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Kjeldsen SE, Egan BM, Burnier M, Narkiewicz K, Kreutz R, Mancia G. Highlights of the 2023 European Society of Hypertension Guidelines: what has changed in the management of hypertension in patients with cardiac diseases? Blood Press 2024; 33:2329571. [PMID: 38555859 DOI: 10.1080/08037051.2024.2329571] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo Ullevaal Hospital, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of SC, Greenville, SC, USA
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-University Medicine, Berlin, Germany
| | - Giuseppe Mancia
- Department of Medicine, University of Milan-Bicocca, Milan, Italy
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Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Kjeldsen SE, Muiesan ML, Thomopoulos C, Tsioufis K, Mancia G. Beta-blocker bashing and downgrading in hypertension management: a fashionable trend representing a matter of concern. J Hypertens 2024; 42:966-967. [PMID: 38690902 DOI: 10.1097/hjh.0000000000003735] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Reinhold Kreutz
- Charite-Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Germany
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Sverre E Kjeldsen
- Institute for Clinical Medicine, University of Oslo
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway
| | - Maria L Muiesan
- OC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
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Mancia G, Brunström M, Burnier M, Grassi G, Januszewicz A, Kjeldsen SE, Muiesan ML, Thomopoulos C, Tsioufis K, Kreutz R. Rationale for the Inclusion of β-Blockers Among Major Antihypertensive Drugs in the 2023 European Society of Hypertension Guidelines. Hypertension 2024; 81:1021-1030. [PMID: 38477109 PMCID: PMC11025609 DOI: 10.1161/hypertensionaha.124.22821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
We address the reasons why, unlike other guidelines, in the 2023 guidelines of the European Society of Hypertension β-blockers (BBs) have been regarded as major drugs for the treatment of hypertension, at the same level as diuretics, calcium channel blockers, and blockers of the renin-angiotensin system. We argue that BBs, (1) reduce blood pressure (the main factor responsible for treatment-related protection) not less than other drugs, (2) reduce pooled cardiovascular outcomes and mortality in placebo-controlled trials, in which there has also been a sizeable reduction of all major cause-specific cardiovascular outcomes, (3) have been associated with a lower global cardiovascular protection in 2 but not in several other comparison trials, in which the protective effect of BBs versus the other major drugs has been similar or even greater, with a slightly smaller or no difference of global benefit in large trial meta-analyses and a similar protective effect when comparisons extend to BBs in combination versus other drug combinations. We mention the large number of cardiac and other comorbidities for which BBs are elective drugs, and we express criticism against the exclusion of BBs because of their lower protective effect against stroke in comparison trials, because, for still uncertain reasons, differences in protection against cause-specific events (stroke, heart failure, and coronary disease) have been reported for other major drugs. These partial data cannot replace global benefits as the main deciding factor for drug choice, also because in the general hypertensive population whether and which type of event might occur is unknown.
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Affiliation(s)
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Sweden (Mattias Brunström)
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Switzerland (Michel Burnier)
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy (G.G.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.J.)
| | - Sverre E. Kjeldsen
- Institute for Clinical Medicine, University of Oslo, Norway (S.E.K.)
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway (S.E.K.)
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M.)
| | - Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens “Laiko”, Greece (C.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Reinhold Kreutz
- Charite-Universitaetsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Germany (R.K.)
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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Kjeldsen SE, Grassi G. The role of β-blockers in medical treatment. Curr Med Res Opin 2024; 40:1-2. [PMID: 38597062 DOI: 10.1080/03007995.2024.2324138] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Osloand, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Milan, Italy
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Mancia G, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Kjeldsen SE, Kreutz R. Rationale of treatment recommendations in the 2023 ESH hypertension guidelines. Eur J Intern Med 2024; 121:4-8. [PMID: 38216445 DOI: 10.1016/j.ejim.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
No abstract available.
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Affiliation(s)
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, Hippokration Hospital, University of Athens, Athens, Greece
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Institute for Clinical Medicine, and Ulleval Hospital, University of Oslo, Oslo, Norway
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin and Humboldt- Universitaet zu Berlin, Berlin, Germany
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Rist A, Sevre K, Wachtell K, Devereux RB, Aurigemma GP, Smiseth OA, Kjeldsen SE, Julius S, Pitt B, Burnier M, Kreutz R, Oparil S, Mancia G, Zannad F. The current best drug treatment for hypertensive heart failure with preserved ejection fraction. Eur J Intern Med 2024; 120:3-10. [PMID: 37865559 DOI: 10.1016/j.ejim.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.
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Affiliation(s)
- Aurora Rist
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kaja Sevre
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Wachtell
- Weill-Cornell Medicine, Division of Cardiology, New York City, NY, USA
| | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan School of Medicine, Worcester, MA, USA
| | - Otto A Smiseth
- Institute for Surgical Research and Department of Cardiology, University of Oslo, Rikshospitalet, Oslo, Norway
| | - Sverre E Kjeldsen
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Ullevaal Hospital, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bertram Pitt
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michel Burnier
- Centre Hospitalier Universitaire Vaudois, Service of Nephrology and Hypertension, Lausanne, Switzerland
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | | | - Faiez Zannad
- Inserm, Centre d'Investigations Cliniques-1433 and F-CRIN INI CRCT, Universite de Lorraine, Nancy, France
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Sevre K, Rist A, Wachtell K, Devereux RB, Aurigemma GP, Smiseth OA, Kjeldsen SE, Julius S, Pitt B, Burnier M, Kreutz R, Oparil S, Mancia G, Zannad F. What Is the Current Best Drug Treatment for Hypertensive Heart Failure With Preserved Ejection Fraction? Review of the Totality of Evidence. Am J Hypertens 2024; 37:1-14. [PMID: 37551929 PMCID: PMC10724525 DOI: 10.1093/ajh/hpad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. METHODS HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. RESULTS For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. CONCLUSIONS Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.
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Affiliation(s)
- Kaja Sevre
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
| | - Aurora Rist
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
| | - Kristian Wachtell
- Weill-Cornell Medicine, Division of Cardiology, New York City, New York, USA
| | - Richard B Devereux
- Weill-Cornell Medicine, Division of Cardiology, New York City, New York, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMassChan School of Medicine, Worcester, Massachusetts, USA
| | - Otto A Smiseth
- University of Oslo, Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo, Norway
| | - Sverre E Kjeldsen
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Stevo Julius
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Bertram Pitt
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Reinhold Kreutz
- Charité – Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Suzanne Oparil
- University of Alabama at Birmingham, Vascular Biology and Hypertension Program, Department of Medicine, Birmingham, Alabama, USA
| | | | - Faiez Zannad
- Universite de Lorraine, Inserm, Centre d’Investigations Cliniques-1433 and F-CRIN INI CRCT, Nancy, France
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Mancia G, Kjeldsen SE. Randomized Clinical Outcome Trials in Hypertension. Hypertension 2024; 81:17-23. [PMID: 37795644 PMCID: PMC10734776 DOI: 10.1161/hypertensionaha.123.21725] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
| | - Sverre E. Kjeldsen
- University of Oslo, Institute of Clinical Medicine, Medical Faculty, Oslo, Norway (S.E.K.)
- Departments of Cardiology and Nephrology, Oslo University Hospital, Ullevål, Norway (S.E.K.)
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Burnier M, Brguljan J, Algharably EAE, Kjeldsen SE, Narkiewicz K, Egan B, Oparil S, Kreutz R. Women's health, cardiovascular risk and hypertension: the perspective still needs to improve. Blood Press 2023; 32:2193648. [PMID: 37066492 DOI: 10.1080/08037051.2023.2193648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Michel Burnier
- Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jana Brguljan
- Department of Internal Medicine, Hypertension Division, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Engi Abd Elhady Algharably
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Brent Egan
- University of South Carolina, Greenville, SC, USA
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
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Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank JK, Cunha PG, Danser AHJ, Pinho RMD, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41:1874-2071. [PMID: 37345492 DOI: 10.1097/hjh.0000000000003480] [Citation(s) in RCA: 258] [Impact Index Per Article: 258.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
DOCUMENT REVIEWERS Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).
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Affiliation(s)
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Engi Abd Elhady Algharably
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Michel Azizi
- Université Paris Cité, Paris, France; AP-HP Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE
- INSERM, Paris
| | - Athanase Benetos
- Université de Lorraine, CHRU-Nancy, Department of Geriatric Medicine and INSERM DCAC, Nancy, France
| | - Claudio Borghi
- Department of Medical and Surgical Sciences-IRCCS AOU S. Orsola di Bologna, Bologna, Italy
| | - Jana Brguljan Hitij
- University Medical Centre Ljubljana, Department of Hypertension, Medical University Ljubljana, Ljubljana, Slovenia
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Spain
| | | | | | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital Senhora da Oliveira, Guimarães/Minho University
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - A H Jan Danser
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Maria Dorobantu
- University of Medicine and Pharmacy 'Carol Davila', The Romanian Academy
| | - Michalis Doumas
- 2nd Prop Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - María S Fernández-Alfonso
- Instituto Pluridisciplinar and Facultad de Farmacia, Universidad Complutense de Madrid
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, CHRU Tours
- Equipe d'Accueil EA4245, Université de Tours
- INI-CRCT, Tours, France
| | - Zoltán Járai
- South-Buda Center Hospital St. Imre University Hospital, Budapest & Semmelweis University, Budapest, Hungary
| | - Bojan Jelaković
- UHC Zagreb, Dept for Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Dragan Lovic
- Singidunum University, Clinic for internal Disease Intermedica Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Empar Lurbe
- Consorcio Hospital General Universitario de Valencia, Valencia
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid
- University of Valencia, Valencia, Spain
| | - Felix Mahfoud
- Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital and Saarland University, Homburg, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Krzystof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Teemu Niiranen
- Department of Internal Medicine, Turku University Hospital and University of Turku, Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padova, Padova, Italy
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Ospedale San Luca
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Atul Pathak
- Princess Grace Hospital Monaco (Centre Hospitalier Princesse Grace, CHPG)
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | - Josep Redon
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid
- Incliva Research Institute, University of Valencia
- CIBEROBN, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Pantelis Sarafidis
- 1st Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Roland Schmieder
- University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany
| | - Bart Spronck
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Stella Stabouli
- First Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki
| | - George Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Christoph Wanner
- Division of Nephrology, Wuerzburg University Clinic, Wuerzburg, Germany
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London (UCL); National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - Zhen-Yu Zhang
- Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Institute for Clinical Medicine, and Ullevål Hospital, University of Oslo, Oslo, Norway
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12
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Brunström M, Carlberg B, Kjeldsen SE. Effect of antihypertensive treatment in isolated systolic hypertension (ISH) - systematic review and meta-analysis of randomised controlled trials. Blood Press 2023; 32:2226757. [PMID: 37395100 DOI: 10.1080/08037051.2023.2226757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Isolated systolic hypertension (ISH) in middle-aged and elderly is associated with high cardiovascular risk, but no randomised controlled trial has assessed the effect of antihypertensive treatment in ISH using today's definition, i.e. systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg. METHODS A systematic review and meta-analysis of randomised controlled trials was performed. Studies with ≥1000 patient-years of follow-up, comparing more intensive versus less intensive BP targets, or active drug versus placebo, were included if the mean baseline SBP was ≥140 mmHg and the mean baseline DBP was <90 mmHg. The primary outcome was major adverse cardiovascular events (MACE). Relative risks from each trial were pooled in random-effects meta-analyses, stratified by baseline and attained SBP level. RESULTS Twenty-four trials, including 113,105 participants (mean age 67 years; mean blood pressure 149/83 mmHg) were included in the analysis. Overall, treatment reduced the risk of MACE by 9% (relative risk 0.91, 95% confidence interval 0.88-0.93). Treatment was more effective if baseline SBP was ≥160 mmHg (RR 0.77, 95% CIs 0.70-0.86) compared to 140-159 mmHg (RR 0.92, 95% CIs 0.89-0.95; p = 0.002 for interaction), but provided equal additional benefit across all attained SBP levels (RR 0.80, 95% CIs 0.70-0.92 for <130 mmHg, RR 0.92, 95% CIs 0.89-0.96 for 130-139 mmHg, and RR 0.87, 95% CIs 0.82-0.93 for ≥140 mmHg; p = 0.070 for interaction). CONCLUSIONS These findings support antihypertensive treatment of isolated systolic hypertension, regardless of baseline SBP, to target SBP <140 mmHg and even <130 mmHg if well tolerated.
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Affiliation(s)
- Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sverre E Kjeldsen
- Department of Cardiology, Institute for Clinical Medicine, Ullevaal Hospital, University of Oslo, Oslo, Norway
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13
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Kjeldsen SE, Egan BM, Narkiewicz K, Kreutz R, Burnier M, Oparil S, Mancia G. TIME to face the reality about evening dosing of antihypertensive drugs in hypertension. Blood Press 2023; 32:1-3. [PMID: 36369908 DOI: 10.1080/08037051.2022.2142512] [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: 11/15/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of South Carolina, Greenville, SC, USA
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Krzysztof Narkiewicz, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Persu A, Stoenoiu MS, Maes F, Kreutz R, Mancia G, Kjeldsen SE. Late outcomes of renal denervation are more favourable than early ones: facts or fancies? Clin Kidney J 2023; 16:2357-2364. [PMID: 38046011 PMCID: PMC10689164 DOI: 10.1093/ckj/sfad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Indexed: 12/05/2023] Open
Abstract
Following second-generation randomized trials, there is evidence that renal denervation (RDN) decreases blood pressure (BP), although to a lesser extent than suggested in the initial controlled and observational studies. The recent publication of the 36-month follow-up of the Symplicity HTN-3 trial has raised expectations, suggesting increasing, late benefits of the procedure, despite initially negative results. These findings come after those obtained at 36 months in the sham-controlled trial SPYRAL HTN-ON MED and in the Global Symplicity Registry. However, they are susceptible to biases inherent in observational studies (after unblinding for sham-control) and non-random, substantial attrition of treatment groups at 36 months, and used interpolation of missing BPs. More importantly, in SPYRAL HTN-ON MED and Symplicity HTN-3, long-term BP changes in patients from the initial RDN group were compared with those in a heterogeneous control group, including both control patients who did not benefit from RDN and patients who eventually crossed over to RDN. In crossover patients, the last BP before RDN was imputed to subsequent follow-up. In Symplicity HTN-3, this particular approach led to the claim of increasing long-term benefits of RDN. However, comparison of BP changes in patients from the RDN group and control patients who did not undergo RDN, without imputation of BPs from crossover patients, does not support this view. The good news is that despite the suggestion of sympathetic nerve regrowth after RDN in some animal models, there is no strong signal in favour of a decreasing effect of RDN over time, up to 24 or even 36 months. Still, current data do not support a long-term increase in the effect of RDN and the durability of RDN-related BP reduction remains to be formally demonstrated.
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Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Maria S Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Reinhold Kreutz
- Charité – Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway
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15
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Mariampillai JE, Kjeldsen SE. Real-world data show the effect of statins in primary prevention. Eur J Prev Cardiol 2023; 30:1881-1882. [PMID: 37439146 DOI: 10.1093/eurjpc/zwad231] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Julian E Mariampillai
- Department of Internal Medicine, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, Norway
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Burnier M, Narkiewicz K, Kjeldsen SE. How to optimize the use of diuretics in patients with heart failure? Kardiol Pol 2023; 81:944-949. [PMID: 37718589 DOI: 10.33963/v.kp.97315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
Considering the pathophysiology and clinical presentation of heart failure, using diuretics or drugs with diuretic properties is indispensable for adequate management of heart failure patients. However, in clinical practice, fluid expansion is often undiagnosed, and diuretic therapy is not always adequately titrated. Today, several drug classes with diuretic properties are available in addition to classical thiazides, thiazide-like, and loop diuretics. The purpose of this short review is to discuss different ways to optimize diuretic therapy using currently available drugs. Several approaches are considered, including a combination of diuretics to obtain a sequential nephron blockade, use of a drug combining a blocker of the renin-angiotensin system (RAS) and an inhibitor of the metabolism of natriuretic peptides (ARNI), prescription of potassium binders to maintain and up-titrate RAS blockers and mineralocorticoid antagonists, and finally use of inhibitors of renal reabsorption of glucose through the sodium-glucose cotransporter 2 system. Optimal use of these various drug classes should improve the quality of life and reduce the need for hospital admissions and mortality in heart failure patients.
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Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Hypertension Research Foundation, Saint-Légier, Switzerland.
- Medical University of Gdansk, Gdańsk, Poland.
| | | | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
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17
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Feinberg JB, Nielsen EE, Kjeldsen SE, Devereux RB, Gerdts E, Wachtell K, Olsen MH. Sex Differences in Atrial Fibrillation and Associated Complications in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study. Am J Hypertens 2023; 36:536-541. [PMID: 37382177 DOI: 10.1093/ajh/hpad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND There is no consensus on whether biological differences account for the higher risk of stroke seen in females compared to males with atrial fibrillation (AF). METHODS Capitalizing on The Losartan Intervention for Endpoint study, a multicenter randomized clinical trial randomizing 9,193 patients and followed for at least four years, we aimed to identify sex differences in the risk of stroke in the presence of AF in patients with hypertension and left ventricular hypertrophy (LVH). RESULTS 342 Patients had a history of AF, and 669 developed new-onset AF. History of AF and new-onset AF were more prevalent among males (5.0% vs. 2.9% and 3.0% vs. 0.9%) in patients aged 55-63 years, but the relative difference decreased with age. Females with new-onset AF tended to have a higher risk of stroke than males (HR 1.52 [95% CI 0.95-2.43]). However, females with a history of AF did not have a higher risk than males (HR 0.88 [95% CI 0.5-1.6]). In patients with new-onset AF, the relative higher stroke risk in females increased with age. Among patients with a history of AF, stroke risk was comparable and increased with age in both sexes. CONCLUSIONS Among patients with hypertension and LVH, females with new-onset AF had a higher risk of stroke than males, especially in patients above 64 years. However, the risk did not differ between the sexes among patients with a history of AF.
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Affiliation(s)
- Joshua B Feinberg
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Emil E Nielsen
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sverre E Kjeldsen
- Department of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Richard B Devereux
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristian Wachtell
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael H Olsen
- Department of Internal Medicine, Cardiology Section, Holbaek Hospital, Holbaek, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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18
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Kjeldsen SE, Mariampillai JE, Høieggen A. Uric acid and left ventricular mass in prediction of cardiovascular risk-New insight from the URRAH study. Eur J Intern Med 2023; 114:45-46. [PMID: 37179137 DOI: 10.1016/j.ejim.2023.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Sverre E Kjeldsen
- University of Oslo, Medical Faculty, Institute for Clinical Medicine, Oslo, Norway; Oslo University Hospital Ullevaal, Departments of Cardiology and Nephrology, Oslo, Norway.
| | | | - Aud Høieggen
- University of Oslo, Medical Faculty, Institute for Clinical Medicine, Oslo, Norway; Oslo University Hospital Ullevaal, Departments of Cardiology and Nephrology, Oslo, Norway
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19
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Heimark S, Mehlum MH, Mancia G, Søraas CL, Liestøl K, Wachtell K, Larstorp AC, Rostrup M, Mariampillai JE, Kjeldsen SE, Julius S, Weber MA. Middle-Aged and Older Patients With Left Ventricular Hypertrophy: Higher Mortality With Drug Treated Systolic Blood Pressure Below 130 mm Hg. Hypertension 2023. [PMID: 37350267 DOI: 10.1161/hypertensionaha.123.21454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Approximately 40% of people with hypertension have left ventricular hypertrophy (LVH) detected by ECG or echocardiography. Because patients with LVH have poor myocardial microcirculation, they may be too sensitive to lowering systolic blood pressure (SBP) too much due to a lack of myocardial perfusion pressure. We aimed to investigate whether the average achieved SBP <130 mm Hg may cause harm in patients with LVH in the Valsartan Antihypertensive Long-Term Use Evaluation trial (VALUE). METHODS Of the 15 245 VALUE participants, we identified 13 803 patients without cardiovascular events during the first 6 months after randomization. Of these, 2458 patients had electrocardiographic LVH (ECG-LVH). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other prespecified end points for patients who achieved average SBP 130 to 139 mm Hg (No-LVH group n=4863; ECG-LVH group n=929) and <130 mm Hg (No-LVH group n=2107; ECG-LVH group n=305). Reference groups were patients who achieved average SBP ≥140 mm Hg following the first excluded 6 months (No-LVH group n=4375; ECG-LVH group n=1224). RESULTS The No-LVH group achieving average SBP <130 mm Hg had a significantly lower incidence of several cardiovascular end points. The ECG-LVH group achieving average SBP <130 mm Hg had higher cardiac mortality (hazard ratio, 1.98 [95% CIs, 1.06-3.70]; P=0.032) and all-cause mortality (hazard ratio, 1.74 [95% CIs, 1.17-2.60]; P=0.007), and SBP <130 mm Hg was not associated with a reduction in any end point. CONCLUSIONS Our findings may be seen as a signal that caution is warranted when treating middle-aged and older patients with electrocardiographic or echocardiographic LVH to SBP <130 mm Hg.
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Affiliation(s)
- Sondre Heimark
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Nephrology, Oslo University Hospital, Ullevaal, Norway. (S.H.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Ullevaal, Norway. (M.H.M.)
| | | | - Camilla L Søraas
- Department of Environmental and Occupational Medicine, Oslo University Hospital, Ullevaal, Norway. (C.L.S.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Knut Liestøl
- Institute of Informatics, University of Oslo, Norway. (K.L.)
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (K.W.)
| | - Anne C Larstorp
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Norway. (A.C.L.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Morten Rostrup
- Institute of Basic Medical Sciences University of Oslo, Norway. (M.R.)
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Norway. (M.R.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | | | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway. (S.E.K.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Michael A Weber
- Department of Cardiovascular Medicine, SUNY Downstate College of Medicine, NY (M.A.W.)
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20
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Kjeldsen SE, Burnier M, Narkiewicz K, Kreutz R, Mancia G. Key questions regarding the SYMPLICITY HTN-3 trial. Lancet 2023; 401:1336-1337. [PMID: 37087164 DOI: 10.1016/s0140-6736(23)00340-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/10/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Sverre E Kjeldsen
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology and Department of Nephrology, Ullevaal Hospital, Oslo 0407, Norway.
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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21
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Egan BM, Kjeldsen SE, Narkiewicz K, Kreutz R, Burnier M. Single-pill combinations, hypertension control and clinical outcomes: potential, pitfalls and solutions. Blood Press 2022; 31:164-168. [DOI: 10.1080/08037051.2022.2095254] [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: 11/02/2022]
Affiliation(s)
| | - Sverre E. Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Charité – Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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22
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Narkiewicz K, Kjeldsen SE, Egan BM, Kreutz R, Burnier M. Masked hypertension in type 2 diabetes: never take normotension for granted and always assess out-of-office blood pressure. Blood Press 2022; 31:207-209. [PMID: 35941816 DOI: 10.1080/08037051.2022.2107483] [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: 11/02/2022]
Affiliation(s)
- Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Sverre E Kjeldsen
- Department of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of South Carolina, Greenville, South Carolina, USA
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Universitatsmedizin Berlin Institut fur Medizin- Pflegepadagogik und Pflegewissenschaft, Berlin, Germany
| | - Michel Burnier
- Department of Nephrology, University of Lausanne, Lausanne, Switzerland
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23
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Kjeldsen SE, Egan BM, Narkiewicz K, Kreutz R, Burnier M, Oparil S. Thirty years with LIFE-a randomized clinical trial with more than 200 published articles on clinical aspects of left ventricular hypertrophy. Blood Press 2022; 31:125-128. [PMID: 35674494 DOI: 10.1080/08037051.2022.2083578] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of South Carolina, Greenville, SC, USA
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Charité, Institute of Clinical Pharmacology and Toxicology, Medical University of Berlin, Berlin, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, University of Lausanne, Lausanne, Switzerland
| | - Suzanne Oparil
- Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
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Kjeldsen SE, Brunström M, Thomopoulos C, Carlberg B, Kreutz R, Mancia G. Blood pressure reduction and major cardiovascular events in people with and without type 2 diabetes. Lancet Diabetes Endocrinol 2022; 10:840. [PMID: 36427519 DOI: 10.1016/s2213-8587(22)00312-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Sverre E Kjeldsen
- University of Oslo, Faculty of Medicine, Department of Cardiology, Ullevaal Hospital, N-0407 Oslo, Norway.
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Reinhold Kreutz
- Charité - Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
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Esler M, Kjeldsen SE, Pathak A, Grassi G, Kreutz R, Mancia G. Diverse pharmacological properties, trial results, comorbidity prescribing and neural pathophysiology suggest European hypertension guideline downgrading of beta-blockers is not justified. Blood Press 2022; 31:210-224. [PMID: 36029011 DOI: 10.1080/08037051.2022.2110858] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Beta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trials. Hypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rate. Beta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic properties. This position is manifest by reference to another clinical context, beta-blocker treatment of heart failure, where unequivocally there is no class effect (no similar benefit from all beta-blockers); there are good and less good beta-blockers for heart failure. Analogous differences in beta-blocker efficacy is also likely in hypertension. Beta-blockers are widely used for the treatment of diseases comorbid with hypertension, in approximately 50 different concomitant medical conditions that are frequent in patients with hypertension, leading to many de facto beta-blocker first choices in clinical practice. Thus, beta-blockers should be regarded as relevant first choices for hypertension in clinical practice, particularly if characterised by a long half-life, highly selective beta-1 blocking activity and no intrinsic agonist properties.SUMMARYBeta-blockers have solid documentation in preventing cardiovascular complications in the treatment of hypertension; atenolol, metoprolol, oxprenolol and propranolol demonstrate proven cardiovascular prevention in hypertension mega-trialsHypertension is characterised by activation of the sympathetic nervous system from early to late phases, which makes beta-blockers an appropriate treatment seen from a pathophysiological viewpoint, especially in patients with an elevated heart rateBeta-blockers represent a heterogenous class of drugs with regard to both pharmacodynamic and pharmacokinetic propertiesThis position is manifest by reference to another clinical context, beta-blocker treatment of heart failure, where unequivocally there is no class effect (no similar benefit from all beta-blockers); there are good and less good beta-blockers for heart failureAnalogous differences in beta-blocker efficacy is also likely in hypertensionBeta-blockers are widely used for the treatment of diseases comorbid with hypertension, in approximately 50 different concomitant medical conditions that are frequent in patients with hypertension, leading to many de facto beta-blockers first choices in clinical practiceThese observations, in totality, inform our opinion that beta-blockers are relevant first choices for hypertension in clinical practice and this fact needs highlightingFurther, these arguments suggest European hypertension guideline downgrading of beta-blockers is not justified.
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Affiliation(s)
- Murray Esler
- Baker Heart and Diabetes Institute, Human Neurotransmitters Laboratory and Monash University, Melbourne, Australia
| | - Sverre E Kjeldsen
- Department of Cardiology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Atul Pathak
- Department of Cardiology, and UMR UT3 CNRS 5288 Hypertension and heart failure: molecular and clinical investigations, INI-CRCT F-CRIN, GREAT Networks, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | | | - Reinhold Kreutz
- Charité - Medical University of Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
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Halvorsen LV, Bergland OU, Søraas CL, Larstorp ACK, Hjørnholm U, Kjær VN, Kringen MK, Clasen PE, Haldsrud R, Kjeldsen SE, Rostrup M, Fadl Elmula FEM, Opdal MS, Høieggen A. Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy. J Am Heart Assoc 2022; 11:e025879. [PMID: 36073648 DOI: 10.1161/jaha.121.025879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.
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Affiliation(s)
- Lene V Halvorsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ola U Bergland
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Section for Environmental and Occupational Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Anne Cecilie K Larstorp
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Medical Biochemistry Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Vibeke N Kjær
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | | | - Per-Erik Clasen
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Renate Haldsrud
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Sverre E Kjeldsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Cardiology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Basic Medical Sciences University of Oslo Norway
| | - Fadl Elmula M Fadl Elmula
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Mimi S Opdal
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
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Wachtell K, Julius S, Okin PM, Greve AM, Devereux RB, Oparil S, Kjeldsen SE, Boman K. Abstract P221: Cardiovascular Outcomes In Hypertensive Patients Who Discontinue Study Medication In A Large Outcome Trial. The Life Study. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Patient discontinuation of study medication during a hypertension outcome trial has implications for study power. We aimed to assess patient characteristics and outcomes in patients with hypertension and left ventricular hypertrophy (LVH) who discontinued the study drug but otherwise remained in the study until the end of follow-up.
Methods:
In patients who discontinued vs. those continuing, Cox proportional hazards models identified baseline variables that had a significant impact on the occurrence of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 9,193 hypertensive patients and LVH in the LIFE study.
Results:
During a mean follow-up of 4.8 years, 3,281 patients (35.7%) discontinued one or more days, not counting death as a reason for discontinuation. The distribution of days to discontinuation was highly skewed towards the first part of the study; the 25
th
percentile was at day 161, and the median was at day 669. Reasons for discontinuation were a clinical adverse event (50%), a secondary study endpoint (19%), required study therapy (11%), withdrawal (2%), administrative (18%), and lost to follow-up (0.2%). Those who discontinued were older, more often male, had slightly lower body mass index, higher systolic and lower diastolic pressure, higher Framingham Risk Score (FRS), and more ECG LVH determined by either Cornell product or Sokolow-Lyon criteria. Patients randomized to losartan discontinued less than those randomized to atenolol. Multivariate analyses showed that older age, male gender, FRS, Sokolow-Lyon criteria, atenolol treatment as well as a history of pre-study myocardial infarction, cerebral vascular disease, peripheral vascular disease, and atrial fibrillation as well as lower levels of hemoglobin, higher serum creatinine and lower cholesterol independently predicted discontinuation.
Conclusions:
Patients discontinued during the first part of the study mainly due to a clinical adverse event. Patients who discontinued the study drug had, on average, more previous and concurrent cardiovascular disease than those who continued until the study ended. Thus, too high risk in an outcome study implies early drug discontinuation and thus reduction in the study power.
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Burnier M, Kjeldsen SE, Narkiewicz K, Egan B, Kreutz R. Hypertension management during the COVID-19 pandemic: what can we learn for the future? Blood Press 2022; 31:47-49. [DOI: 10.1080/08037051.2022.2058909] [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: 11/02/2022]
Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sverre E. Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway
- Department of Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Brent Egan
- University of South Carolina, Greenville, SC, USA
| | - Reinhold Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
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Mancia G, Kjeldsen SE, Kreutz R, Pathak A, Grassi G, Esler M. Individualized Beta-Blocker Treatment for High Blood Pressure Dictated by Medical Comorbidities: Indications Beyond the 2018 European Society of Cardiology/European Society of Hypertension Guidelines. Hypertension 2022; 79:1153-1166. [PMID: 35378981 DOI: 10.1161/hypertensionaha.122.19020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several hypertension guidelines have removed beta-blockers from their previous position as first-choice drugs for the treatment of hypertension. However, this downgrading may not be justified by available evidence because beta-blockers lower blood pressure as effectively as other major antihypertensive drugs and have solid documentation in preventing cardiovascular complications. Suspected inconveniences of beta-blockers such as increased risk of depression or erectile dysfunction may have been overemphasized, while patients with chronic obstructive pulmonary disease or peripheral artery disease, that is, conditions in which their use was previously restricted, will benefit from beta-blocker therapy. Besides, evidence that from early to late phases, hypertension is accompanied by activation of the sympathetic nervous system makes beta-blockers pathophysiologically an appropriate treatment in hypertension. Beta-blockers have favorable effects on a variety of clinical conditions that may coexist with hypertension, making their use either as specific treatment or as co-treatment potentially common in clinical practice. Guidelines typically limit recommendations on specific beta-blocker use to cardiac conditions including angina pectoris, postmyocardial infarction, or heart failure, with little or no mention of the additional cardiovascular or noncardiovascular conditions in which these drugs may be needed or preferred. In the present narrative review, we focus on multiple additional diseases and conditions that may occur and affect patients with hypertension, often more frequently than people without hypertension, and that may favor the choice of beta-blocker. Notwithstanding, beta-blockers represent an in-homogenous group of drugs and choosing beta-blockers with documented effect in prevention and treatment of disease is important for first choice in guidelines.
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Affiliation(s)
| | - Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.E.K.)
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Germany (R.K.)
| | - Atul Pathak
- Department of Cardiology, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco (A.P.)
| | - Guido Grassi
- University of Milano-Bicocca, Milan, Italy (G.M., G.G.)
| | - Murray Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, and Monash University, Melbourne, Australia (M.E.)
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Chinali M, Aurigemma GP, Gerdts E, Wachtell K, Okin PM, Muthiah A, Kjeldsen SE, Julius S, de Simone G, Devereux RB. Development of systolic dysfunction unrelated to myocardial infarction in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: While it is commonly thought that left ventricular (LV) systolic function may insidiously deteriorate in hypertensive patients, few prospective data are available to support this notion.
Methods: We evaluated 680 hypertensive patients (66 ± 7 years; 45% women) with electrocardiographic (ECG)-LV hypertrophy (ECG-LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echo-sub-study free of prevalent cardiovascular disease and with baseline ejection fraction (EF) ≥ 55%. Echocardiographic examinations were performed annually for 5 years during anti-hypertensive treatment. Development of reduced systolic function was defined as incident EF < 50%.
Results: During a mean follow-up of 4.8 ± 1 years, 37 patients developed reduced EF without an inter-current myocardial infarction (5.4%). In analysis of covariance, patients who developed reduced EF were more often men, had greater baseline LV diameter and LV mass, lower mean EF (all P < 0.05), and similar diastolic function indices. At the last available examination before EF reduction, independently of covariates, patients with reduced EF showed a significant increase in left atrium (LA) size, LV diameter, end-systolic stress and mitral E/A ratio, as compared to those who did not develop reduced EF (all P < 0.05). In time-varying Cox regression analysis, also controlling for baseline EF, predictors of developing reduced EF were higher in-treatment LV diameter [hazard ratio (HR) = 5.19 per cm; 95% confidence interval (CI): 2.58–10.41] and higher in-treatment mitral E/A ratio (HR = 2.37 per unit; 95% CI: 1.58–3.56; both P < 0.0001).
Conclusions: In treated hypertensive patients with ECG-LVH at baseline, incident reduced EF is associated with the development of dilated LV chamber and signs of increased LV filling pressure (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Marcello Chinali
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy; Division of Cardiology, Bambino Gesù Children’s Hospital–IRCSS, 001655 Rome, Italy; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Gerard P. Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 02241, USA
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Anujan Muthiah
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Giovanni de Simone
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA; Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Bang CN, Li Z, Stokke IM, Kjeldsen SE, Julius S, Hille DA, Wachtell K, Devereux RB, Okin PM. Incident left bundle branch block predicts cardiovascular events and death in hypertensive patients with left ventricular hypertrophy. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Whether incident left bundle branch block (LBBB) is associated with increased cardiovascular (CV) morbidity and mortality in treated hypertensive patients with left ventricular hypertrophy (LVH) is unknown. Thus, the present study aimed to examine CV outcomes of incident LBBB in treated hypertensive patients with LVH.
Methods: In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, 9,193 hypertensive patients with LVH on screening electrocardiogram (ECG) were randomized to losartan or atenolol based treatment. Participants (n = 8,567) did not have LBBB (Minnesota code 7.1) on baseline ECG. Cox regression models controlling for significant covariates assessed independent associations of incident LBBB with CV events and all-cause mortality during 4.8 years mean follow-up.
Results: Annual follow-up ECGs identified 295 patients (3.4%) with incident LBBB associated with male gender (P < 0.05), older age, higher Cornell voltage (both P < 0.005) and history of diabetes, isolated systolic hypertension and prevalent CV disease. When adjusted for the history of previous CV disease, diabetes, isolated systolic hypertension, the Framingham risk score, ECG-LVH and randomized study treatment, Cox regression models showed that incident LBBB predicted higher risk of the composite endpoint CV death, myocardial infarction and stroke [hazard ratio (HR) 1.9, 95% confidence intervals (CIs) 1.3–2.9, P < 0.001], CV death (HR 3.0, 95% CIs 1.84–5.0, P < 0.001), heart failure (HR 3.6, 95% CIs 1.9–6.6, P < 0.001) and all-cause mortality (HR 3.0, 95% CIs 2.0–4.3, P < 0.001).
Conclusions: These data suggest that among hypertensive patients with ECG-LVH receiving aggressive antihypertensive therapy, incident LBBB independently predicts increased risk of subsequent CV events including congestive heart failure and CV and all-cause mortality (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Casper N. Bang
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, 2200 Copenhagen, Denmark
| | - Zhibin Li
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ildri M. Stokke
- 3Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 3Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Darcy A. Hille
- 5Merck Research Laboratories, North Wales, PA 19454, USA
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Bang CN, Greve AM, Køber L, Muthiah A, Kjeldsen SE, Julius S, Wachtell K, Devereux RB, Okin PM. Incident atrial fibrillation and heart failure in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: The present study investigated the appearance and severity of atrial fibrillation (AF) and heart failure (HF) in 8,702 hypertensive patients with left ventricular hypertrophy (LVH) receiving antihypertensive treatment in a prospective trial.
Methods: Patients who had a history of AF or HF were not included, and the participants had sinus rhythm when they were randomly allocated to blinded study medication. Endpoints were adjudicated.
Results: Incident AF occurred in 679 patients (7.8%) and HF in 246 patients (2.8%) during 4.7 ± 1.1 years mean follow-up. Incident AF was associated with a > 4-fold increased risk of developing subsequent HF [hazards ratios (HRs) = 4.7; 95% confidence intervals (CIs), 3.1–7.0; P < 0.001] in multivariable Cox analyses adjusting for age, sex, race, randomized treatment, standard cardiovascular risk factors and incident myocardial infarction. The development of HF as a time-dependent variable was associated with a multivariable-adjusted 3-fold increase of the primary study endpoint (HRs = 3.11; 95% CIs, 1.52–6.39; P < 0.001) which was a composite of myocardial infarction, stroke or cardiovascular death. Incident HF was associated with a > 3-fold increased risk of developing subsequent AF (HRs = 3.3; 95% CIs, 2.3–4.9; P < 0.001). This development of AF was associated with a > 2-fold increase of the composite primary study endpoint in multivariable Cox analysis (HRs = 2.26; 95% CIs, 1.09–4.67; P = 0.028).
Conclusions: Incident atrial fibrillation and heart failure are associated with increased risk of the other in treated hypertensive patients with left ventricular hypertrophy. Such high-risk hypertensive patients who subsequently develop both atrial fibrillation and heart failure have particular high risk of composite myocardial infarction, stroke or cardiovascular death (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Casper N. Bang
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, 2200 Copenhagen, Denmark
| | - Anders M. Greve
- 3Department of Clinical Biochemistry, Rigshopsitalet, 2200 Copenhagen, Denmark
| | - Lars Køber
- 4The Heart Center, Department of Cardiology, Rigshospitalet, 2200 Copenhagen, Denmark
| | - Anujan Muthiah
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Zacks ES, Stokke IM, Wachtell K, Hille DA, Høieggen A, Kjeldsen SE, Julius S, Gerdts E, Okin PM, Devereux RB. Time-varying serum uric acid predicts new-onset atrial fibrillation in treated hypertensive patients. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study showed less new-onset atrial fibrillation (AF) in hypertensive patients receiving losartan- vs. atenolol-based treatment. Because losartan reduces serum uric acid (SUA) levels, the aim of the present study was to investigate relations of SUA with new-onset AF in the study.
Methods: Hypertensive patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) and no prior AF (n = 8,243) were treated for 5.0 ± 0.4 years with losartan- or atenolol-based therapy. Associations of SUA with new-onset AF documented by Minnesota coding were assessed by Cox models using SUA and systolic blood pressure as time-varying covariates to take into account changes of SUA related to losartan or diuretic treatment, changes in renal function, and aging.
Results: Time-varying SUA was associated with new AF defined by Minnesota code [hazard ratio (HR) = 1.19 per 16.8 μmol/L (1 mg/dL), (95% confidence intervals (CIs), 1.12–1.26), P < 0.0001], independent of losartan treatment [HR = 0.75 (95% CIs, 0.61–0.93), P = 0.007], older age [HR = 1.95 per 7.0 years (95% CIs, 1.73–2.20), P < 0.0001], male sex [HR = 1.46 (95% CIs, 1.09–1.94), P = 0.010] and higher Cornell voltage-duration product [HR = 1.10 per 1,023 ms·mm (95% CIs, 1.01–1.21), P = 0.034]. Similar results were obtained in Cox models with SUA levels partitioned according to baseline quartiles and in which AF was defined by physician reports or by both Minnesota coding and physician reports.
Conclusions: In-treatment SUA is a strong predictor for new-onset AF in hypertensive patients, independent of effects of antihypertensive treatment, age, sex, and ECG-LVH. Further research is needed to clarify how uric acid may provoke AF (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Eran S. Zacks
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ildri M. Stokke
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Darcy A. Hille
- 3Merck Research Laboratories, North Wales, PA 19454, USA
| | - Aud Høieggen
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eva Gerdts
- 5Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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Lilja-Cyron A, Bang CN, Gerdts E, Larstorp AC, Kjeldsen SE, Julius S, Okin PM, Wachtell K, Devereux RB. Aortic Root Dilatation in Hypertensive Patients with Left Ventricular Hypertrophy–Application of A New Multivariate Predictive Model. The Life Study. Rev Cardiovasc Med 2022; 23:95. [DOI: 10.31083/j.rcm2303095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022] Open
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Burnier M, Kjeldsen SE. A 30th anniversary and a glimpse of the future. Blood Press 2022; 31:1-3. [DOI: 10.1080/08037051.2021.2021638] [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: 11/02/2022]
Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sverre E. Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
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Affiliation(s)
- Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
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Affiliation(s)
- Sverre E Kjeldsen
- Faculty of Medicine, University of Oslo.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Giuseppe Mancia
- Clinica Medica, University Milano-Bicocca, Milan, Italy.,Policlinico di Monza Milan, Italy
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. The five RADIANCE-HTN and SPYRAL-HTN randomised studies suggest that the BP lowering effect of RDN corresponds to the effect of one antihypertensive drug. Blood Press 2021; 30:327-331. [PMID: 34714185 DOI: 10.1080/08037051.2021.1995975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Falk RS, Mariampillai JE, Prestgaard EE, Heir T, Bodegård J, Robsahm TE, Grundvold I, Skretteberg PT, Engeseth K, Bjornholt JV, Stavem K, Liestøl K, Sandvik L, Thaulow E, Erikssen G, Kjeldsen SE, Gjesdal K, Erikssen JE. The Oslo Ischaemia Study: cohort profile. BMJ Open 2021; 11:e049111. [PMID: 34645662 PMCID: PMC8515426 DOI: 10.1136/bmjopen-2021-049111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives. PARTICIPANTS In 1972-1975, 2014 healthy men, 40-59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017. FINDINGS TO DATE The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain ('silent ischaemia'), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors. FUTURE PLANS Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens.
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Affiliation(s)
- Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | | | - Trond Heir
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Irene Grundvold
- Department of Cardiology, Akershus University Hospital, Lorenskog, Lørenskog, Norway
| | | | - Kristian Engeseth
- Department of Cardiology, Akershus University Hospital, Lorenskog, Lørenskog, Norway
| | - Jorgen Vildershoj Bjornholt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Knut Stavem
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway
| | - Knut Liestøl
- Institute of Informatics, University of Oslo, Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Erik Thaulow
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Knut Gjesdal
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jan E Erikssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Narkiewicz K, Burnier M, Kjeldsen SE, Oparil S. Combining proteomics, home blood pressure telemonitoring and patient empowerment to improve cardiovascular and renal protection. Blood Press 2021; 30:267-268. [PMID: 34586009 DOI: 10.1080/08037051.2021.1975878] [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: 10/20/2022]
Affiliation(s)
- Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Rahimi K, Bidel Z, Nazarzadeh M, Copland E, Canoy D, Wamil M, Majert J, McManus R, Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, Black H, Boersma E, Brouwers FPJ, Brown M, Brugts JJ, Bulpitt CJ, Byington RP, Cushman WC, Cutler J, Devereaux RB, Dwyer JP, Estacio R, Fagard R, Fox K, Fukui T, Gupta AK, Holman RR, Imai Y, Ishii M, Julius S, Kanno Y, Kjeldsen SE, Kostis J, Kuramoto K, Lanke J, Lewis E, Lewis JB, Lievre M, Lindholm LH, Lueders S, MacMahon S, Mancia G, Matsuzaki M, Mehlum MH, Nissen S, Ogawa H, Ogihara T, Ohkubo T, Palmer CR, Patel A, Pfeffer MA, Pitt B, Poulter NR, Rakugi H, Reboldi G, Reid C, Remuzzi G, Ruggenenti P, Saruta T, Schrader J, Schrier R, Sever P, Sleight P, Staessen JA, Suzuki H, Thijs L, Ueshima K, Umemoto S, van Gilst WH, Verdecchia P, Wachtell K, Whelton P, Wing L, Woodward M, Yui Y, Yusuf S, Zanchetti A, Zhang ZY, Anderson C, Baigent C, Brenner BM, Collins R, de Zeeuw D, Lubsen J, Malacco E, Neal B, Perkovic V, Rodgers A, Rothwell P, Salimi-Khorshidi G, Sundström J, Turnbull F, Viberti G, Wang J, Chalmers J, Davis BR, Pepine CJ, Teo KK. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021; 398:1053-1064. [PMID: 34461040 PMCID: PMC8473559 DOI: 10.1016/s0140-6736(21)01921-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline. METHODS We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55-64 years, 65-74 years, 75-84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission. FINDINGS We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59-75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55-64 years, 128 506 (35·8%) 65-74 years, 54 016 (15·1%) 75-84 years, and 4788 (1·3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg reduction in systolic blood pressure for each age group were 0·82 (95% CI 0·76-0·88) in individuals younger than 55 years, 0·91 (0·88-0·95) in those aged 55-64 years, 0·91 (0·88-0·95) in those aged 65-74 years, 0·91 (0·87-0·96) in those aged 75-84 years, and 0·99 (0·87-1·12) in those aged 85 years and older (adjusted pinteraction=0·050). Similar patterns of proportional risk reductions were observed for a 3 mm Hg reduction in diastolic blood pressure. Absolute risk reductions for major cardiovascular events varied by age and were larger in older groups (adjusted pinteraction=0·024). We did not find evidence for any clinically meaningful heterogeneity of relative treatment effects across different baseline blood pressure categories in any age group. INTERPRETATION Pharmacological blood pressure reduction is effective into old age, with no evidence that relative risk reductions for prevention of major cardiovascular events vary by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mm Hg. Pharmacological blood pressure reduction should, therefore, be considered an important treatment option regardless of age, with the removal of age-related blood-pressure thresholds from international guidelines. FUNDING British Heart Foundation, National Institute of Health Research Oxford Biomedical Research Centre, Oxford Martin School.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
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Bergland OU, Halvorsen LV, Søraas CL, Hjørnholm U, Kjær VN, Rognstad S, Brobak KM, Aune A, Olsen E, Fauchald YM, Heimark S, Thorstensen CW, Liestøl K, Solbu MD, Gerdts E, Mo R, Rostrup M, Kjeldsen SE, Høieggen A, Opdal MS, Larstorp ACK, Fadl Elmula FEM. Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations. Hypertension 2021; 78:617-628. [PMID: 34275336 DOI: 10.1161/hypertensionaha.121.17514] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ola Undrum Bergland
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Lene V Halvorsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Camilla L Søraas
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Section for Environmental and Occupational Medicine (C.L.S.)
| | - Ulla Hjørnholm
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Vibeke N Kjær
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Stine Rognstad
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Pharmacology (S.R., C.W.T., M.S.O.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Karl Marius Brobak
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Arleen Aune
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Eirik Olsen
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Ylva M Fauchald
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Sondre Heimark
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | | | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo
| | - Marit D Solbu
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Rune Mo
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Morten Rostrup
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.).,Department of Behavioral Sciences, Institute of Basic Medical Sciences (M.R.), University of Oslo
| | - Sverre E Kjeldsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Cardiology (S.E.K.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Aud Høieggen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Mimi S Opdal
- Department of Pharmacology (S.R., C.W.T., M.S.O.)
| | - Anne Cecilie K Larstorp
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Medical Biochemistry (A.C.K.L.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Fadl Elmula M Fadl Elmula
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.)
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Brunström M, Kjeldsen SE, Kreutz R, Gjesdal K, Narkiewicz K, Burnier M, Oparil S, Mancia G. Missing Verification of Source Data in Hypertension Research: The HYGIA PROJECT in Perspective. Hypertension 2021; 78:555-558. [PMID: 34232677 PMCID: PMC8260337 DOI: 10.1161/hypertensionaha.121.17356] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden (M. Brunström)
| | - Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.E.K., K.G.)
| | - Reinhold Kreutz
- Department of Clinical Pharmacology and Toxicology, Charité Medical University, Berlin, Germany (R.K.)
| | - Knut Gjesdal
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.E.K., K.G.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.)
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (M. Burnier)
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama, Birmingham (S.O.)
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Mahfoud F, Azizi M, Ewen S, Pathak A, Ukena C, Blankestijn PJ, Böhm M, Burnier M, Chatellier G, Durand Zaleski I, Grassi G, Joner M, Kandzari DE, Kirtane A, Kjeldsen SE, Lobo MD, Lüscher TF, McEvoy JW, Parati G, Rossignol P, Ruilope L, Schlaich MP, Shahzad A, Sharif F, Sharp ASP, Sievert H, Volpe M, Weber MA, Schmieder RE, Tsioufis C, Wijns W. Proceedings from the 3rd European Clinical Consensus Conference for clinical trials in device-based hypertension therapies. Eur Heart J 2021; 41:1588-1599. [PMID: 32211888 PMCID: PMC7174031 DOI: 10.1093/eurheartj/ehaa121] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/19/2019] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michel Azizi
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Hypertension Unit, F-75015 Paris, France.,F-CRIN INI-CRCT Network, Nancy, France
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Atul Pathak
- F-CRIN INI-CRCT Network, Nancy, France.,Department of Cardivascular Medicine, INSERM 1048, Princess Grace Hospital (CHPG), Avenue Pasteur, 98000 Monaco, Monaco
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Gilles Chatellier
- Université de Paris, INSERM CIC1418, F-75015 Paris, France.,APHP, Hôpital Européen Georges Pompidou, Clinical Trial Unit, F-75015 Paris, France
| | | | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Michael Joner
- Deutsches Herzzentrum München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich, Munich, Germany
| | | | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA
| | | | - Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, Zürich, Switzerland.,Royal Brompton and Harefield Hospital Trust, Imperial College London, London, UK
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca-Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Patrick Rossignol
- F-CRIN INI-CRCT Network, Nancy, France.,Université de Lorraine, Inserm, Centre d'Investigations cliniques-plurithématique 1433, Inserm U1116, Nancy, France.,CHRU Nancy, Nancy, France
| | - Luis Ruilope
- Institute of Research i+12 and CIBER CV, Hospital 12 de Octubre and Faculty of Sport Medicine, European University, Madrid, Spain
| | - Markus P Schlaich
- Dobney Hypertension Centre, The University of Western Australia-Royal Perth Hospital Campus, Perth, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Atif Shahzad
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Faisal Sharif
- National University of Ireland Galway, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, UK.,University of Exeter, Exeter, UK
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK.,University California San Francisco UCSF, San Francisco, USA.,Yunnan Hospital Fuwai, Kunming, China
| | - Massimo Volpe
- Sapienza University of Rome-Sant'Andrea Hospital Rome and IRCCS Neuromed, Pozzilli, Italy
| | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, Erlangen, Germany
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, National University of Ireland Galway, Galway, Ireland
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Rahimi K, Bidel Z, Nazarzadeh M, Copland E, Canoy D, Ramakrishnan R, Pinho-Gomes AC, Woodward M, Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, Black H, Brouwers FPJ, Brown M, Bulpitt CJ, Byington RP, Cushman WC, Cutler J, Devereaux RB, Dwyer J, Estacio R, Fagard R, Fox K, Fukui T, Gupta AK, Holman RR, Imai Y, Ishii M, Julius S, Kanno Y, Kjeldsen SE, Kostis J, Kuramoto K, Lanke J, Lewis E, Lewis JB, Lievre M, Lindholm LH, Lueders S, MacMahon S, Mancia G, Matsuzaki M, Mehlum MH, Nissen S, Ogawa H, Ogihara T, Ohkubo T, Palmer CR, Patel A, Pfeffer MA, Pitt B, Poulter NR, Rakugi H, Reboldi G, Reid C, Remuzzi G, Ruggenenti P, Saruta T, Schrader J, Schrier R, Sever P, Sleight P, Staessen JA, Suzuki H, Thijs L, Ueshima K, Umemoto S, van Gilst WH, Verdecchia P, Wachtell K, Whelton P, Wing L, Yui Y, Yusuf S, Zanchetti A, Zhang ZY, Anderson C, Baigent C, Brenner BM, Collins R, de Zeeuw D, Lubsen J, Malacco E, Neal B, Perkovic V, Rodgers A, Rothwell P, Salimi-Khorshidi G, Sundström J, Turnbull F, Viberti G, Wang J, Chalmers J, Teo KK, Pepine CJ, Davis BR. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021; 397:1625-1636. [PMID: 33933205 PMCID: PMC8102467 DOI: 10.1016/s0140-6736(21)00590-0] [Citation(s) in RCA: 348] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1-Q3 2·97-4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3-32·5) in the comparator group and 25·9 (25·4-26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0-40·5) and 36·0 (95% CI 35·3-36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89-0·94 for partipants without previous cardiovascular disease and 0·89, 0·86-0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories. INTERPRETATION In this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself. FUNDING British Heart Foundation, UK National Institute for Health Research, and Oxford Martin School.
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47
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Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Better drug adherence improves blood pressure control and lowers cardiovascular disease outcomes - from single pill combinations to monitoring of a nationwide health insurance database. Blood Press 2021; 30:143-144. [PMID: 33910432 DOI: 10.1080/08037051.2021.1917192] [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: 10/21/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
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48
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Kreutz R, Cífková R, Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S, Mancia G. In Memoriam: Jiří Widimský Sr. 1925-2020. J Hypertens 2021; 39:386-388. [PMID: 37696754 DOI: 10.1097/hjh.0000000000002768] [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: 11/26/2022]
Affiliation(s)
- Reinhold Kreutz
- Department of Clinical Pharmacology and Toxicology, Charité University Medicine, Berlin, Germany
| | - Renata Cífková
- Center for Cardiovascular Prevention, Charles University Medical School I and Thomayer Hospital, Prague, Czech Republic
| | - Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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49
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Olsen E, Holzhauer B, Julius S, Kjeldsen SE, Larstorp ACK, Mancia G, Mehlum MH, Mo R, Rostrup M, Søraas CL, Zappe D, Weber MA. Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus compared to all middle-aged and elderly hypertensive study patients with high cardiovascular risk. Blood Press 2021; 30:90-97. [PMID: 33403890 DOI: 10.1080/08037051.2020.1856642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Event-based clinical outcome trials have shown limited evidence to support guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly hypertensive patients with diabetes mellitus or with general high cardiovascular (CV) risk. We addressed this issue by post-hoc analysing the risk of CV events in patients who participated in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and compared the hypertensive patients with type 2 diabetes mellitus with all high-risk hypertensive patients. MATERIALS AND METHODS Patients were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥75%) in which BP was reduced to <140/90 or <130/80 mmHg. Patients with diabetes mellitus (n = 5250) were compared with the entire VALUE population with high CV risk (n = 15,245). RESULTS After adjustments for baseline differences between groups, a reduction in the proportion of visits in which BP was reduced to <140/90 mmHg, but not to <130/80 mmHg, was accompanied by a progressive increase in the risk of CV morbidity and mortality as well as stroke, myocardial infarction and heart failure in both diabetes mellitus and in all high-risk patients. Target BP <130/80 mmHg reduced stroke risk in the main population but not in the diabetes mellitus patients. Patients with diabetes mellitus had higher event rates for the primary cardiac endpoint and all-cause mortality driven by a higher rate of heart failure. CONCLUSION In the high-risk hypertensive patients of the VALUE trial achieving more frequently BP <140/90 mmHg, but not <130/80 mmHg, showed principally the same protective effect on overall and cause-specific cardiovascular outcomes in patients with diabetes mellitus and in the general high-risk hypertensive population.
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Affiliation(s)
- Eirik Olsen
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | | | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sverre E Kjeldsen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Departments of Cardiology and Nephrology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | - Morten Rostrup
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Camilla L Søraas
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Unit of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Michael A Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA
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50
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Olsen E, Holzhauer B, Julius S, Kjeldsen SE, Larstorp ACK, Mancia G, Mehlum MH, Mo R, Rostrup M, Søraas CL, Zappe D, Weber MA. Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus and hypertension. Blood Press 2021; 30:82-89. [PMID: 33403886 DOI: 10.1080/08037051.2020.1855968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Available data of event-based clinical outcomes trials show that little evidence supports the guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly people with type 2 diabetes mellitus and hypertension. We addressed this issue by post-hoc analysing the risk of cardiovascular (CV) events in mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. MATERIAL AND METHODS Patients (n = 5250) were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥ 75%) in which BP was reduced to <140/90 or <130/80 mmHg. RESULTS After adjustment for baseline demographic differences between groups, a reduction in the proportion of visits in which BP achieved <140/90 mmHg accompanied a progressive increase in the risk of CV mortality and morbidity as well as of cause-specific events such as stroke, myocardial infarction and heart failure. A progressive reduction in the proportion of visits in which BP was reduced <130/80 mmHg did not have any effect on CV risks. CONCLUSION In mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the VALUE trial, achieving more frequently BP <140/90 mmHg showed a marked protective effect on overall and all cause-specific cardiovascular outcomes. This was not the case for a more frequent achievement of the more intensive BP target, i.e. <130/80 mmHg.
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Affiliation(s)
- Eirik Olsen
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | | | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sverre E Kjeldsen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Departments of Cardiology and Nephrology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | - Morten Rostrup
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Camilla L Søraas
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Unit of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Michael A Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA
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