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Age trajectories of physiological indices in relation to healthy life course. Mech Ageing Dev 2011; 132:93-102. [PMID: 21262255 DOI: 10.1016/j.mad.2011.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 12/22/2010] [Accepted: 01/16/2011] [Indexed: 11/24/2022]
Abstract
We analysed relationship between the risk of onset of "unhealthy life" (defined as the onset of cancer, cardiovascular diseases, or diabetes) and longitudinal changes in body mass index, diastolic blood pressure, hematocrit, pulse pressure, pulse rate, and serum cholesterol in the Framingham Heart Study (Original Cohort) using the stochastic process model of human mortality and aging. The analyses demonstrate how decline in resistance to stresses and adaptive capacity accompanying human aging can be evaluated from longitudinal data. We showed how these components of the aging process, as well as deviation of the trajectories of physiological indices from those minimising the risk at respective ages, can lead to an increase in the risk of onset of unhealthy life with age. The results indicate the presence of substantial gender difference in aging related decline in stress resistance and adaptive capacity, which can contribute to differences in the shape of the sex-specific patterns of incidence rates of aging related diseases.
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Bangalore S, Qin J, Sloan S, Murphy SA, Cannon CP. What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation 2010; 122:2142-51. [PMID: 21060068 DOI: 10.1161/circulationaha.109.905687] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aggressive blood pressure (BP) control has been advocated in patients with acute coronary syndrome, but few data exist in this population relative to cardiovascular outcomes. METHODS AND RESULTS We evaluated 4162 patients enrolled in the PRavastatin Or atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial (acute coronary syndrome patients randomized to pravastatin 40 mg versus atorvastatin 80 mg). The average follow-up BP (systolic and diastolic) was categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke. The secondary outcome was a composite of death due to coronary heart disease, nonfatal myocardial infarction, or revascularization. The relationship between BP (systolic or diastolic) followed a J- or U-shaped curve association with primary, secondary, and individual outcomes, with increased events rates at both low and high BP values, both unadjusted and after adjustment for baseline variables, baseline C-reactive protein, and on-treatment average levels of low-density lipoprotein cholesterol. A nonlinear Cox proportional hazards model showed a nadir of 136/85 mm Hg (range 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic) at which the incidence of primary outcome was lowest. The curve was relatively flat for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg. CONCLUSIONS After acute coronary syndrome, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, with lowest event rates in the BP range of approximately 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic and a relatively flat curve for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg, which suggests that too low of a pressure (especially <110/70 mm Hg) may be dangerous. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00382460.
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Noveanu M, Breidthardt T, Reichlin T, Gayat E, Potocki M, Pargger H, Heise A, Meissner J, Twerenbold R, Muravitskaya N, Mebazaa A, Mueller C. Effect of oral β-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R198. [PMID: 21047406 PMCID: PMC3219994 DOI: 10.1186/cc9317] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 07/14/2010] [Accepted: 11/03/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Acute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study. METHODS The BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70 (62 to 79) years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide- (BNP) guided management strategy on short-term outcomes. RESULTS In-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital (HR 0.33 (0.14 to 0.74) P = 0.007) and one-year mortality (HR 0.29 (0.16 to 0.51) P = 0.0003). Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral beta-blocker and further shows that the beneficial effect of oral beta-blockers at admission holds true in the two subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality. CONCLUSIONS Established beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless of the cardiac or non-cardiac etiology of respiratory failure. TRIAL REGISTRATION clinicalTrials.gov Identifier: NCT00130559.
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Affiliation(s)
- Markus Noveanu
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland
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Nelson K, Singh G, Boyer S, Gay D. Two presentations of nonarteritic ischemic optic neuropathy. OPTOMETRY (ST. LOUIS, MO.) 2010; 81:587-597. [PMID: 21035747 DOI: 10.1016/j.optm.2010.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 01/23/2010] [Accepted: 02/05/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Nonarteritic ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in adults over the age of 50. Patients affected notice sudden and painless loss of vision in 1 eye, often upon awaking. Studies have found that the opposite eye may be affected in approximately 15% to 20% of cases within a 5-year period. NAION vision loss results from an ischemic event often affecting the short posterior ciliary arteries. This results in optic nerve pallor, nerve fiber layer defects, and corresponding visual field defects. CASE REPORTS Two cases of NAION are discussed here. The first patient, a 57-year-old woman, had a 10-year history of visual symptoms, and the second, a 66-year-old man, presented in less than a week after first noticing symptoms. Both had predisposing systemic risk factors and resultant visual field loss and decreased visual acuity. CONCLUSIONS Predisposing factors for NAION include small cup-to-disc ratios of the optic nerve, obstructive sleep apnea, nocturnal hypotension, diabetes, and other vascular diseases. The vision loss is irreversible, and there is no known effective treatment to prevent subsequent disc atrophy or recurring episodes.
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Affiliation(s)
- Kiersten Nelson
- Veterans Affairs Illiana Health Care System, Danville, Illinois, USA
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Evidence for aggressive blood pressure-lowering goals in patients with coronary artery disease. Curr Atheroscler Rep 2010; 12:134-9. [PMID: 20425249 DOI: 10.1007/s11883-010-0094-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lowering blood pressure (BP) reduces the risk of major cardiovascular mortality and morbidity. Current consensus targets for BP reduction are less than 140/90 mm Hg in uncomplicated hypertension and less than 130/80 mm Hg in those patients with diabetes, chronic kidney disease, and coronary artery disease or in those who are at high risk for developing coronary artery disease (defined as a Framingham risk score of > or = 10%). There is solid epidemiologic evidence for lower BP targets, supported by some clinical studies with surrogate end points. On the other hand, there are meager data from clinical trials using hard end points, and there is a concern that overly aggressive BP lowering, especially of diastolic BP, may impair coronary perfusion, particularly in patients with left ventricular hypertrophy and/or coronary artery disease. This review evaluates the evidence for the benefit of lower BP targets in hypertension management.
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Bangalore S, Messerli FH, Wun CC, Zuckerman AL, DeMicco D, Kostis JB, LaRosa JC. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J 2010; 31:2897-908. [PMID: 20846991 DOI: 10.1093/eurheartj/ehq328] [Citation(s) in RCA: 264] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM In patients with coronary artery disease (CAD), a J-curve relationship has been reported between blood pressure (BP) and future cardiovascular events. However, this is controversial. The purpose of the study was to determine the relationship between on-treatment BP and cardiovascular outcomes in patients with CAD. METHODS AND RESULTS We evaluated 10 001 patients with CAD and a low-density lipoprotein (LDL) cholesterol level <130 mg/dL, randomized to atorvastatin 80 vs. 10 mg, enrolled in the TNT trial. The post-baseline, time-dependent BPs [systolic blood pressure (SBP) and diastolic blood pressure (DBP)] were categorized into 10 mmHg increments. The primary outcome was a composite of death from coronary disease, non-fatal myocardial infarction (MI), resuscitated cardiac arrest, and fatal or non-fatal stroke. Among the 10 001 patients, 982 (9.82%) experienced a primary outcome at 4.9 years (median) of follow-up. The relationship between SBP or DBP and primary outcome followed a J-curve with increased event rates above and below the reference BP range, both unadjusted and adjusted (for baseline covariates, treatment effect, and LDL levels). A time-dependent, non-linear, multivariate Cox proportional hazard model identified a nadir of 146.3/81.4 mmHg where the event rate was lowest. A similar non-linear relationship with a higher risk of events at lower pressures was found for most of the secondary outcomes of all-cause mortality, cardiovascular mortality, non-fatal MI, or angina. However, for the outcome of stroke, lower was better for SBP. CONCLUSION In patients with CAD, a low BP (<110-120/<60-70 mmHg) portends an increased risk of future cardiovascular events (except stroke).
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Chrysant SG, Chrysant GS. Effectiveness of lowering blood pressure to prevent stroke versus to prevent coronary events. Am J Cardiol 2010; 106:825-9. [PMID: 20816123 DOI: 10.1016/j.amjcard.2010.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 05/11/2010] [Accepted: 05/11/2010] [Indexed: 12/31/2022]
Abstract
The concept of the J-curve effect has been around for a long time and is a subject of contention among various investigators. The J-curve effect describes an inverse relation between low blood pressure (BP) and cardiovascular complications. Because the coronary arteries are perfused during diastole, this effect is seen mostly with low diastolic BP in the range of 70 to 80 mm Hg, depending on preexisting coronary artery disease, hypertension, or left ventricular hypertrophy. Although national and international guidelines recommend aggressive BP control to <140/90 mm Hg for uncomplicated hypertension or <130/80 mm Hg for hypertension associated with coronary artery disease, diabetes, or chronic kidney disease, recent large clinical outcomes trials have observed a J-curve effect between diastolic BP <80 mm Hg as well as systolic BP <130 mm Hg and have cast some doubt regarding the aggressive BP treatment, or "the lower the better," concept. Other recent studies have shown no benefit with respect to cardiovascular complications between aggressive and less aggressive BP control. In contrast to cardiovascular complications, no J-curve effect has been noted for strokes. A Medline search of English-language reports published from 1992 to 2010 regarding this topic was conducted, and 11 reports were selected and are discussed in this brief review, together with collateral published research. In conclusion, most of the reviewed publications suggest a J-curve effect with low diastolic and systolic BP for cardiovascular disease complications but not stroke complications.
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Zhang Y, Safar ME, Iaria P, Agnoletti D, Protogerou AD, Blacher J. Prevalence and prognosis of left ventricular diastolic dysfunction in the elderly: The PROTEGER Study. Am Heart J 2010; 160:471-8. [PMID: 20826255 DOI: 10.1016/j.ahj.2010.06.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 06/16/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) was reported as a significant predictor of mortality, mainly in patients with heart failure. However, prospective data are scarce in the hospitalized elderly population. METHODS We studied the association of severe LVDD, defined by conventional echocardiographic parameters, with cardiovascular and all-cause mortality in a population of 331 hospitalized elderly patients with a history of cardiovascular disease (mean age +/- SD, 87 +/- 7 years). After a mean follow-up of 378 days, 110 deaths occurred. RESULTS Compared with left ventricular systolic dysfunction (LVSD), subjects with severe diastolic dysfunction had a similar prevalence (12% vs 10%) and similar cardiovascular and all-cause mortality (18% vs 19%, 49% vs 50%). Both cardiovascular and all-cause mortality increased progressively and significantly with increasing number of diagnostic criteria of LVDD (P = .035, P = .013) and reached 48.7% for all-cause mortality when at least 2 criteria were met. In addition to cardiovascular risk factors and LVSD, severe LVDD provided incremental and independent prognostic information of all-cause mortality with increased chi(2) value of Cox regression model (48.1 vs 43.5, P = .022). CONCLUSIONS Severe LVDD, diagnosed by conventional echocardiography, has similar prevalence and prognosis as LVSD and provides incremental prognostic value, which highlights the clinical significance of routine evaluation of LVDD in risk assessment strategies of the hospitalized elderly.
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Miyagawa K, Dohi Y, Nakazawa A, Sugiura T, Yamashita S, Sato K, Kimura G. Renoprotective effect of calcium channel blockers in combination with an angiotensin receptor blocker in elderly patients with hypertension. A randomized crossover trial between benidipine and amlodipine. Clin Exp Hypertens 2010; 32:1-7. [PMID: 20144066 DOI: 10.3109/10641960902929446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anti-hypertensive medication with an angiotensin II receptor blocker (ARB) is effective in slowing the progression of chronic kidney disease. The present study was designed to investigate whether calcium channel blockers (CCBs) in combination with an ARB differentially affect kidney function. Elderly hypertensive patients with chronic kidney disease (n = 17, 72 +/- 6 years old) were instructed to self-measure blood pressure. They were randomly assigned to receive either benidipine (4-8 mg/day) or amlodipine (5-10 mg/day) combined with olmesartan (10 mg/day). After 3 months, CCBs were switched in each patient and the same protocol was applied for another 3 months. At baseline, significant correlation was obtained between urine albumin (22.8 +/- 16.7 (median +/- median absolute deviation) mg/g creatinine) and self-measured blood pressure (170 +/- 23/87 +/- 10 (mean +/- SD) mmHg, r = 0.65, p < 0.01). Both regimens reduced blood pressure to a similar extent (139 +/- 22/75 +/- 11 mmHg and 133 +/- 17/72 +/- 10 mmHg, respectively; both p < 0.001), while urine albumin decreased only after combination therapy including benidipine (11.7 +/- 6.1 mg/g creatinine, p < 0.05). Benidipine, but not amlodipine, in combination with olmesartan, reduced urinary albumin excretion in elderly hypertensive patients with chronic kidney disease. The results suggest the importance of selecting medications used in combination with ARB in hypertensive patients with chronic kidney disease.
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Affiliation(s)
- Koichi Miyagawa
- Department of Internal Medicine, Nagoya Kosein Geriatric Hospital, Nagoya, Japan
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161
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"Predicting" parental longevity from offspring endophenotypes: data from the Long Life Family Study (LLFS). Mech Ageing Dev 2010; 131:215-22. [PMID: 20184914 DOI: 10.1016/j.mad.2010.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 01/04/2010] [Accepted: 02/14/2010] [Indexed: 10/19/2022]
Abstract
While there is evidence that longevity runs in families, the study of long-lived families is complicated by the fact that longevity-related information is available only for the oldest old, many of whom may be deceased and unavailable for testing, and information on other living family members, primarily descendents, is censored. This situation requires a creative approach for analyzing determinants of longevity in families. There are likely biomarkers that predict an individual's longevity, suggesting the possibility that those biomarkers which are heritable may constitute valuable endophenotypes for exceptional survival. These endophenotypes could be studied in families to identify human longevity genes and elucidate possible mechanisms of their influence on longevity. In this paper, we analyze data collected in the Long Life Family Study (LLFS) investigating whether indicators of physiological state, cognitive functioning and health/well-being among offspring predict longevity in parents. Good predictors can be used as endophenotypes for exceptional survival. Our analyses revealed significant associations between cumulative indices describing physiological state, as well as a number of offspring phenotypes, and parental lifespan, supporting both their familial basis and relevance to longevity. We conclude that the study of endophenotypes within families is a valid approach to the genetics of human longevity.
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162
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Washida N, Wakino S, Hayashi K, Kuwahara T, Itoh H. Brachial-ankle pulse wave velocity predicts silent cerebrovascular diseases in patients with end-stage renal diseases. J Atheroscler Thromb 2010; 17:165-72. [PMID: 20124736 DOI: 10.5551/jat.2097] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cerebrovascular disease (CVD) is a major determinant of the prognosis in end-stage renal diseases (ESRD). The purpose of this study was to examine whether factors associated with arterial stiffness contributed to the development of CVD in patients with ESRD. METHODS CVD (lacunes and carotid/intracranial artery stenosis) was evaluated with brain magnetic resonance imaging (MRI), and carotid/intracranial artery magnetic resonance angiography (MRA) in 44 pre-dialytic patients. The severity of CVD was evaluated by the number of lacunes and the degree of stenosis, respectively. The association between CVD and atherosclerotic parameters was evaluated. RESULTS Patients with severe lacunes (n=18) manifested older age, lower diastolic blood pressure, serum creatinine and albumin, and higher CRP and serum calcium than those with absent-moderate lacunes (n=26). When assessed by multivariate analysis, only baPWV was adopted as an independent risk factor for severe lacunes. Furthermore, baPWV and i-PTH were associated with the severity of carotid/intracranial artery stenosis, both of which were independent of other risk factors, including age and diabetes. CONCLUSIONS Arterial stiffness may constitute a novel determinant predicting the severity of CVD in pre-dialytic patients besides classical risk factors.
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Affiliation(s)
- Naoki Washida
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
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163
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Temmar M, Jankowski P, Peltier M, Mouquet V, Dębicka-Dąbrowska D, Hamida F, Kawecka-Jaszcz K, Safar ME. Intraaortic Pulse Pressure Amplification in Subjects at High Coronary Risk. Hypertension 2010; 55:327-32. [DOI: 10.1161/hypertensionaha.109.142851] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamed Temmar
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Piotr Jankowski
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Marcel Peltier
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Vincent Mouquet
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Dorota Dębicka-Dąbrowska
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Farah Hamida
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Kalina Kawecka-Jaszcz
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
| | - Michel E. Safar
- From the Division of Clinical Pharmacology and Cardiology (M.T.) and Department of Cardiology (M.P., V.M.), Amiens University South Hospital, INSERM ERI 12, Amiens, France; Le Telomere Cardiology Center of Ghardaïa (M.T.), Ghardaïa, Algeria; I Department of Cardiology and Hypertension (P.J., D.D.-D., K.K.-J.), Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Department of Cardiology (F.H.), Blida University Hospital, Blida, Algeria; Assistance Publique-Hôpitaux
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The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol 2009; 54:1827-34. [PMID: 19892233 DOI: 10.1016/j.jacc.2009.05.073] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 04/10/2009] [Accepted: 05/06/2009] [Indexed: 01/05/2023]
Abstract
The topic of the J-curve relationship between blood pressure and coronary artery disease (CAD) has been the subject of much controversy for the past decades. An inverse relationship between diastolic pressure and adverse cardiac ischemic events (i.e., the lower the diastolic pressure the greater the risk of coronary heart disease and adverse outcomes) has been observed in numerous studies. This effect is even more pronounced in patients with underlying CAD. Indeed, a J-shaped relationship between diastolic pressure and coronary events was documented in treated patients with CAD in most large trials that scrutinized this relationship. In contrast to any other vascular bed, the coronary circulation receives its perfusion mostly during diastole; hence, an excessive decrease in diastolic pressure can significantly hamper perfusion. This adverse effect of too low a diastolic pressure on coronary heart disease leaves the practicing physician with the disturbing possibility that, in patients at risk, lowering blood pressure to levels that prevent stroke or renal disease might actually precipitate myocardial ischemia. However, these concerns should not deter physicians from pursuing a more aggressive control of hypertension, because currently blood pressure is brought to recommended target levels in only approximately one-third of patients.
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165
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Vesin C, Protogerou AD, Lieber A, Safar H, Iaria P, Ducimetière P, Safar ME, Blacher J. Predictive factors for all-cause mortality in the hospitalized elderly subject: The importance of arrhythmia. Atherosclerosis 2009; 207:507-13. [DOI: 10.1016/j.atherosclerosis.2009.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 04/27/2009] [Accepted: 04/27/2009] [Indexed: 11/30/2022]
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Bangalore S, Messerli FH. Simple-Minded Antihypertensive Treatment: Of Assumptions, Potpourri, and Sausages. J Clin Hypertens (Greenwich) 2009; 11:702-6. [DOI: 10.1111/j.1751-7176.2009.00203.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Affiliation(s)
- Rupert A Payne
- Clinical Pharmacology Unit, Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
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Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Pulse pressure predicts mortality in elderly patients. J Gen Intern Med 2009; 24:893-6. [PMID: 19472017 PMCID: PMC2710466 DOI: 10.1007/s11606-009-1008-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 03/24/2009] [Accepted: 03/31/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pulse pressure (PP) values increase with age. The impact of PP on mortality in elderly patients has not been established. OBJECTIVES To evaluate the effect of PP on mortality among very elderly hospitalized patients. DESIGN A prospective clinical study. PARTICIPANTS AND MEASUREMENTS The medical records of 420 inpatients aged >60 (187 males, mean age of 81.4 +/- 7 years) hospitalized in an acute geriatric ward were reviewed. Patients were followed up for a mean of 3.46 +/- 1.87 years. Mortality data were extracted from death certificates. Using relative operating characteristic (ROC) curves, we identified PP of 62.5 mmHg as a cutoff point. Subjects were categorized as having low PP (< or = 62.5 mmHg; N = 116) or high PP (>62.5 mmHg; N = 304). MAIN RESULTS The mortality rate was greater in patients with high PP than in those with low PP. During the follow-up, 201 patients died, 155 patients (51%) in the high PP group and 46 patients (39.7%) in the low PP group (p = 0.038). Pulse pressure was associated with all-cause mortality (HR = 1.69, 95% CI = 1.19-2.38, p = 0.003) even after controlling for gender, age, diabetes mellitus, atrial fibrillation and heart rate. CONCLUSION High PP is an independent predictor of mortality among elderly hospitalized patients.
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Affiliation(s)
- Avraham Weiss
- Geriatric Ward, Rabin Medical Center, Petah Tikvah, Israel.
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169
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Tomlinson LA, Holt SG, Leslie AR, Rajkumar C. Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4. Nephrol Dial Transplant 2009; 24:3751-5. [DOI: 10.1093/ndt/gfp357] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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170
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Mourad JJ. The evolution of systolic blood pressure as a strong predictor of cardiovascular risk and the effectiveness of fixed-dose ARB/CCB combinations in lowering levels of this preferential target. Vasc Health Risk Manag 2009; 4:1315-25. [PMID: 19337545 PMCID: PMC2663439 DOI: 10.2147/vhrm.s4073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Elevated blood pressure is an important cardiovascular risk factor. Although targets for both diastolic blood pressure (DBP) and systolic blood pressure (SBP) are defined by current guidelines, DBP has historically taken precedence in hypertension management. However, there is strong evidence that SBP is superior to DBP as a predictor of cardiovascular events. Moreover, achieving control of SBP is assuming greater importance amongst an aging population. In spite of the growing recognition of the importance of SBP in reducing cardiovascular risk and the emphasis by current guidelines on SBP control, a substantial proportion of patients still fail to achieve SBP targets, and SBP control is achieved much less frequently than DBP control. Thus, new approaches to the management of hypertension are required in order to control SBP and minimize cardiovascular risk. Fixed-dose combination (FDC) therapy is an approach that offers the advantages of multiple drug administration and a reduction in regimen complexity that favors compliance. We have reviewed the latest evidence demonstrating the efficacy in targeting SBP of the most recent FDC products; combinations of the calcium channel blocker (CCB), amlodipine, with angiotensin receptor blockers (ARBs), valsartan or olmesartan. In addition, results from studies with new classes of agent are outlined.
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Affiliation(s)
- Jean-Jacques Mourad
- Hypertension Unit, Avicenne, Hospital-AP-HP and Paris XIII, University Bobigny, 125 rue de Stalingrad, Bobigny, France.
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171
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Abstract
BACKGROUND Simple hypertension outcome measures may not indicate which patients receive poor care. This could be problematic as incentives increase. OBJECTIVE Compare measured quality using simple outcome measures to more sophisticated measures utilizing data available within an electronic health record. DESIGN Cross-sectional study. SUBJECTS A total of 5905 hypertensive adults with 3 or more clinic visits between July 1, 2005 and December 31, 2006 at an internal medicine clinic. MEASURES We measured simple control as the proportion of diagnosed hypertension patients with their last blood pressure below goal (<140/90 mm Hg or <130/80 if diabetic). We compared this to sequentially more complex measures. RESULTS Among nondiabetic patients, baseline measurement of control was 58.1% [95% confidence interval (CI), 56.5-59.6]. Counting patients as having adequate care whose last or mean blood pressure was at or below goal raised performance to 75.4%. Accounting for patients prescribed aggressive treatment raised it to 82.5%. Accounting for low diastolic blood pressure raised it to 83.6%. Including patients with undiagnosed hypertension lowered it to 80.5%. For diabetes patients, baseline measurement of control was 29.9% (95% CI, 27.6-32.3) and changed to 46.4%, 72.8%, 76.7%, and 73.6%, respectively. CONCLUSIONS It is possible to use electronic health record data to devise hypertension measures that may better reflect who has actionable uncontrolled blood pressure, do not penalize clinicians treating resistant hypertension patients, reduce the encouragement of potentially unsafe practices, and identify patients possibly receiving poor care with no hypertension diagnosis. This could improve the detection of true quality problems and remove incentives to over treat or stop caring for patients with resistant hypertension.
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172
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Vischer U, Safar M, Safar H, Iaria P, Le Dudal K, Henry O, Herrmann F, Ducimetière P, Blacher J. Cardiometabolic determinants of mortality in a geriatric population: Is there a “reverse metabolic syndrome”? DIABETES & METABOLISM 2009; 35:108-14. [DOI: 10.1016/j.diabet.2008.08.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 08/24/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
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173
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Arbeev KG, Akushevich I, Kulminski AM, Arbeeva LS, Akushevich L, Ukraintseva SV, Culminskaya IV, Yashin AI. Genetic model for longitudinal studies of aging, health, and longevity and its potential application to incomplete data. J Theor Biol 2009; 258:103-11. [PMID: 19490866 DOI: 10.1016/j.jtbi.2009.01.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 01/14/2009] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
Abstract
Many longitudinal studies of aging collect genetic information only for a sub-sample of participants of the study. These data also do not include recent findings, new ideas and methodological concepts developed by distinct groups of researchers. The formal statistical analyses of genetic data ignore this additional information and therefore cannot utilize the entire research potential of the data. In this paper, we present a stochastic model for studying such longitudinal data in joint analyses of genetic and non-genetic sub-samples. The model incorporates several major concepts of aging known to date and usually studied independently. These include age-specific physiological norms, allostasis and allostatic load, stochasticity, and decline in stress resistance and adaptive capacity with age. The approach allows for studying all these concepts in their mutual connection, even if respective mechanisms are not directly measured in data (which is typical for longitudinal data available to date). The model takes into account dependence of longitudinal indices and hazard rates on genetic markers and permits evaluation of all these characteristics for carriers of different alleles (genotypes) to address questions concerning genetic influence on aging-related characteristics. The method is based on extracting genetic information from the entire sample of longitudinal data consisting of genetic and non-genetic sub-samples. Thus it results in a substantial increase in the accuracy of statistical estimates of genetic parameters compared to methods that use only information from a genetic sub-sample. Such an increase is achieved without collecting additional genetic data. Simulation studies illustrate the increase in the accuracy in different scenarios for datasets structurally similar to the Framingham Heart Study. Possible applications of the model and its further generalizations are discussed.
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Affiliation(s)
- Konstantin G Arbeev
- Center for Population Health and Aging, Duke University, Trent Hall, Room 002, Box 90408, Durham, NC 27708-0408, USA.
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174
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175
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Vongpatanasin W. Management of hypertension in patients with coronary artery disease. Curr Hypertens Rep 2008; 10:349-54. [DOI: 10.1007/s11906-008-0066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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176
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Abstract
The treatment of hypertension on an outpatient basis should be approached in a systematic manner. The diagnosis of hypertension should always be verified first before treatment is initiated and, where indicated, a workup should be done. Lifestyle modifications should be considered in all patients with hypertension. Blood pressure can be brought to goal in the majority of patients if antihypertensive medications are correctly dosed or combined. As blood pressure is brought to goal in the patient with hypertension, ongoing attention should be directed to long-term adherence to therapy.
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Affiliation(s)
- Domenic A Sica
- Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, 1101 East Marshall Street, Sanger Hall, Room 8-062, Richmond, VA 23298-0160, USA.
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177
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Moretti R, Torre P, Antonello RM, Manganaro D, Vilotti C, Pizzolato G. Risk factors for vascular dementia: hypotension as a key point. Vasc Health Risk Manag 2008; 4:395-402. [PMID: 18561514 PMCID: PMC2496988 DOI: 10.2147/vhrm.s2434] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Physiologically, the cerebral autoregulation system allows maintenance of constant cerebral blood flow over a wide range of blood pressure. In old people, there is a progressive reshape of cerebral autoregulation from a sigmoid curve to a straight line. This implies that any abrupt change in blood pressure will result in a rapid and significant change in cerebral blood flow. Hypertension has often been observed to be a risk factor for vascular dementia (VaD) and sometimes for Alzheimer disease although not always. Indeed, high blood pressure may accelerate cerebral white matter lesions, but white matter lesions have been found to be facilitated by excessive fall in blood pressure, including orthostatic dysregulation and postprandial hypotension. Many recent studies observed among other data, that there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. Baseline blood pressure level was not significantly related to cognitive decline with initial good cognition. Some researchers speculate that blood pressure reduction might be an early change of the dementing process. The most confounding factor is that low pressure by itself might be a predictor of death; nevertheless, the effect of low blood pressure on cognition is underestimated because of a survival bias. Another explanation is that clinically unrecognized vascular lesions in the brain or atherosclerosis are responsible for both cognitive decline and blood pressure reduction. We discuss the entire process, and try to define a possible mechanism that is able to explain the dynamic by which hypotension might be related to dementia.
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Affiliation(s)
- Rita Moretti
- Department of Internal Medicine and Clinical Neurology, University of Trieste, Italy.
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Krakoff LR. Older Patients Need Better Guidelines for Optimal Treatment of High Blood Pressure. Hypertension 2008; 51:817-8. [DOI: 10.1161/hypertensionaha.108.110205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lawrence R. Krakoff
- From the Mount Sinai School of Medicine, New York, NY; and the Englewood Hospital and Medical Center, Englewood, NJ
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