1
|
Kern KC, Nasrallah IM, Bryan RN, Williamson J, Reboussin DM, Pajewski NM, Wright CB. Intensive Blood Pressure Treatment and Subclinical Brain Infarcts: A Secondary Analysis of SPRINT (Systolic Pressure Intervention Trial). Ann Neurol 2024; 95:866-875. [PMID: 38362733 PMCID: PMC11060925 DOI: 10.1002/ana.26892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/25/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Subclinical brain infarcts (SBI) increase the risk for stroke and dementia, but whether they should be considered equivalent to symptomatic stroke when determining blood pressure targets remains unclear. We tested whether intensive systolic blood pressure (SBP) treatment reduced the risk of new SBI or stroke and determined the association between SBI and cognitive impairment. METHODS In this secondary analysis of SPRINT (Systolic Pressure Intervention Trial), participants ≥50 years old, with SBP 130-180mmHg and elevated cardiovascular risk but without known clinical stroke, dementia, or diabetes, were randomized to intensive (<120mmHg) or standard (<140mmHg) SBP treatment. Brain magnetic resonance images collected at baseline and follow-up were read for SBI. The occurrence of mild cognitive impairment (MCI) or probable dementia (PD) was evaluated. RESULTS For 667 participants at baseline, SBI were identified in 75 (11%). At median 3.9 years follow-up, 12 of 457 had new SBI on magnetic resonance imaging (5 intensive, 7 standard), whereas 8 had clinical stroke (4 per group). Baseline SBI (subhazard ratio [sHR] = 3.90; 95% CI 1.49 to 10.24; p = 0.006), but not treatment group, was associated with new SBI or stroke. For participants with baseline SBI, intensive treatment reduced their risk for recurrent SBI or stroke (sHR = 0.050; 95% CI 0.0031 to 0.79; p = 0.033). Baseline SBI also increased risk for MCI or PD during follow-up (sHR = 2.38; 95% CI 1.23 to 4.61; p = 0.010). INTERPRETATION New cerebral ischemic events were infrequent, but intensive treatment mitigated the increased risk for participants with baseline SBI, indicating primary prevention SBP goals are still appropriate when SBI are present. ANN NEUROL 2024;95:866-875.
Collapse
Affiliation(s)
- Kyle C. Kern
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Ilya M. Nasrallah
- Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - R. Nick Bryan
- Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeff Williamson
- Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Clinton B. Wright
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
2
|
Petersen KS, Smith S, Lichtenstein AH, Matthan NR, Li Z, Sabate J, Rajaram S, Segovia-Siapco G, Reboussin DM, Kris-Etherton PM. One Avocado per Day as Part of Usual Intake Improves Diet Quality: Exploratory Results from a Randomized Controlled Trial. Curr Dev Nutr 2024; 8:102079. [PMID: 38375072 PMCID: PMC10875193 DOI: 10.1016/j.cdnut.2024.102079] [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: 10/27/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 02/21/2024] Open
Abstract
Background Few clinical trials have evaluated diet quality change as a predictor of intervention effectiveness. Objectives The aim of this study was to examine changes in the Healthy Eating Index (HEI)-2015 after a food-based intervention, and assess the associations between HEI-2015 change and intervention effects on cardiometabolic risk-related outcomes. Methods The Habitual Diet and Avocado Trial was a 26-wk, multicenter, randomized, controlled parallel-arm study. Participants were 1008 individuals aged ≥25 y with abdominal obesity (females ≥ 35 inches; males ≥ 40 inches). The avocado-supplemented diet group was provided 1 avocado per day, and the habitual diet group maintained their usual diet. Change in diet quality was assessed using the HEI-2015 from a single 24-h recall conducted at 4 time points. Mixed models were used for analysis. Results The avocado-supplemented diet group had a greater increase in the HEI-2015 (4.74 points; 95% CI: 2.93, 6.55) at 26 wk than the habitual diet group. Compared with the habitual diet group, the avocado-supplemented diet group had greater increases in the following HEI-2015 components from baseline: total vegetables (0.99 points; 95% CI: 0.77, 1.21), fatty acid ratio (2.25 points; 95% CI: 1.74, 2.77), sodium (1.03 points; 95% CI: 0.52, 1.55), refined grains (0.82 points; 95% CI: 0.32, 1.31), and added sugars (0.84 points; 95% CI: 0.49, 1.19). No differences in HEI-2015 improvements were observed by race, ethnicity, study site, body mass index, or age category. In the avocado-supplemented diet compared with the habitual diet group, the HEI-2015 increased in females (6.50 points; 95% CI: 4.39, 8.62) but not in males (0.02 points; 95% CI: -3.44, 3.48). Median HEI-2015 change was not associated with intervention-related changes in cardiometabolic disease risk factors. Conclusions Intake of 1 avocado per day for 26 wk in adults with abdominal obesity increased adherence to the Dietary Guidelines for Americans. Changes in diet quality did not predict changes in risk factors for cardiometabolic disease.This trial was registered at clinicaltrials.gov as NCT03528031 (https://clinicaltrials.gov/study/NCT03528031).
Collapse
Affiliation(s)
- Kristina S Petersen
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA, United States
| | - Sydney Smith
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, Unite States
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Medford, MA, United States
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Medford, MA, United States
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Joan Sabate
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Sujatha Rajaram
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Gina Segovia-Siapco
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, Unite States
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA, United States
| |
Collapse
|
3
|
Sutfin EL, Lazard AJ, Wagoner KG, King JL, Cornacchione Ross J, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. The Development and Testing of a Point-of-Sale E-Cigarette Health Communication Campaign. Health Commun 2023:1-12. [PMID: 37937858 DOI: 10.1080/10410236.2023.2265648] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Adolescents and young adults continue to use e-cigarettes, and communication campaigns are needed to decrease use among these populations. We developed and tested a point-of-sale communication campaign focused on e-cigarette chemical exposure. We developed messages based on formative research and tested them (versus text-only messages) in a nationally-representative online survey among adolescents and young adults (16-25) (Phase 1). Based on survey findings, we selected a message focused on nicotine and brain development for the point-of-sale trial (Phase 2). We then conducted a cluster-randomized trial at six gas stations with convenience stores, randomly assigned to the intervention (messages displayed) or no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 participants (ages 16-25) per store, at baseline and a four-week follow-up. Phase 1 included 1,636 participants in the online study. Intervention messages were rated as more attention grabbing than plain text messages (p < .05), though were rated similarly on other outcomes. Exposure to intervention messages resulted in larger changes from pre- to posttest for beliefs about addiction and relative harms versus cigarettes (p < .05). Phase 2 included 586 participants in the point-of-sale study. Real-world campaign exposure was low (31.8%), and no differences were found between conditions. E-cigarette prevention messages focused on nicotine's impact on brain development show promise. However, garnering attention for communication campaigns in saturated point-of-sale environments, often dominated by tobacco advertising, is challenging. Future efforts should utilize additional communication channels to directly target adolescents and young adults.
Collapse
Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Allison J Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Jessica L King
- Department of Health and Kinesiology, University of Utah
| | | | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine
| | - Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Cynthia K Suerken
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside
| | - Seth M Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| |
Collapse
|
4
|
Moore JB, Smith SC, Russell LP, Serdoz ES, Dilts NA, Alexander AA, Reboussin DM, Bagwell BM, Spainhour MH, Reeves-Daniel AM, Wesley-Farrington DJ, Ma L, Freedman BI. Creation of a Single Institutional Review Board for Collaborative Research in Nephrology: The APOLLO Experience. Clin J Am Soc Nephrol 2023; 18:1362-1365. [PMID: 37163584 PMCID: PMC10578633 DOI: 10.2215/cjn.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Affiliation(s)
- J. Brian Moore
- Institutional Review Board and Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - S. Carrie Smith
- Department of Internal Medicine, Section on Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie P. Russell
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Emily S. Serdoz
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natalie A. Dilts
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amir A. Alexander
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David M. Reboussin
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Benjamin M. Bagwell
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mitzie H. Spainhour
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Deborah J. Wesley-Farrington
- Institutional Review Board and Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Kern KC, Nasrallah IM, Bryan RN, Reboussin DM, Wright CB. Intensive systolic blood pressure treatment remodels brain perivascular spaces: A secondary analysis of the Systolic Pressure Intervention Trial (SPRINT). Neuroimage Clin 2023; 40:103513. [PMID: 37774646 PMCID: PMC10540038 DOI: 10.1016/j.nicl.2023.103513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Brain perivascular spaces (PVS) are part of the glymphatic system and facilitate clearance of metabolic byproducts. Since enlarged PVS are associated with vascular health, we tested whether intensive systolic blood pressure (SBP) treatment affects PVS structure. METHODS This is a secondary analysis of the Systolic PRessure INtervention Trial (SPRINT) MRI Substudy: a randomized trial of intensive SBP treatment to goal < 120 mm Hg vs < 140 mm Hg. Participants had increased cardiovascular risk, pre-treatment SBP 130-180, and no clinical stroke, dementia, or diabetes. Brain MRIs acquired at baseline and follow-up were used to automatically segment PVS in the supratentorial white matter and basal ganglia using a Frangi filtering method. PVS volumes were quantified as a fraction of the total tissue volume. The effects of SBP treatment group and major antihypertensive classes on PVS volume fraction were separately tested using linear mixed-effects models while covarying for MRI site, age, sex, Black race, baseline SBP, history of cardiovascular disease (CVD), chronic kidney disease, and white matter hyperintensities (WMH). RESULTS For 610 participants with sufficient quality MRI at baseline (mean age 67 ± 8, 40 % female, 32 % Black), greater PVS volume fraction was associated with older age, male sex, non-Black race, concurrent CVD, WMH, and brain atrophy. For 381 participants with MRI at baseline and at follow-up (median ± IQR = 3.9 ± 0.4 years), intensive treatment was associated with decreased PVS volume fraction relative to standard treatment (interaction coefficient: -0.029 [-0.055 to -0.0029] p = 0.029). Reduced PVS volume fraction was also associated with exposure to calcium channel blockers (CCB). CONCLUSIONS PVS enlargement was partially reversed in the intensive SBP treatment group. The association with CCB use suggests that improved vascular compliance may be partly responsible. Improved vascular health may facilitate glymphatic clearance. Clincaltrials.gov: NCT01206062.
Collapse
Affiliation(s)
- Kyle C Kern
- Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Reboussin
- Biostatistics and Data Science, Wake Forest University, Wake Forest, MI, USA
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
6
|
Sutfin EL, Lazard AJ, Wagoner KG, King JL, Ross JC, Wiseman KD, Orlan EN, Suerken CK, Reboussin DM, Wolfson M, Noar SM, Reboussin BA. Point-of-Sale Health Communication Campaigns for Cigarillos and Waterpipe Tobacco: Effects and Lessons Learned from Two Cluster Randomized Trials. Health Commun 2023; 38:1201-1212. [PMID: 34781799 PMCID: PMC9107525 DOI: 10.1080/10410236.2021.1996910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16-25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (p < .01). There were also significant increases in knowledge about ammonia and cyanide in cigarillo smoke and arsenic in WT smoke (p < .05) in the sub-sample who reported exposure to the campaign. No differences were found in outcome expectancies, product attitudes, worry about chemical exposure, or behavioral intentions in either campaign. Garnering attention for communication campaigns in saturated POS environments, often dominated by tobacco advertising, is challenging. Our study demonstrates the feasibility of anti-tobacco campaigns at the POS and points to several lessons learned for future POS campaigns.
Collapse
Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Allison J. Lazard
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Kimberly G. Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Jessica L. King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, U.T., United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Elizabeth N. Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| | - Mark Wolfson
- Department of Social Medicine, Population, and Public Health, University of California at Riverside, Riverside, C.A., United States
| | - Seth M. Noar
- Hussman School of Journalism and Media and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, N.C., United States
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, N.C., United States
| |
Collapse
|
7
|
Kern KC, Nasrallah IM, Bryan RN, Reboussin DM, Wright CB. Intensive Systolic Blood Pressure Treatment Remodels Brain Perivascular Spaces: A Secondary Analysis of SPRINT. medRxiv 2023:2023.02.22.23286329. [PMID: 36865252 PMCID: PMC9980255 DOI: 10.1101/2023.02.22.23286329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background Brain perivascular spaces (PVS) are part of the glymphatic system and facilitate clearance of metabolic byproducts. Since enlarged PVS are associated with vascular health, we tested whether intensive systolic blood pressure (SBP) treatment affects PVS structure. Methods This is a secondary analysis of the Systolic PRessure INTervention (SPRINT) Trial MRI Substudy: a randomized trial of intensive SBP treatment to goal < 120 mm Hg vs. < 140 mm Hg. Participants had increased cardiovascular risk, pre-treatment SBP 130-180, and no clinical stroke, dementia, or diabetes. Brain MRIs acquired at baseline and follow-up were used to automatically segment PVS in the supratentorial white matter and basal ganglia using a Frangi filtering method. PVS volumes were quantified as a fraction of the total tissue volume. The effects of SBP treatment group and major antihypertensive classes on PVS volume fraction were separately tested using linear mixed-effects models while covarying for MRI site, age, sex, black race, baseline SBP, history of cardiovascular disease (CVD), chronic kidney disease, and white matter hyperintensities (WMH). Results For 610 participants with sufficient quality MRI at baseline (mean age 67±8, 40% female, 32% black), greater PVS volume fraction was associated with older age, male sex, non-Black race, concurrent CVD, WMH, and brain atrophy. For 381 participants with MRI at baseline and at follow-up (median = 3.9 years), intensive treatment was associated with decreased PVS volume fraction relative to standard treatment (interaction coefficient: -0.029 [-0.055 to -0.0029] p=0.029). Reduced PVS volume fraction was also associated with exposure to calcium channel blockers (CCB) and diuretics. Conclusions Intensive SBP lowering partially reverses PVS enlargement. The effects of CCB use suggests that improved vascular compliance may be partly responsible. Improved vascular health may facilitate glymphatic clearance. Clincaltrials.gov : NCT01206062.
Collapse
Affiliation(s)
- Kyle C. Kern
- Intramural Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ilya M. Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David M. Reboussin
- Biostatistics and Data Science, Wake Forest University, Wake Forest, MI, USA
| | - Clinton B. Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
8
|
Jaeger BC, Bress AP, Bundy JD, Cheung AK, Cushman WC, Drawz PE, Johnson KC, Lewis CE, Oparil S, Rocco MV, Rapp SR, Supiano MA, Whelton PK, Williamson JD, Wright JT, Reboussin DM, Pajewski NM. Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2022; 7:1138-1146. [PMID: 36223105 PMCID: PMC9558058 DOI: 10.1001/jamacardio.2022.3345] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
Importance The Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure control reduced cardiovascular morbidity and mortality. However, the legacy effect of intensive treatment is unknown. Objective To evaluate the long-term effects of randomization to intensive treatment with the incidence of cardiovascular and all-cause mortality approximately 4.5 years after the trial ended. Design, Setting, and Participants In this secondary analysis of a multicenter randomized clinical trial, randomization began on November 8, 2010, the trial intervention ended on August 20, 2015, and trial close-out visits occurred through July 2016. Patients 50 years and older with hypertension and increased cardiovascular risk but without diabetes or history of stroke were included from 102 clinic sites in the US and Puerto Rico. Analyses were conducted between October 2021 and February 2022. Interventions Randomization to systolic blood pressure (SBP) goal of less than 120 mm Hg (intensive treatment group; n = 4678) vs less than 140 mm Hg (standard treatment group; n = 4683). Main Outcomes and Measures Extended observational follow-up for mortality via the US National Death Index from 2016 through 2020. In a subset of 2944 trial participants, outpatient SBP from electronic health records during and after the trial were examined. Results Among 9361 randomized participants, the mean (SD) age was 67.9 (9.4) years, and 3332 (35.6%) were women. Over a median (IQR) intervention period of 3.3 (2.9-3.9) years, intensive treatment was beneficial for both cardiovascular mortality (hazard ratio [HR], 0.66; 95% CI, 0.49-0.89) and all-cause mortality (HR, 0.83; 95% CI, 0.68-1.01). However, at the median (IQR) total follow-up of 8.8 (8.3-9.3) years, there was no longer evidence of benefit for cardiovascular mortality (HR, 1.02; 95% CI, 0.84-1.24) or all-cause mortality (HR, 1.08; 95% CI, 0.94-1.23). In a subgroup of participants, the estimated mean outpatient SBP among participants randomized to intensive treatment increased from 132.8 mm Hg (95% CI, 132.0-133.7) at 5 years to 140.4 mm Hg (95% CI, 137.8-143.0) at 10 years following randomization. Conclusions and Relevance The beneficial effect of intensive treatment on cardiovascular and all-cause mortality did not persist after the trial. Given increasing outpatient SBP levels in participants randomized to intensive treatment following the trial, these results highlight the importance of consistent long-term management of hypertension. Trial Registration ClinicalTrials.gov Identifier: NCT01206062.
Collapse
Affiliation(s)
- Byron C. Jaeger
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Adam P. Bress
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Joshua D. Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Alfred K. Cheung
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Paul E. Drawz
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Michael V. Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen R. Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Social Science and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mark A. Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jackson T. Wright
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
9
|
Pajewski NM, Elahi FM, Tamura MK, Hinman JD, Nasrallah IM, Ix JH, Miller LM, Launer LJ, Wright CB, Supiano MA, Lerner AJ, Sudduth TL, Killeen AA, Cheung AK, Reboussin DM, Wilcock DM, Williamson JD. Plasma amyloid beta, neurofilament light chain, and total tau in the Systolic Blood Pressure Intervention Trial (SPRINT). Alzheimers Dement 2022; 18:1472-1483. [PMID: 34786815 PMCID: PMC9110563 DOI: 10.1002/alz.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 01/13/2021] [Revised: 06/29/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Lowering blood pressure (BP) reduces the risk for cognitive impairment and the progression of cerebral white matter lesions. It is unclear whether hypertension control also influences plasma biomarkers related to Alzheimer's disease and non-disease-specific neurodegeneration. METHODS We examined the effect of intensive (< 120 mm Hg) versus standard (< 140 mm Hg) BP control on longitudinal changes in plasma amyloid beta (Aβ)40 and Aβ42 , total tau, and neurofilament light chain (NfL) in a subgroup of participants from the Systolic Blood Pressure Intervention Trial (N = 517). RESULTS Over 3.8 years, there were no significant between-group differences for Aβ40, Aβ42, Aβ42 /Aβ40, or total tau. Intensive treatment was associated with larger increases in NfL compared to standard treatment. Adjusting for kidney function, but not BP, attenuated the association between intensive treatment and NfL. DISCUSSION Intensive BP treatment was associated with changes in NfL, which were correlated with changes in kidney function associated with intensive treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01206062.
Collapse
Affiliation(s)
- Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Manjula Kurella Tamura
- Geriatric Research, Education and Clinical Center, Palo Alto Veterans Affairs Health Care System, California and Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason D. Hinman
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Ilya M. Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California San Diego, USA
| | - Lindsay M. Miller
- Division of Nephrology-Hypertension, University of California San Diego, USA
| | - Lenore J. Launer
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Mark A. Supiano
- Geriatric Research, Education and Clinical Center, Veterans Affairs Salt Lake City Health System, Utah and Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Alan J. Lerner
- Department of Neurology, University Hospitals – Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tiffany L. Sudduth
- Department of Physiology, Sanders-Brown Center on Aging, University of Kentucky, Lexington, USA
| | - Anthony A. Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City and Renal Section, Veterans Affairs Salt Lake City Healthcare System, Utah, USA
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Donna M. Wilcock
- Department of Physiology, Sanders-Brown Center on Aging, University of Kentucky, Lexington, USA
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
10
|
Lichtenstein AH, Kris‐Etherton PM, Petersen KS, Matthan NR, Barnes S, Vitolins MZ, Li Z, Sabaté J, Rajaram S, Chowdhury S, Davis KM, Galluccio J, Gilhooly CH, Legro RS, Li J, Lovato L, Perdue LH, Petty G, Rasmussen AM, Segovia‐Siapco G, Sirirat R, Sun A, Reboussin DM. Effect of Incorporating 1 Avocado Per Day Versus Habitual Diet on Visceral Adiposity: A Randomized Trial. J Am Heart Assoc 2022; 11:e025657. [PMID: 35861827 PMCID: PMC9707833 DOI: 10.1161/jaha.122.025657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Excess visceral adiposity is associated with increased risk of cardiometabolic disorders. Short‐term well‐controlled clinical trials suggest that regular avocado consumption favorably affects body weight, visceral adiposity, and satiety.
Methods and Results
The HAT Trial (Habitual Diet and Avocado Trial) was a multicenter, randomized, controlled parallel‐arm trial designed to test whether consuming 1 large avocado per day for 6 months in a diverse group of free‐living individuals (N=1008) with an elevated waist circumference compared with a habitual diet would decrease visceral adiposity as measured by magnetic resonance imaging. Secondary and additional end points related to risk factors associated with cardiometabolic disorders were assessed. The primary outcome, change in visceral adipose tissue volume during the intervention period, was not significantly different between the Avocado Supplemented and Habitual Diet Groups (estimated mean difference (0.017 L [−0.024 L, 0.058 L],
P
=0.405). No significant group differences were observed for the secondary outcomes of hepatic fat fraction, hsCRP (high‐sensitivity C‐reactive protein), and components of the metabolic syndrome. Of the additional outcome measures, modest but nominally significant reductions in total and low‐density lipoprotein cholesterol were observed in the Avocado Supplemented compared with the Habitual Diet Group. Changes in the other additional and post hoc measures (body weight, body mass index, insulin, very low‐density lipoprotein concentrations, and total cholesterol:high‐density lipoprotein cholesterol ratio) were similar between the 2 groups.
Conclusions
Addition of 1 avocado per day to the habitual diet for 6 months in free‐living individuals with elevated waist circumference did not reduce visceral adipose tissue volume and had minimal effect on risk factors associated with cardiometabolic disorders.
Registration
URL:
https://clinicaltrials.gov
; Unique identifier: NCT03528031.
Collapse
Affiliation(s)
| | | | | | | | - Samuel Barnes
- Department of Radiology Loma Linda University School of Medicine Loma Linda CA
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention Wake Forest University School of Medicine Winston‐Salem NC
| | - Zhaoping Li
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Joan Sabaté
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Sujatha Rajaram
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Shilpy Chowdhury
- Department of Radiology Loma Linda University School of Medicine Loma Linda CA
| | - Kristin M. Davis
- Department of Behavioral Health Pennsylvania State University State College PA
| | - Jean Galluccio
- JM USDA Human Nutrition Center on Aging, Tufts University Boston MA
| | | | | | - Jason Li
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Laura Lovato
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
| | - Letitia H. Perdue
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
| | - Gayle Petty
- JM USDA Human Nutrition Center on Aging, Tufts University Boston MA
| | - Anna M. Rasmussen
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - Gina Segovia‐Siapco
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - Rawiwan Sirirat
- Healthy Lifestyles, and Disease Prevention Loma Linda University School of Public Health Center for Nutrition Loma Linda CA
| | - April Sun
- Center for Human Nutrition David Geffen School of Medicine at UCLA Los Angeles CA
| | - David M. Reboussin
- Department of Biostatistics Wake Forest University School of Medicine Winston‐Salem NC
| |
Collapse
|
11
|
Hayden KM, Spira AP, St‐Onge M, Ding J, Anderson A, Molina‐Henry DP, Sanderlin AH, Reboussin DM, Espeland MA, Bahnson J. Effects of a lifestyle intervention on daytime sleepiness and cognitive function. Alzheimers Dement 2021. [DOI: 10.1002/alz.051185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Adam P Spira
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | | | | | | | | | | | | | | | - Judy Bahnson
- Wake Forest School of Medicine Winston‐Salem NC USA
| |
Collapse
|
12
|
Gaussoin SA, Pajewski NM, Chelune G, Cleveland M, Crowe MG, Launer LJ, Lerner AJ, Martindale‐Adams J, Nichols LO, Ogrocki PK, Sachs BC, Sink KM, Supiano MA, Wadley VG, Wilson VM, Wright CB, Williamson JD, Reboussin DM, Rapp SR. Mild cognitive impairment and transitions in cognitive status in the Systolic Blood Pressure Intervention Trial (SPRINT). Alzheimers Dement 2021. [DOI: 10.1002/alz.053865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Alan J Lerner
- Case Western Reserve University School of Medicine Cleveland OH USA
| | | | | | - Paula K Ogrocki
- Case Western Reserve University School of Medicine Cleveland OH USA
| | | | | | - Mark A Supiano
- University of Utah Salt Lake City UT USA
- Salt Lake City VA Geriatric Research, Education and Clinical Center Salt Lake City UT USA
| | | | | | | | | | | | | |
Collapse
|
13
|
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.
Collapse
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
| | | |
Collapse
|
14
|
Gaussoin SA, Pajewski NM, Chelune G, Cleveland ML, Crowe MG, Launer LJ, Lerner AJ, Martindale-Adams J, Nichols LO, Ogrocki PK, Sachs BC, Sink KM, Supiano MA, Wadley VG, Wilson VM, Wright CB, Williamson JD, Reboussin DM, Rapp SR. Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study. J Am Geriatr Soc 2021; 70:1384-1393. [PMID: 34826341 PMCID: PMC9106821 DOI: 10.1111/jgs.17583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND To examine the effect of intensive blood pressure control on the occurrence of subtypes of mild cognitive impairment (MCI) and determine the risk of progression to dementia or death. METHODS Secondary analysis of a randomized trial of community-dwelling adults (≥50 years) with hypertension. Participants were randomized to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment; n = 4678) or <140 mm Hg (Standard treatment; n = 4683). Outcomes included adjudicated MCI, MCI subtype (amnestic, non-amnestic, multi-domain, single domain), and probable dementia. Multistate survival models were used to examine transitions in cognitive status accounting for the competing risk of death. RESULTS Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 640 participants met the protocol definition for MCI, with intensive treatment reducing the risk of MCI overall (hazard ratio [HR], 0.81 [95% confidence interval {CI}, 0.69-0.94]), as previously reported. This effect was largely reflected in amnestic subtypes (HR, 0.78 [95% CI, 0.66-0.92]) and multi-domain subtypes (HR, 0.78 [95% CI, 0.65-0.93]). An adjudication of MCI, as compared with normal cognitive function, substantially increased the probability of progressing to probable dementia (5.9% [95% CI: 4.5%-7.7%] vs. 0.6% [95% CI: 0.3%-0.9%]) and to death (10.0% [95% CI: 8.3%-11.9%] vs. 2.3% [95% CI: 2.0%-2.7%]) within 2 years. CONCLUSIONS Intensive treatment reduced the risk for amnestic and multi-domain subtypes of MCI. An adjudication of MCI was associated with increased risk of progression to dementia and death, highlighting the relevance of MCI as a primary outcome in clinical and research settings.
Collapse
Affiliation(s)
- Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gordon Chelune
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maryjo L Cleveland
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael G Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lenore J Launer
- Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - Alan J Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jennifer Martindale-Adams
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Paula K Ogrocki
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Mark A Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Ohio, USA.,VA Geriatric Research, Education and Clinical Center, Salt Lake City, Ohio, USA
| | - Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Valerie M Wilson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
15
|
Reboussin DM, Kris-Etherton PM, Lichtenstein AH, Li Z, Sabate J, Matthan NR, Petersen K, Rajaram S, Vitolins M, Ford N. The design and rationale of a multi-center randomized clinical trial comparing one avocado per day to usual diet: The Habitual Diet and Avocado Trial (HAT). Contemp Clin Trials 2021; 110:106565. [PMID: 34496276 DOI: 10.1016/j.cct.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/21/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Excess visceral adiposity is associated with increased risk of diabetes and cardiovascular disease. In the U.S. approximately 60% of adults have visceral obesity. Despite high calorie and fat, small, well-controlled clinical studies suggest that avocado consumption has favorable effects on body weight and visceral adiposity. Additionally, short-term studies also suggest that consuming avocados increases satiety, hence, may decrease overall energy intake. The Habitual Diet and Avocado Trial HAT is a multi-center, randomized, controlled trial designed to test whether in a large, diverse cohort providing one avocado per day for consumption for six months compared to a habitual diet essentially devoid of avocados, will result in a decrease in visceral adiposity as measured by magnetic resonance imaging (MRI) in individuals with an increased waist circumference (WC). Additional outcome measures include hepatic lipid content, plasma lipid profiles, blood pressure and high sensitivity C-reactive protein. Inclusion criteria were increased WC and not currently eating more than two avocados per month. Major exclusion criteria were not eating or being allergic to avocados, and not willing or able to undergo MRI scans. From June 27, 2018 to March 4, 2020, 1008 participants were randomized at 4 clinics. The cohort was 72% women, 53% Non-Hispanic White, and had a mean age of 50 years. Follow-up was completed in October 2020 when 936 participants had final MRI scans. HAT will provide information on the effects of avocado consumption on visceral fat adiposity and cardiometabolic disease risk in a diverse sample of participants.
Collapse
Affiliation(s)
- David M Reboussin
- Department of Biostatistics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State University, 319 Chandlee Laboratory, University Park, PA 16802, USA.
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Suite B365, Los Angeles, CA 90095, USA,.
| | - Joan Sabate
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, P.O. Box 41270, Lubbock, TX 79409-1270, USA.
| | - Sujatha Rajaram
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Mara Vitolins
- Department of Epidemiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Nikki Ford
- Hass Avocado Board, 25212 Marguerite Parkway, Suite 250, Mission Viejo, CA 92692, USA.
| | | |
Collapse
|
16
|
Lewis CE, Fine LJ, Beddhu S, Cheung AK, Cushman WC, Cutler JA, Evans GW, Johnson KC, Kitzman DW, Oparil S, Rahman M, Reboussin DM, Rocco MV, Sink KM, Snyder JK, Whelton PK, Williamson JD, Wright JT, Ambrosius WT. Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2021; 384:1921-1930. [PMID: 34010531 PMCID: PMC9907774 DOI: 10.1056/nejmoa1901281] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a previously reported randomized trial of standard and intensive systolic blood-pressure control, data on some outcome events had yet to be adjudicated and post-trial follow-up data had not yet been collected. METHODS We randomly assigned 9361 participants who were at increased risk for cardiovascular disease but did not have diabetes or previous stroke to adhere to an intensive treatment target (systolic blood pressure, <120 mm Hg) or a standard treatment target (systolic blood pressure, <140 mm Hg). The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. Additional primary outcome events occurring through the end of the intervention period (August 20, 2015) were adjudicated after data lock for the primary analysis. We also analyzed post-trial observational follow-up data through July 29, 2016. RESULTS At a median of 3.33 years of follow-up, the rate of the primary outcome and all-cause mortality during the trial were significantly lower in the intensive-treatment group than in the standard-treatment group (rate of the primary outcome, 1.77% per year vs. 2.40% per year; hazard ratio, 0.73; 95% confidence interval [CI], 0.63 to 0.86; all-cause mortality, 1.06% per year vs. 1.41% per year; hazard ratio, 0.75; 95% CI, 0.61 to 0.92). Serious adverse events of hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope were significantly more frequent in the intensive-treatment group. When trial and post-trial follow-up data were combined (3.88 years in total), similar patterns were found for treatment benefit and adverse events; however, rates of heart failure no longer differed between the groups. CONCLUSIONS Among patients who were at increased cardiovascular risk, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg, both during receipt of the randomly assigned therapy and after the trial. Rates of some adverse events were higher in the intensive-treatment group. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062.).
Collapse
Affiliation(s)
- Cora E Lewis
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Lawrence J Fine
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Srinivasan Beddhu
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Alfred K Cheung
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - William C Cushman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jeffrey A Cutler
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Gregory W Evans
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Karen C Johnson
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Dalane W Kitzman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Suzanne Oparil
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Mahboob Rahman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - David M Reboussin
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Michael V Rocco
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Kaycee M Sink
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Joni K Snyder
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Paul K Whelton
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jeff D Williamson
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jackson T Wright
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Walter T Ambrosius
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| |
Collapse
|
17
|
Cornacchione Ross J, Reboussin DM, Noar SM, Wiseman KD, Sutfin EL. What Do Adolescents and Young Adults Think a Cigarillo Is? Implications for Health Communication. Int J Environ Res Public Health 2021; 18:3311. [PMID: 33806872 PMCID: PMC8004959 DOI: 10.3390/ijerph18063311] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term "cigarillo" in such efforts. The study goal was to assess adolescent and young adult perceptions of the term "cigarillo". We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13-25). We asked participants "what is a cigarillo?" with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question "what is a cigarillo" was "I don't know" (51% of participants), followed by "a thinner and smaller version of a traditional cigar" (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was "I don't know" (54.9%) followed by "a thinner and smaller version of a traditional cigar" (45.1%). Cigarillo users were more likely to select the "a thinner and smaller version of a traditional cigar" response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term "cigarillo". Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.
Collapse
Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| |
Collapse
|
18
|
Kuna ST, Reboussin DM, Strotmeyer ES, Millman RP, Zammit G, Walkup MP, Wadden TA, Wing RR, Pi-Sunyer FX, Spira AP, Foster GD. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Am J Respir Crit Care Med 2021; 203:221-229. [PMID: 32721163 DOI: 10.1164/rccm.201912-2511oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA).Objectives: To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years.Methods: Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE).Measurements and Main Results: Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group (P values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively (P values ≤ 0.0004), and 4.0 events/h at 10 years (P = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year (P values < 0.0001), and intervention independent of weight change (P = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%).Conclusions: Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.
Collapse
Affiliation(s)
- Samuel T Kuna
- University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Gary D Foster
- Temple University, Philadelphia, Pennsylvania; and.,WW (formerly Weight Watchers), New York, New York
| | | |
Collapse
|
19
|
Pajewski NM, Elahi FM, Ix JH, Nasrallah IM, Reboussin DM, Tamura MK, Wright CB, Hinman J, Miller LM, Sudduth TL, Wilcock DM, Williamson JD. Fluid biomarkers of Alzheimer’s disease in the Systolic Blood Pressure Intervention Trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.047258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Fanny M Elahi
- University of California, San Francisco San Francisco CA USA
| | - Joachim H Ix
- University of California San Diego San Diego CA USA
| | | | | | | | | | - Jason Hinman
- University of California Los Angeles Los Angeles CA USA
| | | | - Tiffany L Sudduth
- University of Kentucky Sanders Brown Center on Aging Lexington KY USA
| | - Donna M Wilcock
- University of Kentucky Sanders Brown Center on Aging Lexington KY USA
| | | |
Collapse
|
20
|
Barton JC, Wiener HH, Acton RT, Adams PC, Eckfeldt JH, Gordeuk VR, Harris EL, McLaren CE, Harrison H, McLaren GD, Reboussin DM. Prevalence of iron deficiency in 62,685 women of seven race/ethnicity groups: The HEIRS Study. PLoS One 2020; 15:e0232125. [PMID: 32324809 PMCID: PMC7179917 DOI: 10.1371/journal.pone.0232125] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Few cross-sectional studies report iron deficiency (ID) prevalence in women of different race/ethnicity and ages in US or Canada. Materials and methods We evaluated screening observations on women who participated between 2001–2003 in a cross-sectional, primary care-based sample of adults ages ≥25 y whose observations were complete: race/ethnicity; age; transferrin saturation; serum ferritin; and HFE p.C282Y and p.H63D alleles. We defined ID using a stringent criterion: combined transferrin saturation <10% and serum ferritin <33.7 pmol/L (<15 μg/L). We compared ID prevalence in women of different race/ethnicity subgrouped by age and determined associations of p.C282Y and p.H63D to ID overall, and to ID in women ages 25–44 y with or without self-reported pregnancy. Results These 62,685 women included 27,079 whites, 17,272 blacks, 8,566 Hispanics, 7,615 Asians, 449 Pacific Islanders, 441 Native Americans, and 1,263 participants of other race/ethnicity. Proportions of women with ID were higher in Hispanics and blacks than whites and Asians. Prevalence of ID was significantly greater in women ages 25–54 y of all race/ethnicity groups than women ages ≥55 y of corresponding race/ethnicity. In women ages ≥55 y, ID prevalence did not differ significantly across race/ethnicity. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy. Conclusions ID prevalence was greater in Hispanic and black than white and Asian women ages 25–54 y. p.C282Y and p.H63D prevalence did not differ significantly in women with or without ID, regardless of race/ethnicity, age subgroup, or pregnancy.
Collapse
Affiliation(s)
- James C. Barton
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA and Southern Iron Disorders Center, Birmingham, AL, United States of America
- * E-mail:
| | - Howard H. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Ronald T. Acton
- USA and Southern Iron Disorders Center, Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Paul C. Adams
- Department of Medicine, London Health Sciences Centre, London, ONT, Canada
| | - John H. Eckfeldt
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States of America
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Emily L. Harris
- Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Christine E. McLaren
- Department of Epidemiology, University of California, Irvine, CA, United States of America
| | - Helen Harrison
- The Western-Fanshawe Collaborative BScN Program, Fanshawe College, London, ONT, Canada
| | - Gordon D. McLaren
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA and Department of Veterans Affairs Long Beach Healthcare System, Long Beach, CA, United States of America
| | - David M. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| |
Collapse
|
21
|
Pajewski NM, Berlowitz DR, Bress AP, Callahan KE, Cheung AK, Fine LJ, Gaussoin SA, Johnson KC, King J, Kitzman DW, Kostis JB, Lerner AJ, Lewis CE, Oparil S, Rahman M, Reboussin DM, Rocco MV, Snyder JK, Still C, Supiano MA, Wadley VG, Whelton PK, Wright JT, Williamson JD. Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc 2020; 68:496-504. [PMID: 31840813 PMCID: PMC7056569 DOI: 10.1111/jgs.16272] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 08/06/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN Secondary analysis. SETTING Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older. INTERVENTION Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.
Collapse
Affiliation(s)
- Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dan R. Berlowitz
- Bedford Veterans Affairs Hospital, Bedford, Massachusetts;,Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Adam P. Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kathryn E. Callahan
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, Utah
| | - Larry J. Fine
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Sarah A. Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jordan King
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah;,Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Dalane W. Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John B. Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alan J. Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mahboob Rahman
- Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael V. Rocco
- Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joni K. Snyder
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Carolyn Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Mark A. Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah;,Geriatric Research, Education, and Clinical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Virginia G. Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jackson T. Wright
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jeff D. Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
22
|
Freedman BI, Moxey-Mims MM, Alexander AA, Astor BC, Birdwell KA, Bowden DW, Bowen G, Bromberg J, Craven TE, Dadhania DM, Divers J, Doshi MD, Eidbo E, Fornoni A, Gautreaux MD, Gbadegesin RA, Gee PO, Guerra G, Hsu CY, Iltis AS, Jefferson N, Julian BA, Klassen DK, Koty PP, Langefeld CD, Lentine KL, Ma L, Mannon RB, Menon MC, Mohan S, Moore JB, Murphy B, Newell KA, Odim J, Ortigosa-Goggins M, Palmer ND, Park M, Parsa A, Pastan SO, Poggio ED, Rajapakse N, Reeves-Daniel AM, Rosas SE, Russell LP, Sawinski D, Smith SC, Spainhour M, Stratta RJ, Weir MR, Reboussin DM, Kimmel PL, Brennan DC. APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale. Kidney Int Rep 2020; 5:278-288. [PMID: 32154449 PMCID: PMC7056919 DOI: 10.1016/j.ekir.2019.11.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Much of the higher risk for end-stage kidney disease (ESKD) in African American individuals relates to ancestry-specific variation in the apolipoprotein L1 gene (APOL1). Relative to kidneys from European American deceased-donors, kidneys from African American deceased-donors have shorter allograft survival and African American living-kidney donors more often develop ESKD. The National Institutes of Health (NIH)-sponsored APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) is prospectively assessing kidney allograft survival from donors with recent African ancestry based on donor and recipient APOL1 genotypes. METHODS APOLLO will evaluate outcomes from 2614 deceased kidney donor-recipient pairs, as well as additional living-kidney donor-recipient pairs and unpaired deceased-donor kidneys. RESULTS The United Network for Organ Sharing (UNOS), Association of Organ Procurement Organizations, American Society of Transplantation, American Society for Histocompatibility and Immunogenetics, and nearly all U.S. kidney transplant programs, organ procurement organizations (OPOs), and histocompatibility laboratories are participating in this observational study. APOLLO employs a central institutional review board (cIRB) and maintains voluntary partnerships with OPOs and histocompatibility laboratories. A Community Advisory Council composed of African American individuals with a personal or family history of kidney disease has advised the NIH Project Office and Steering Committee since inception. UNOS is providing data for outcome analyses. CONCLUSION This article describes unique aspects of the protocol, design, and performance of APOLLO. Results will guide use of APOL1 genotypic data to improve the assessment of quality in deceased-donor kidneys and could increase numbers of transplanted kidneys, reduce rates of discard, and improve the safety of living-kidney donation.
Collapse
Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children's National Health System, Washington, DC, USA
| | - Amir A. Alexander
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brad C. Astor
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kelly A. Birdwell
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University, Nashville, Tennessee, USA
| | - Donald W. Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jonathan Bromberg
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy E. Craven
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Darshana M. Dadhania
- Division of Nephrology, Weill Cornell Medicine, New York, New York, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mona D. Doshi
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Elling Eidbo
- Association of Organ Procurement Organizations, Vienna, Virginia, USA
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael D. Gautreaux
- Human Leukocyte Antigen/Immunogenetics and Immunodiagnostics Laboratories, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrick O. Gee
- APOLLO Community Advisory Council, Cleveland Clinic, Cleveland, Ohio, USA
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chi-yuan Hsu
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | - Ana S. Iltis
- Center for Bioethics, Health and Society, Department of Philosophy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Nichole Jefferson
- APOLLO Steering Committee, APOLLO Community Advisory Council, Dallas, Texas, USA
| | - Bruce A. Julian
- Department of Medicine, Division of Nephrology, University of Alabama School of Medicine in Birmingham, Birmingham, Alabama, USA
| | - David K. Klassen
- United Network for Organ Sharing, Office of the Chief Medical Officer, Richmond, Virginia, USA
| | - Patrick P. Koty
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl D. Langefeld
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Krista L. Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Roslyn B. Mannon
- Department of Medicine, Division of Nephrology, University of Alabama School of Medicine in Birmingham, Birmingham, Alabama, USA
| | - Madhav C. Menon
- Department of Nephrology, Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - J. Brian Moore
- Institutional Review Board, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barbara Murphy
- Department of Nephrology, Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kenneth A. Newell
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonah Odim
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mariella Ortigosa-Goggins
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicholette D. Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Meyeon Park
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | - Afshin Parsa
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emilio D. Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nishadi Rajapakse
- National Institutes of Health, National Institute on Minority Health and Health Disparities, Division of Scientific Programs, Bethesda, Maryland, USA
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvia E. Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Laurie P. Russell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deirdre Sawinski
- Renal Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S. Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mitzie Spainhour
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert J. Stratta
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew R. Weir
- Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul L. Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Daniel C. Brennan
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
23
|
Al-Kindi SG, Reboussin DM, Brook RD, Bhatt U, Brauer M, Cushman WC, Hanson H, Kostis J, Lash J, Paine R, Raphael K, Rapp S, Tamariz L, Wright JT, Rajagopalan S. THE BENEFITS OF INTENSIVE VERSUS STANDARD BLOOD PRESSURE TREATMENT ACCORDING TO FINE PARTICULATE MATTER AIR POLLUTION EXPOSURE: A POST-HOC ANALYSIS OF SPRINT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)34290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
Affiliation(s)
- David M Reboussin
- From the Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC (D.M.R.)
| | - Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville, VA (R.M.C.)
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.)
| |
Collapse
|
25
|
Nasrallah IM, Pajewski NM, Auchus AP, Chelune G, Cheung AK, Cleveland ML, Coker LH, Crowe MG, Cushman WC, Cutler JA, Davatzikos C, Desiderio L, Doshi J, Erus G, Fine LJ, Gaussoin SA, Harris D, Johnson KC, Kimmel PL, Kurella Tamura M, Launer LJ, Lerner AJ, Lewis CE, Martindale-Adams J, Moy CS, Nichols LO, Oparil S, Ogrocki PK, Rahman M, Rapp SR, Reboussin DM, Rocco MV, Sachs BC, Sink KM, Still CH, Supiano MA, Snyder JK, Wadley VG, Walker J, Weiner DE, Whelton PK, Wilson VM, Woolard N, Wright JT, Wright CB, Williamson JD, Bryan RN. Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions. JAMA 2019; 322:524-534. [PMID: 31408137 PMCID: PMC6692679 DOI: 10.1001/jama.2019.10551] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 06/27/2019] [Indexed: 01/18/2023]
Abstract
Importance The effect of intensive blood pressure lowering on brain health remains uncertain. Objective To evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain volumes. Design, Setting, and Participants A substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016. Interventions Participants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315). Main Outcomes and Measures The primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome. Results Among 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 [95% CI, 0.69 to 1.14]) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3 [95% CI, 1.21 to 1.70]) in the standard treatment group (between-group difference in change, -0.54 cm3 [95% CI, -0.87 to -0.20]). Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, -30.6 cm3 [95% CI, -32.3 to -28.8]) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, -26.9 cm3 [95% CI, 24.8 to 28.8]) in the standard treatment group (between-group difference in change, -3.7 cm3 [95% CI, -6.3 to -1.1]). Conclusions and Relevance Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small. Trial Registration ClinicalTrials.gov Identifier: NCT01206062.
Collapse
Affiliation(s)
- Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexander P Auchus
- Department of Neurology, University of Mississippi Medical Center, Jackson
| | - Gordon Chelune
- Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City
| | - Maryjo L Cleveland
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laura H Coker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael G Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - William C Cushman
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Jeffrey A Cutler
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Lisa Desiderio
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Jimit Doshi
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Guray Erus
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Larry J Fine
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Darrin Harris
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Disorders, Bethesda, Maryland
| | | | - Lenore J Launer
- Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Alan J Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | | | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Linda O Nichols
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham
| | - Paula K Ogrocki
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mahboob Rahman
- Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael V Rocco
- Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kaycee M Sink
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Now with Genentech, South San Francisco, California
| | - Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Mark A Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City
| | - Joni K Snyder
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Jennifer Walker
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Valerie M Wilson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nancy Woolard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia
| |
Collapse
|
26
|
Wagoner KG, Reboussin DM, King JL, Orlan E, Cornacchione Ross J, Sutfin EL. Who Is Exposed to E-Cigarette Advertising and Where? Differences between Adolescents, Young Adults and Older Adults. Int J Environ Res Public Health 2019; 16:E2533. [PMID: 31315189 PMCID: PMC6679184 DOI: 10.3390/ijerph16142533] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 12/28/2022]
Abstract
Little is known about differences between adolescents' and adults' exposure to e-cigarette advertising in various media channels, such as retail establishments, print, television, radio, and digital marketing. We examined the exposure to e-cigarette advertising in these channels amongst adolescents (13-17), young adults (18-25), and older adults (26+). Adolescents (N = 1124), young adults (N = 809), and adults (N = 4186) were recruited through two nationally representative phone surveys from 2014-2015. Lifetime e-cigarette advertising exposure was prevalent (84.5%). Overall, older adult males and older adult cigarette smokers reported the highest exposure to e-cigarette advertising (p < 0.001). Television was the largest source of exposure for all age groups. Adolescents and young adults had higher odds than older adults of exposure through television and digital marketing. However, adolescents had lower odds than young adults and older adults of exposure through retailers and print media. Although e-cigarette advertising appears to be reaching the intended audience of adult smokers, vulnerable populations are being exposed at high rates via television and digital marketing. Regulations aimed at curbing exposure through these media channels are needed, as are counter advertising and prevention campaigns.
Collapse
Affiliation(s)
- Kimberly G Wagoner
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - David M Reboussin
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Jessica L King
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Elizabeth Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Blvd, Winston-Salem, NC 27157, USA
| |
Collapse
|
27
|
Reboussin DM, Pajewski NM, Williamson JD. Analysis of Long-term Benefits of Intensive Blood Pressure Control-Reply. JAMA 2019; 322:170. [PMID: 31287519 DOI: 10.1001/jama.2019.5860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David M Reboussin
- Department of Biostatistics and Data Science, 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, North Carolina
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
28
|
Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung AK, Cleveland ML, Coker LH, Crowe MG, Cushman WC, Cutler JA, Davatzikos C, Desiderio L, Erus G, Fine LJ, Gaussoin SA, Harris D, Hsieh MK, Johnson KC, Kimmel PL, Tamura MK, Launer LJ, Lerner AJ, Lewis CE, Martindale-Adams J, Moy CS, Nasrallah IM, Nichols LO, Oparil S, Ogrocki PK, Rahman M, Rapp SR, Reboussin DM, Rocco MV, Sachs BC, Sink KM, Still CH, Supiano MA, Snyder JK, Wadley VG, Walker J, Weiner DE, Whelton PK, Wilson VM, Woolard N, Wright JT, Wright CB. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA 2019; 321:553-561. [PMID: 30688979 PMCID: PMC6439590 DOI: 10.1001/jama.2018.21442] [Citation(s) in RCA: 682] [Impact Index Per Article: 136.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE There are currently no proven treatments to reduce the risk of mild cognitive impairment and dementia. OBJECTIVE To evaluate the effect of intensive blood pressure control on risk of dementia. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 102 sites in the United States and Puerto Rico among adults aged 50 years or older with hypertension but without diabetes or history of stroke. Randomization began on November 8, 2010. The trial was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. The final date for follow-up of cognitive outcomes was July 22, 2018. INTERVENTIONS Participants were randomized to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment group; n = 4678) or less than 140 mm Hg (standard treatment group; n = 4683). MAIN OUTCOMES AND MEASURES The primary cognitive outcome was occurrence of adjudicated probable dementia. Secondary cognitive outcomes included adjudicated mild cognitive impairment and a composite outcome of mild cognitive impairment or probable dementia. RESULTS Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 8563 (91.5%) completed at least 1 follow-up cognitive assessment. The median intervention period was 3.34 years. During a total median follow-up of 5.11 years, adjudicated probable dementia occurred in 149 participants in the intensive treatment group vs 176 in the standard treatment group (7.2 vs 8.6 cases per 1000 person-years; hazard ratio [HR], 0.83; 95% CI, 0.67-1.04). Intensive BP control significantly reduced the risk of mild cognitive impairment (14.6 vs 18.3 cases per 1000 person-years; HR, 0.81; 95% CI, 0.69-0.95) and the combined rate of mild cognitive impairment or probable dementia (20.2 vs 24.1 cases per 1000 person-years; HR, 0.85; 95% CI, 0.74-0.97). CONCLUSIONS AND RELEVANCE Among ambulatory adults with hypertension, treating to a systolic blood pressure goal of less than 120 mm Hg compared with a goal of less than 140 mm Hg did not result in a significant reduction in the risk of probable dementia. Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01206062.
Collapse
Affiliation(s)
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Department of Internal 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, North Carolina
| | - Alexander P Auchus
- Department of Neurology, University of Mississippi Medical Center, Jackson
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Gordon Chelune
- Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City
| | - Maryjo L Cleveland
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laura H Coker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael G Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - William C Cushman
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Jeffrey A Cutler
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Lisa Desiderio
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Guray Erus
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Larry J Fine
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Darrin Harris
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meng-Kang Hsieh
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Disorders, Bethesda, Maryland
| | | | - Lenore J Launer
- Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Alan J Lerner
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | | | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia
| | - Linda O Nichols
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham
| | - Paula K Ogrocki
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mahboob Rahman
- Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael V Rocco
- Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kaycee M Sink
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Mark A Supiano
- Division of Geriatrics, University of Utah School of Medicine, Salt Lake City
| | - Joni K Snyder
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - Jennifer Walker
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Valerie M Wilson
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nancy Woolard
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| |
Collapse
|
29
|
Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller E(PR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2018; 138:e595-e616. [DOI: 10.1161/cir.0000000000000601] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective
To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy?
Methods
Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses.
Results
Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
Collapse
Affiliation(s)
- David M. Reboussin
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Norrina B. Allen
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Michael E. Griswold
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Eliseo Guallar
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Yuling Hong
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Daniel T. Lackland
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Edgar (Pete) R. Miller
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Tamar Polonsky
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Angela M. Thompson-Paul
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| | - Suma Vupputuri
- These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
| |
Collapse
|
30
|
Chang TI, Reboussin DM, Chertow GM, Cheung AK, Cushman WC, Kostis WJ, Parati G, Riessen E, Shapiro B, Stergiou GS, Tsioufis K, Whelton PK, Whittle J, Wright JT, Papademetriou V. Prognostic relevance of visit-to-visit office blood pressure variability in Systolic Blood Pressure Intervention Trial: Same data, different conclusions? J Clin Hypertens (Greenwich) 2018; 20:1644-1645. [DOI: 10.1111/jch.13395] [Citation(s) in RCA: 2] [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: 11/30/2022]
Affiliation(s)
- Tara I. Chang
- Division of Nephrology; Stanford University Medical Center; Palo Alto California
| | | | | | - Alfred K. Cheung
- Veterans Affairs Salt Lake City Health Care System; Salt Lake City Utah
| | | | - William J. Kostis
- Rutgers Robert Wood Johnson Medical School New Brunswick; New Brunswick New Jersey
| | - Gianfranco Parati
- Department of Medicine and Surgery; University of Milano-Bicocca; Milan Italy
| | - Erik Riessen
- Veterans Affairs Salt Lake City Health Care System; Salt Lake City Utah
| | - Brian Shapiro
- Veterans Affairs Salt Lake City Health Care System; Salt Lake City Utah
| | - George S. Stergiou
- School of Medicine, 3Hypertension Center STRIDE-7, Third Department of Medicine, Sotiria Hospital; National and Kapodistrian University of Athens; Athens Greece
| | | | - Paul K. Whelton
- Epidemiology; Tulane University School of Public; New Orleans Louisiana
| | - Jeffrey Whittle
- Clement J. Zablocki VA Medical Center, Primary Care; Medical College of Wisconsin, Internal Medicine; Milwaukee Wisconsin
| | | | - Vasilios Papademetriou
- Division of Nephrology and Hypertension; Georgetown University; Washington District of Columbia
| |
Collapse
|
31
|
Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller EPR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71:2176-2198. [PMID: 29146534 PMCID: PMC8654280 DOI: 10.1016/j.jacc.2017.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
Collapse
|
32
|
Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK, Ambrosius WT, Beddhu S, Cheung AK, Fine LJ, Lewis CE, Rahman M, Reboussin DM, Rocco MV, Oparil S, Wright JT. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 2018. [PMID: 29531173 DOI: 10.1161/hypertensionaha.117.10479] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent publications have stated that the blood pressure (BP) measurement technique used in SPRINT (Systolic Blood Pressure Intervention Trial) was unattended. However, the SPRINT protocol does not address the issue of attendance. A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff. There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time (always alone), 2247 at 25 sites that had personnel in the room the entire time (never alone), 1746 at 19 sites that left the participant alone only during the rest period (alone for rest), and 570 at 6 sites that left the participant alone only during the BP readings (alone for BP measurement). Similar systolic and diastolic BPs within randomized groups were noted during follow-up at the majority of visits in all 4 measurement categories. In the always alone and never alone categories, the intensive group had a similarly reduced risk for the primary outcome compared with the standard group (hazard ratio, 0.62; 95% confidence interval, 0.51-0.76 and hazard ratio, 0.64; 95% confidence interval, 0.46-0.91, respectively; pairwise interaction P value, 0.88); risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories. Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
Collapse
Affiliation(s)
- Karen C Johnson
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH.
| | - Paul K Whelton
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - William C Cushman
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Jeffrey A Cutler
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Gregory W Evans
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Joni K Snyder
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Walter T Ambrosius
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Srinivasan Beddhu
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Alfred K Cheung
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Lawrence J Fine
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Cora E Lewis
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Mahboob Rahman
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - David M Reboussin
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Michael V Rocco
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Suzanne Oparil
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Jackson T Wright
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | | |
Collapse
|
33
|
Rocco MV, Sink KM, Lovato LC, Wolfgram DF, Wiegmann TB, Wall BM, Umanath K, Rahbari-Oskoui F, Porter AC, Pisoni R, Lewis CE, Lewis JB, Lash JP, Katz LA, Hawfield AT, Haley WE, Freedman BI, Dwyer JP, Drawz PE, Dobre M, Cheung AK, Campbell RC, Bhatt U, Beddhu S, Kimmel PL, Reboussin DM, Chertow GM. Effects of Intensive Blood Pressure Treatment on Acute Kidney Injury Events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis 2017; 71:352-361. [PMID: 29162340 DOI: 10.1053/j.ajkd.2017.08.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 04/07/2017] [Accepted: 08/25/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treating to a lower blood pressure (BP) may increase acute kidney injury (AKI) events. STUDY DESIGN Data for AKI resulting in or during hospitalization or emergency department visits were collected as part of the serious adverse events reporting process of the Systolic Blood Pressure Intervention Trial (SPRINT). SETTING & PARTICIPANTS 9,361 participants 50 years or older with 1 or more risk factors for cardiovascular disease. INTERVENTIONS Participants were randomly assigned to a systolic BP target of <120 (intensive arm) or <140mmHg (standard arm). OUTCOMES & MEASUREMENTS Primary outcome was the number of adjudicated AKI events. Secondary outcomes included severity of AKI and degree of recovery of kidney function after an AKI event. Baseline creatinine concentration was defined as the most recent SPRINT outpatient creatinine value before the date of the AKI event. RESULTS There were 179 participants with AKI events in the intensive arm and 109 in the standard arm (3.8% vs 2.3%; HR, 1.64; 95% CI, 1.30-2.10; P<0.001). Of 288 participants with an AKI event, 248 (86.1%) had a single AKI event during the trial. Based on modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria for severity of AKI, the number of AKI events in the intensive versus standard arm by KDIGO stage was 128 (58.5%) versus 81 (62.8%) for AKI stage 1, 42 (19.2%) versus 18 (14.0%) for AKI stage 2, and 42 (19.2%) versus 25 (19.4%) for AKI stage 3 (P=0.5). For participants with sufficient data, complete or partial resolution of AKI was seen for 169 (90.4%) and 9 (4.8%) of 187 AKI events in the intensive arm and 86 (86.9%) and 4 (4.0%) of 99 AKI events in the standard arm, respectively. LIMITATIONS Trial results are not generalizable to patients with diabetes mellitus or without risk factors for cardiovascular disease. CONCLUSIONS More intensive BP lowering resulted in more frequent episodes of AKI. Most cases were mild and most participants had complete recovery of kidney function. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT01206062.
Collapse
Affiliation(s)
- Michael V Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC.
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Laura C Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Dawn F Wolfgram
- Section of Nephrology, Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI; Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Thomas B Wiegmann
- Department of Clinical Research, Veterans Affairs Hospital, Kansas City, MO
| | - Barry M Wall
- University of Tennessee Health Science Center, Memphis, TN; Department of Veterans Affairs Medical Center, Memphis, TN
| | - Kausik Umanath
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI
| | | | - Anna C Porter
- Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Roberto Pisoni
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Julia B Lewis
- Division of Nephrology/Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - James P Lash
- Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Lois A Katz
- VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY
| | - Amret T Hawfield
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - William E Haley
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Jamie P Dwyer
- Division of Nephrology/Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - Paul E Drawz
- Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, MN
| | - Mirela Dobre
- Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT; Medical Service, Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT
| | - Ruth C Campbell
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Udayan Bhatt
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Srinivasan Beddhu
- Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT; Medical Service, Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - David M Reboussin
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | | |
Collapse
|
34
|
Reboussin DM, Allen NB, Griswold ME, Guallar E, Hong Y, Lackland DT, Miller EPR, Polonsky T, Thompson-Paul AM, Vupputuri S. Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e116-e135. [PMID: 29133355 DOI: 10.1161/hyp.0000000000000067] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.
Collapse
|
35
|
Bress AP, King JB, Kreider KE, Beddhu S, Simmons DL, Cheung AK, Zhang Y, Doumas M, Nord J, Sweeney ME, Taylor AA, Herring C, Kostis WJ, Powell J, Rastogi A, Roumie CL, Wiggers A, Williams JS, Yunis R, Zias A, Evans GW, Greene T, Rocco MV, Cushman WC, Reboussin DM, Feinglos MN, Papademetriou V. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017; 40:dc170885. [PMID: 28793997 PMCID: PMC5606306 DOI: 10.2337/dc17-0885] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/14/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether the effects of intensive (<120 mmHg) compared with standard (<140 mmHg) systolic blood pressure (SBP) treatment are different among those with prediabetes versus those with fasting normoglycemia at baseline in the Systolic Blood Pressure Intervention Trial (SPRINT). RESEARCH DESIGN AND METHODS This was a post hoc analysis of SPRINT. SPRINT participants were categorized by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose <100 mg/dL). The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment among those with prediabetes and normoglycemia. RESULTS Among 9,361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (P value for interaction 0.30). For all-cause mortality, the hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (P value for interaction 0.74). Effects of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia (all interaction P > 0.05). CONCLUSIONS In SPRINT, the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia.
Collapse
Affiliation(s)
- Adam P Bress
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT
- VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Jordan B King
- Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO
| | | | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Debra L Simmons
- VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yingying Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Michael Doumas
- Washington Veterans Affairs Medical Center, Washington, DC
| | - John Nord
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Mary Ellen Sweeney
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Addison A Taylor
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX
| | - Charles Herring
- Department of Pharmacy Practice, Campbell University, Buies Creek, NC
| | - William J Kostis
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - James Powell
- Division of General Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Anjay Rastogi
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Christianne L Roumie
- VA Tennessee Valley Healthcare System Geriatrics Research Education Clinical Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Wiggers
- Department of Medicine, CWRU School of Medicine, Cleveland, OH
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, and Harvard Medical School, and VA Boston Healthcare Systems, Boston, MA
| | - Reem Yunis
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Athena Zias
- Northport VA Medical Center, Northport, NY
- Stony Brook University School of Medicine, Stony Brook, NY
| | - Greg W Evans
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tom Greene
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Michael V Rocco
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - William C Cushman
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN
| | - David M Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark N Feinglos
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | | |
Collapse
|
36
|
Chang TI, Reboussin DM, Chertow GM, Cheung AK, Cushman WC, Kostis WJ, Parati G, Raj D, Riessen E, Shapiro B, Stergiou GS, Townsend RR, Tsioufis K, Whelton PK, Whittle J, Wright JT, Papademetriou V. Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 2017; 70:751-758. [PMID: 28760939 DOI: 10.1161/hypertensionaha.117.09788] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/10/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP using measurements taken during the 3-,6-, 9-, and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease, and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV whereas angiotensin-converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events (n=324 primary end points; adjusted hazard ratio, 1.20; 95% confidence interval, 0.85-1.69, highest versus lowest quintile) nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted hazard ratio, 1.92; confidence interval, 1.22-3.03) although the association of OBPV overall with all-cause mortality was marginal (P=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
Collapse
Affiliation(s)
- Tara I Chang
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - David M Reboussin
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Glenn M Chertow
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Alfred K Cheung
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - William C Cushman
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - William J Kostis
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Gianfranco Parati
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Dominic Raj
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Erik Riessen
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Brian Shapiro
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - George S Stergiou
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Raymond R Townsend
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Konstantinos Tsioufis
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Paul K Whelton
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Jeffrey Whittle
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Jackson T Wright
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Vasilios Papademetriou
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.).
| |
Collapse
|
37
|
Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, Cushman WC, Hawfield AT, Johnson KC, Lewis CE, Oparil S, Rocco MV, Sink KM, Whelton PK, Wright JT, Basile J, Beddhu S, Bhatt U, Chang TI, Chertow GM, Chonchol M, Freedman BI, Haley W, Ix JH, Katz LA, Killeen AA, Papademetriou V, Ricardo AC, Servilla K, Wall B, Wolfgram D, Yee J. Effects of Intensive BP Control in CKD. J Am Soc Nephrol 2017. [PMID: 28642330 DOI: 10.1681/asn.2017020148] [Citation(s) in RCA: 293] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; n=1330) or <140 mm Hg (standard group; n=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD (P values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.
Collapse
Affiliation(s)
- Alfred K Cheung
- Division of Nephrology and Hypertension and .,Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University Hospitals, Cleveland, Ohio.,Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - David M Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Timothy E Craven
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Kaycee M Sink
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jackson T Wright
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University Hospitals, Cleveland, Ohio
| | - Jan Basile
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Primary Care Research, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension and.,Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Udayan Bhatt
- Division of Nephrology, Ohio State University Medical Center, Columbus, Ohio
| | - Tara I Chang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michel Chonchol
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - William Haley
- Division of Nephrology and Hypertension, Mayo Clinic Florida, Jacksonville, Florida
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, California
| | - Lois A Katz
- Medical Service, Veterans Affairs New York Harbor Healthcare System, New York, New York.,Department of Medicine, New York University School of Medicine, New York, New York
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Vasilios Papademetriou
- Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Ana C Ricardo
- Department of Medicine, Division of Nephrology, University of Illinois, Chicago, Illinois
| | - Karen Servilla
- Renal Section, Medicine Service, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
| | - Barry Wall
- Nephrology Section, Internal Medicine, Memphis Veterans Affairs Medical Center, Memphis, Tennessee.,Department of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Dawn Wolfgram
- Section of Nephrology, Department of Medicine, Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin; and
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | | |
Collapse
|
38
|
Shechter A, Foster GD, Lang W, Reboussin DM, St-Onge MP, Zammit G, Newman AB, Millman RP, Wadden TA, Jakicic JM, Strotmeyer ES, Wing RR, Pi-Sunyer FX, Kuna ST. Effects of a lifestyle intervention on REM sleep-related OSA severity in obese individuals with type 2 diabetes. J Sleep Res 2017; 26:747-755. [PMID: 28560832 DOI: 10.1111/jsr.12559] [Citation(s) in RCA: 18] [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: 09/21/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid-eye movement (REM) sleep, and to determine if longitudinal changes in glycaemic control are related to changes in OSA severity during REM sleep over a 4-year follow-up. This was a randomized controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea-hypopnea index (AHI) during REM sleep (REM-AHI) and non-REM sleep (NREM-AHI) and glycated haemoglobin (HbA1c) at baseline and year 1, year 2 and year 4 follow-ups. Mean baseline values of REM-AHI were significantly higher than NREM-AHI in both groups. Both REM-AHI and NREM-AHI were reduced significantly more in ILI versus DSE, but these differences were attenuated slightly after adjustment for weight changes. Repeated-measure mixed-model analyses including data to year 4 demonstrated that changes in HbA1c were related significantly to changes in weight, but not to changes in REM-AHI and NREM-AHI. Compared to control, the ILI reduced REM-AHI and NREM-AHI during the 4-year follow-up. Weight, as opposed to REM-AHI and NREM-AHI, was related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycaemic control in T2D patients with OSA.
Collapse
Affiliation(s)
- Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.,Weight Watchers International, New York, NY, USA
| | - Wei Lang
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David M Reboussin
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Marie-Pierre St-Onge
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University, New York, NY, USA
| | | | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard P Millman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - John M Jakicic
- Physical Activity and Weight Management Research Center, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elsa S Strotmeyer
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - F Xavier Pi-Sunyer
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University, New York, NY, USA
| | - Samuel T Kuna
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | | |
Collapse
|
39
|
Affiliation(s)
- Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - David M. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lawrence J. Fine
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| |
Collapse
|
40
|
Abstract
Psoriasis is a chronic, disabling skin disease affecting up to 2 percent of the population. Little is known about how physical, psychological and social features of the illness interact to create a negative impact. In this article, a biopsychosocial model of the impact of psoriasis is described, and results from a survey of 317 psoriasis patients are presented. The types of functional disability, psychological distress and disease-related stressors are described for highly strained patients (i.e. those with disease-related suicidal ideation) and compared with less strained patients (i.e. those without suicidal ideation). As predicted by the model, significantly more disability, psychological distress and disease-related stressors are found among highly strained patients. Logistical regression analysis revealed that strain is more strongly associated with disability, distress and disease-related stress level than with disease severity. Implications for research and clinical interventions are discussed.
Collapse
Affiliation(s)
- Stephen R. Rapp
- Bowman Gray School of Medicine, Wake Forest University, NC, USA
| | - M. Lyn Exum
- Bowman Gray School of Medicine, Wake Forest University, NC, USA
| | | | | | - Alan Fleischer
- Bowman Gray School of Medicine, Wake Forest University, NC, USA
| | - Adele Clark
- Bowman Gray School of Medicine, Wake Forest University, NC, USA
| |
Collapse
|
41
|
|
42
|
Kline CE, Reboussin DM, Foster GD, Rice TB, Strotmeyer ES, Jakicic JM, Millman RP, Pi-Sunyer FX, Newman AB, Wadden TA, Zammit G, Kuna ST. The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes. Sleep 2016; 39:317-25. [PMID: 26446118 DOI: 10.5665/sleep.5436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 06/18/2015] [Accepted: 09/04/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention. METHODS As secondary analyses of a randomized controlled trial, 263 overweight/obese adults with type 2 diabetes and OSA participated in an intensive lifestyle intervention or education control condition. Measures of OSA severity, cardiorespiratory fitness, and body weight were obtained at baseline, year 1, and year 4. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents [METs]) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates. RESULTS At baseline, greater METs were associated with lower AHI (B [SE] = -1.48 [0.71], P = 0.038), but this relationship no longer existed (B [SE] = -0.24 [0.73], P = 0.75) after adjustment for weight (B [SE] = 0.31 [0.07], P < 0.0001). Fitness significantly increased at year 1 (+16.53 ± 28.71% relative to baseline), but returned to near-baseline levels by year 4 (+1.81 ± 24.48%). In mixed-model analyses of AHI change over time without consideration of weight change, increased fitness at year 1 (B [SE] = -0.15 [0.04], P < 0.0001), but not at year 4 (B [SE] = 0.04 [0.05], P = 0.48), was associated with AHI reduction. However, with weight change in the model, greater weight loss was associated with AHI reduction at years 1 and 4 (B [SE] = 0.81 [0.16] and 0.60 [0.16], both P < 0.0001), rendering the association between fitness and AHI change at year 1 nonsignificant (B [SE] = -0.04 [0.04], P = 0.31). CONCLUSIONS Among overweight/obese adults with type 2 diabetes, fitness change did not influence OSA severity change when weight change was taken into account. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identification number NCT00194259.
Collapse
Affiliation(s)
| | | | - Gary D Foster
- Temple University, Philadelphia, PA.,Weight Watchers International, New York, NY
| | | | | | | | | | | | | | | | | | - Samuel T Kuna
- University of Pennsylvania, Philadelphia PA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | |
Collapse
|
43
|
Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103-16. [PMID: 26551272 PMCID: PMC4689591 DOI: 10.1056/nejmoa1511939] [Citation(s) in RCA: 3871] [Impact Index Per Article: 430.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. RESULTS At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group. CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
Collapse
|
44
|
Affiliation(s)
- William C Cushman
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Paul K Whelton
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Lawrence J Fine
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Jackson T Wright
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - David M Reboussin
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Karen C Johnson
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Suzanne Oparil
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | | |
Collapse
|
45
|
Shechter A, St-Onge MP, Kuna ST, Zammit G, RoyChoudhury A, Newman AB, Millman RP, Reboussin DM, Wadden TA, Jakicic JM, Pi-Sunyer FX, Wing RR, Foster GD. Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index. J Clin Sleep Med 2014; 10:1205-11. [PMID: 25325608 DOI: 10.5664/jcsm.4202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 06/26/2014] [Accepted: 07/20/2014] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES To determine if weight loss and/ or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/ obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). METHODS This was a randomized controlled trial including 264 overweight/ obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. RESULTS Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009). CONCLUSIONS Compared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/ obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT00194259.
Collapse
Affiliation(s)
| | | | - Samuel T Kuna
- University of Pennsylvania, Philadelphia, PA and Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Langefeld CD, Divers J, Pajewski NM, Hawfield AT, Reboussin DM, Bild DE, Kaysen GA, Kimmel PL, Raj DS, Ricardo AC, Wright JT, Sedor JR, Rocco MV, Freedman BI. Apolipoprotein L1 gene variants associate with prevalent kidney but not prevalent cardiovascular disease in the Systolic Blood Pressure Intervention Trial. Kidney Int 2014; 87:169-75. [PMID: 25029429 PMCID: PMC4281289 DOI: 10.1038/ki.2014.254] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/13/2022]
Abstract
Apolipoprotein L1 gene (APOL1) G1 and G2 coding variants are strongly associated with chronic kidney disease (CKD) in African Americans. Here APOL1 association was tested with baseline estimated glomerular filtration rate (eGFR), urine albumin:creatinine ratio (UACR), and prevalent cardiovascular disease (CVD) in 2,571 African Americans from the Systolic Blood Pressure Intervention Trial (SPRINT), a trial assessing effects of systolic blood pressure reduction on renal and CVD outcomes. Logistic regression models that adjusted for potentially important confounders tested for association between APOL1 risk variants and baseline clinical CVD (myocardial infarction, coronary or carotid artery revascularization) and CKD (eGFR under 60 ml/min/1.73m2 and/or UACR over 30 mg/g). African American SPRINT participants were 45.3% female with mean (median) age of 64.3 (63) years, mean arterial pressure 100.7 (100) mmHg, eGFR 76.3 (77.1) ml/min/1.73m2, UACR 49.9 (9.2) mg/g, and 8.2% had clinical CVD. APOL1 (recessive inheritance) was positively associated with CKD (odds ratio 1.37, 95% confidence interval 1.08–1.73) and log UACR estimated slope [β] 0.33) and negatively associated with eGFR (β −3.58), all significant. APOL1 risk variants were not significantly associated with prevalent CVD (1.02, 0.82–1.27). Thus, SPRINT data show that APOL1 risk variants are associated with mild CKD but not prevalent CVD in African American with a UACR under 1000 mg/g.
Collapse
Affiliation(s)
- Carl D Langefeld
- 1] Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA [2] Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jasmin Divers
- 1] Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA [2] Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas M Pajewski
- 1] Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA [2] Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amret T Hawfield
- Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David M Reboussin
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Diane E Bild
- Patient-Centered Outcomes Research Institute (PCORI), Washington, District of Columbia, USA
| | - George A Kaysen
- Medicine, Biochemistry and Molecular Medicine, University of California, Davis, Davis, California, USA
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Dominic S Raj
- Medicine-Nephrology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Ana C Ricardo
- Medicine-Nephrology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jackson T Wright
- Medicine-Hypertension, University Hospitals, Case Medical Center, Cleveland, Ohio, USA
| | - John R Sedor
- Medicine, Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael V Rocco
- Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barry I Freedman
- Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | |
Collapse
|
47
|
Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC, Fine LJ, Goff DC, Johnson KC, Killeen AA, Lewis CE, Oparil S, Reboussin DM, Rocco MV, Snyder JK, Williamson JD, Wright JT, Whelton PK. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials 2014; 11:532-46. [PMID: 24902920 DOI: 10.1177/1740774514537404] [Citation(s) in RCA: 377] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial. PURPOSE To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants. METHODS The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ≥50 years (no upper limit) with an average baseline systolic blood pressure ≥130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ≥15%, or age ≥75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease. RESULTS Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ≥75 years of age. LIMITATIONS Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned. CONCLUSIONS The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ≥75 years.
Collapse
Affiliation(s)
- Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Capri G Foy
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dan R Berlowitz
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Hospital, Bedford, MA, USA
| | - Alfred K Cheung
- Department of Internal Medicine, University of Utah and Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - William C Cushman
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN, USA
| | - Lawrence J Fine
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - David C Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David M Reboussin
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael V Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joni K Snyder
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | |
Collapse
|
48
|
Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, Newman AB, Wadden TA, Jakicic JM, Wing RR, Pi-Sunyer FX, Foster GD. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013; 36:641-649A. [PMID: 23633746 DOI: 10.5665/sleep.2618] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. DESIGN Randomized controlled trial with follow-up at 1, 2, and 4 years. SETTING 4 Look AHEAD clinical centers. PARTICIPANTS Two hundred sixty-four obese adults with type 2 diabetes and OSA. INTERVENTIONS Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. MEASUREMENTS Change in apnea-hypopnea index on polysomnogram. RESULTS The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). CONCLUSIONS Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.
Collapse
|
49
|
Neiberg RH, Wing R, Bray GA, Reboussin DM, Rickman AD, Johnson KC, Kitabchi AE, Faulconbridge L, Kitzman D, Espeland MA. Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD Study. Obesity (Silver Spring) 2012; 20:2048-56. [PMID: 22327053 PMCID: PMC3632374 DOI: 10.1038/oby.2012.33] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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] [Indexed: 11/08/2022]
Abstract
This article provides an assessment of the associations that weight-loss patterns during the first year of an intensive lifestyle intervention have with 4-year maintenance and health outcomes. Two components described patterns of weight change during the first year of intervention: one reflected the typical pattern of weight loss over the 12 months, but distinguished those who lost larger amounts across the monthly intervals from those who lost less. The second component reflected the weight change trajectory, and distinguished a pattern of initial weight loss followed by regain vs. a more sustained pattern of weight loss. Two thousand four hundred and thirty eight individuals aged 45-76 years with type 2 diabetes mellitus, who enrolled in the weight-loss intervention of a randomized clinical trial, were assigned scores according to how their weight losses reflected these patterns. Relationships these scores had with weight losses and health outcomes (glycosolated hemoglobin--hemoglobin A1c (HbA1c); systolic blood pressure, high-density lipoprotein (HDL)-cholesterol, and triglycerides) over 4 years were described. When compared to those with lower scores on the two components, both individuals who had larger month-to-month weight losses in year 1 and whose weight loss was more sustained during the first year had better maintenance of weight loss over 4 years, independent of characteristics traditionally linked to weight loss success (P < 0.001). While relationships with year 4 weight loss were stronger, the pattern of larger monthly weight loss during year 1 was also independently predictive of year 4 levels of HbA1c, HDL-cholesterol, and systolic blood pressure.
Collapse
Affiliation(s)
| | - Rena Wing
- The Miriam Hospital Medical School, Providence RI
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
St-Onge MP, Zammit G, Reboussin DM, Kuna ST, Sanders MH, Millman R, Newman AB, Wadden TA, Wing RR, Pi-Sunyer FX, Foster GD. Associations of sleep disturbance and duration with metabolic risk factors in obese persons with type 2 diabetes: data from the Sleep AHEAD Study. Nat Sci Sleep 2012; 4:143-50. [PMID: 23620687 PMCID: PMC3630980 DOI: 10.2147/nss.s35797] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Some studies have found an association between sleep disturbances and metabolic risk, but none has examined this association in individuals with type 2 diabetes. The objective of this study was to determine the relationship between sleep disturbances and metabolic risk factors in obese patients with type 2 diabetes. PATIENTS AND METHODS This study was a cross-sectional examination of the relationship between sleep parameters (apnea/hypopnea index [AHI], time spent in various sleep stages) and metabolic risk markers (fasting glucose, hemoglobin A1c, lipids) using baseline data of the Sleep AHEAD cohort. Subjects (n = 305) were participants in Sleep AHEAD (Action for Health in Diabetes), a four-center ancillary study of the Look AHEAD study, a 16-center clinical trial of overweight and obese participants with type 2 diabetes, designed to assess the long-term effects of an intensive lifestyle intervention on cardiovascular events. All participants underwent one night of in-home polysomnography and provided a fasting blood sample. Regression analyses estimated the relationship between sleep variables and metabolic risk factors. Models were adjusted for study center, age, sex, race/ethnicity, waist circumference, smoking, alcohol intake, diabetes duration, and relevant medications. RESULTS Of 60 associations tested, only one was significant: fasting glucose was associated with sleep efficiency (estimate -0.53 ± [standard error] 0.26, P = 0.041). No associations were found between any of the sleep variables and lipid profile or hemoglobin A1c. CONCLUSIONS The present data show only weak associations between select sleep variables and metabolic risk factors and do not provide strong support for a role of sleep on metabolic abnormalities in obese patients with type 2 diabetes.
Collapse
Affiliation(s)
- Marie-Pierre St-Onge
- New York Obesity Research Center, St Luke's/Roosevelt Hospital, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|