ClinicalTrials.gov Identifier: NCT02774460.
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Affiliation(s)
- Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Shamim Nowrouzi
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Lytsy
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kerstin Marttala
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Greco B, Chait Y, Nathanson BH, Germain MJ. A Novel Hypertension Management Algorithm Guided by Hemodynamic Data. Kidney Int Rep 2022; 7:330-333. [PMID: 35155873 PMCID: PMC8820980 DOI: 10.1016/j.ekir.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
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Wang Y, Wan EYF, Mak IL, Ho MK, Chin WY, Yu EYT, Lam CLK. The association between trajectories of risk factors and risk of cardiovascular disease or mortality among patients with diabetes or hypertension: A systematic review. PLoS One 2022; 17:e0262885. [PMID: 35085329 PMCID: PMC8794125 DOI: 10.1371/journal.pone.0262885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiometabolic risk factors and renal function are monitored regularly for patients with diabetes mellitus (DM)/ hypertension (HT). In addition to risk factor levels at a single time point, their trajectory (changes over time) can also be differentially related to the risk of cardiovascular diseases (CVD) and mortality. This study aimed to systematically examine the evidence regarding the association between risk factor trajectories and risk of CVD/mortality in patients with DM/HT. Method PubMed, MEDLINE, and Embase were searched for articles from January 1963 to April 2021. Inclusion criteria: studies that 1) analyzed trajectories of risk factors including haemoglobin A1c (HbA1c), blood pressure, estimated glomerular filtration rate (eGFR), body mass index (BMI), and blood lipids; 2) were performed in the DM/HT population and, 3) included risk of CVD/mortality as outcomes. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. Results A total of 22,099 articles were identified. After screening by title and abstract, 22,027 articles were excluded by irrelevant outcomes, exposure, population, or type of articles. Following full-text screening, 11 articles investigating the trajectories of HbA1c (N = 7), systolic blood pressure (SBP) (N = 3), and eGFR (N = 1) were included for data extraction and analysis. No studies were identified examining the association of BMI or lipid trajectories with CVD/mortality. All included studies were of good quality based on the NOS criteria. In general, stable trajectories within optimal ranges of the risk factors (HbA1c: <7%, SBP: 120-139mmHg, eGFR: >60mL/min/1.73m2) had the lowest CVD/mortality risk compared to an increasing HbA1c trajectory (from 8% to 10%), an increasing SBP trajectory (from 120–139 to ≥140mmHg), or a decreasing eGFR trajectory (from 90 to 70mL/min/1.73m2). Conclusion A relatively stable and well-controlled trajectory for cardiometabolic risk factors was associated with the lowest risk of CVD/mortality. Risk factor trajectories have important clinical implications in addition to single time point measurements. More attention should be given to patients with suboptimal control and those with unstable trends of cardiometabolic risk factors.
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Affiliation(s)
- Yuan Wang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- * E-mail:
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Margaret Kay Ho
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Guide de Pratique Clinique. Prise en charge de l’hypertension artérielle chez l’adulte en Tunisie. LA TUNISIE MÉDICALE 2021. [PMCID: PMC9003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ce document a été réalisé dans le cadre d'une collaboration entre l'Instance Nationale de l’Évaluation et de l'Accréditation en Santé (INEAS), la Société Tunisienne de Cardiologie et de Chirurgie Cardiovasculaire (STCCCV) et la Caisse Nationale d’Assurance Maladie (CNAM).
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Oh W, Steinbach MS, Castro MR, Peterson KA, Kumar V, Caraballo PJ, Simon GJ. A Computational Method for Learning Disease Trajectories From Partially Observable EHR Data. IEEE J Biomed Health Inform 2021; 25:2476-2486. [PMID: 34129510 PMCID: PMC8388183 DOI: 10.1109/jbhi.2021.3089441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diseases can show different courses of progression even when patients share the same risk factors. Recent studies have revealed that the use of trajectories, the order in which diseases manifest throughout life, can be predictive of the course of progression. In this study, we propose a novel computational method for learning disease trajectories from EHR data. The proposed method consists of three parts: first, we propose an algorithm for extracting trajectories from EHR data; second, three criteria for filtering trajectories; and third, a likelihood function for assessing the risk of developing a set of outcomes given a trajectory set. We applied our methods to extract a set of disease trajectories from Mayo Clinic EHR data and evaluated it internally based on log-likelihood, which can be interpreted as the trajectories' ability to explain the observed (partial) disease progressions. We then externally evaluated the trajectories on EHR data from an independent health system, M Health Fairview. The proposed algorithm extracted a comprehensive set of disease trajectories that can explain the observed outcomes substantially better than competing methods and the proposed filtering criteria selected a small subset of disease trajectories that are highly interpretable and suffered only a minimal (relative 5%) loss of the ability to explain disease progression in both the internal and external validation.
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Zhang H, Chai Y, Li Q, Han Q, Lv Z. Effects of fast-track anesthesia on miR-1 and neuropeptides in serum of patients undergoing cardiac surgery. Exp Ther Med 2020; 20:1480-1486. [PMID: 32742381 PMCID: PMC7388412 DOI: 10.3892/etm.2020.8823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Effects of fast-track anesthesia (FTA) on miR-1 and neuropeptides in serum of patients undergoing cardiac surgery were investigated. A total of 147 patients who underwent cardiac surgery at Jining No. 1 people's Hospital from August 2015 to July 2018 were selected. There were 72 patients who received the FTA technology during cardiac surgery in the intervention group, and 75 patients who received routine anesthesia during cardiac surgery in the control group. Venous blood was, respectively, collected before anesthesia (T0), 30 min after artery opening (T1), 60 min after artery opening (T2), and 180 min after artery opening (T3). Expression of serum miR-1 in patients at T0 to T3 were detected by real-time fluorescence quantitative PCR. Expression of neuropeptide indexes such as neuron-specific enolase (NSE), S100β protein (S100β), and amyloid β-protein (Aβ) in serum of patients in the two groups at T0 to T3 were detected by ELISA, and the correlation of expression of serum miR-1, serum NSE, S100β and Aβ was analyzed. There was no significant difference in the expression of serum miR-1 between the two groups at T0 (P>0.05). There was no significant difference in the expression of NSE, S100β and Aβ between the two groups at T0 (P>0.05). Expression of serum NSE, S100β and Aβ in both groups increased gradually, and expression of serum NSE, S100β and Aβ in the intervention group were significantly lower than those in the control group at T1-T3 (P<0.05). There was a positive correlation between expression of serum miR-1, serum NSE, S100β and Aβ (r=0.773, P<0.05; r=0.683, P<0.05; r=0.769, P<0.05). Application of the FTA technology in cardiac surgery can effectively reduce the level of serum miR-1 in patients undergoing surgical treatment and improve their neurological function.
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Affiliation(s)
- Hongxia Zhang
- Department of Anesthesiology, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Yongjian Chai
- Department of Anesthesiology, First People's Hospital of Jinan, Jinan, Shandong 250000, P.R. China
| | - Qinggang Li
- Medical Department, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Qingtao Han
- Interventional Vascular Diseases, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Zhenqian Lv
- Cardiac Surgery, Qingdao Fuwai Cardiovascular Disease Hospital, Qingdao, Shandong 266034, P.R. China
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Mahajan S, Gu J, Lu Y, Khera R, Spatz ES, Zhang M, Sun N, Zheng X, Zhao H, Lu H, Ma ZJ, Krumholz HM. Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance. Am J Med 2020; 133:e127-e139. [PMID: 31525336 DOI: 10.1016/j.amjmed.2019.08.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Blood pressure is a physiologic measure that reflects cardiac output and systemic vascular resistance. Classification by these components could be useful in characterizing subtypes of hypertension, which may have a role in selecting treatment strategies. However, hemodynamic phenotypes of a large, stable, outpatient population with hypertension remain unknown. METHODS We included 34,238 people with systolic blood pressure of ≥130 mm Hg, who underwent impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between 2012 and 2018. Hemodynamic parameters measured included stroke volume, stroke volume index, heart rate, cardiac output, cardiac index, systemic vascular resistance, and systemic vascular resistance index. We characterized these by systolic blood pressure categories and assessed patient characteristics associated with the ratio of cardiac index to systemic vascular resistance index. RESULTS Among the study cohort (n = 33,414; mean age 52 ± 13 years; 36.6% female), 49%, 40%, and 11% had systolic blood pressure130-139, 140-159, and ≥160 mm Hg, respectively. Among patients with systolic blood pressure 140-159 mm Hg, 9353 (70%) had high systemic vascular resistance index but normal/low cardiac index, 1949 (15%) had high cardiac index but low/normal systemic vascular resistance index, and 2053 (15%) had low/normal cardiac index and systemic vascular resistance index. Using multivariable analysis, we found that cardiac index to systemic vascular resistance index ratio was negatively associated with age and body mass index (all P <0.05; R-square 0.16, 0.12, and 0.09 for systolic blood pressure 130-139, 140-159 and ≥160 mm Hg, respectively). CONCLUSIONS Different hemodynamic blood pressure phenotypes were identified across all hypertensive blood pressure categories. Although individual characteristics were associated with the cardiac index to systemic vascular resistance index ratio, they only weakly explained the variation.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Jianlei Gu
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China; Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Shanghai, China
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - MaoZhen Zhang
- iKang Healthcare Group, Inc., Shanghai, China; Department of Cardiology, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - NingLing Sun
- Department of Hypertension at Heart Center, People's Hospital, Peking University, Beijing, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyu Zhao
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China; Department of Biostatistics, School of Public Health, Yale University, New Haven, Conn
| | - Hui Lu
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China; Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Zheng J Ma
- SJTU-Yale Joint Center for Biostatistics, School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai, China; Department of Biostatistics, School of Public Health, Yale University, New Haven, Conn; Beijing Li-Heng Medical Technologies, Ltd, Beijing, China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn.
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9
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Affiliation(s)
| | - Federico Rea
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Guido Grassi
- Department of Medicine and Surgery Clinica Medica (G.G.), University of Milano-Bicocca, Italy
- IRCCS Mutimedica, Sesto San Giovanni, Milan, Italy (G.G.)
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10
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The evidence on the 2018 ESC/ESH Guidelines for the management of arterial hypertension in African ancestry patients. J Hypertens 2019; 37:650-651. [PMID: 30702496 DOI: 10.1097/hjh.0000000000002024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Li T, Yang S, She X, Yan Q, Zhang P, Zhu H, Wang F, Luo X, Sun X. Modulation of α-adrenoceptor signalling protects photoreceptors after retinal detachment by inhibiting oxidative stress and inflammation. Br J Pharmacol 2019; 176:801-813. [PMID: 30588605 DOI: 10.1111/bph.14565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/20/2018] [Accepted: 11/29/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Currently available treatments do not halt progression of photoreceptor death and subsequent visual impairment related to retinal detachment (RD) which is observed in various retinal disorders. This study investigated the neuroprotective effects of two adrenoceptor ligands, the α1 -adrenoceptor antagonist doxazosin and the α2 -adrenoceptor agonist guanabenz, against photoreceptor cell death in RD. EXPERIMENTAL APPROACH We used a model of experimental RD in Brown-Norway rats induced by subretinal injection of sodium hyaluronate. Oxidative stress biomarkers and cytokine production were quantified with elisa. Protein expression levels and immunofluorescent labelling were determined in rats with RD and controls for mechanistic elucidation. The effects of systemic (i.p.) administration of doxazosin or guanabenz on photoreceptor apoptosis, retinal histology and electroretinography were evaluated in rats with RD and compared to the effects in vehicle controls. KEY RESULTS Photoreceptors were the major source of RD-induced ROS overproduction in the rat retina through the regulation of NADPH oxidase. Systemic administration of doxazosin or guanabenz decreased the RD-induced production of ROS and proinflammatory cytokines, including IL-1β and the chemokine CCL2, and suppressed retinal gliosis, resulting in attenuation of photoreceptor death and preservation of retinal structures and functions in RD. CONCLUSIONS AND IMPLICATIONS Our findings point to α-adrenoceptors as novel therapeutic targets to provide photoreceptor protection and suggest that both doxazosin and guanabenz, two FDA-approved drugs, could be further explored to treat retinal diseases.
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Affiliation(s)
- Tong Li
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiqi Yang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangjun She
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan Yan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengfei Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zhu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xueting Luo
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Shin SY, Lip GYH. Are Alpha-Adrenergic Receptor Antagonists Beneficial to Prevent Heart Failure?: Alpha-Adrenergic Receptor Antagonists Revisited. JACC. HEART FAILURE 2018; 6:926-927. [PMID: 30316937 DOI: 10.1016/j.jchf.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Seung Yong Shin
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiovascular and Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom.
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Huang C, Dhruva SS, Coppi AC, Warner F, Li SX, Lin H, Nasir K, Krumholz HM. Systolic Blood Pressure Response in SPRINT (Systolic Blood Pressure Intervention Trial) and ACCORD (Action to Control Cardiovascular Risk in Diabetes): A Possible Explanation for Discordant Trial Results. J Am Heart Assoc 2017; 6:JAHA.117.007509. [PMID: 29133522 PMCID: PMC5721802 DOI: 10.1161/jaha.117.007509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background SPRINT (Systolic Blood Pressure Intervention Trial) and the ACCORD (Action to Control Cardiovascular Risk in Diabetes) blood pressure trial used similar interventions but produced discordant results. We investigated whether differences in systolic blood pressure (SBP) response contributed to the discordant trial results. Methods and Results We evaluated the distributions of SBP response during the first year for the intensive and standard treatment groups of SPRINT and ACCORD using growth mixture models. We assessed whether significant differences existed between trials in the distributions of SBP achieved at 1 year and the treatment‐independent relationships of achieved SBP with risks of primary outcomes defined in each trial, heart failure, stroke, and all‐cause death. We examined whether visit‐to‐visit variability was associated with heterogeneous treatment effects. Among the included 9027 SPRINT and 4575 ACCORD participants, the difference in mean SBP achieved between treatment groups was 15.7 mm Hg in SPRINT and 14.2 mm Hg in ACCORD, but SPRINT had significantly less between‐group overlap in the achieved SBP (standard deviations of intensive and standard groups, respectively: 6.7 and 5.9 mm Hg in SPRINT versus 8.8 and 8.2 mm Hg in ACCORD; P<0.001). The relationship between achieved SBP and outcomes was consistent across trials except for stroke and all‐cause death. Higher visit‐to‐visit variability was more common in SPRINT but without treatment‐effect heterogeneity. Conclusions SPRINT and ACCORD had different degrees of separation in achieved SBP between treatment groups, even as they had similar mean differences. The greater between‐group overlap of achieved SBP may have contributed to the discordant trial results.
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Affiliation(s)
- Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Sanket S Dhruva
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Andreas C Coppi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Frederick Warner
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Khurram Nasir
- Center for Healthcare Advancement and Outcomes Research and Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT .,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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Elias MF, Torres RV. Delayed Response to Antihypertension Medication: A Harbinger of Stroke, Heart Failure, and Vascular Disease. Hypertension 2017; 70:30-31. [PMID: 28559395 DOI: 10.1161/hypertensionaha.117.09306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Merrill F Elias
- From the Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono (M.F.E.); and Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark (R.V.T.).
| | - Rachael V Torres
- From the Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono (M.F.E.); and Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark (R.V.T.)
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