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Joseph G, Thanh Pham V, Kragh Andersen P, Louis Marott J, Møgelvang R, Biering-Sørensen T, Søgaard P, Nielsen G, Prescott E, Boje Jensen G, Eske Bruun N, Torp-Pedersen C. Cardiovascular events according to blood pressure thresholds recommended by ACC/AHA. Blood Press 2024; 33:2380346. [PMID: 39018201 DOI: 10.1080/08037051.2024.2380346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
AIM The latest guidelines from ACC/AHA define hypertension at systolic blood pressure (SBP) 130-139 mmHg or diastolic blood pressure (DBP) 80-89 mmHg in contrast to guidelines from ESC/ESH defining hypertension at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The aim was to determine whether the ACC/AHA definition of hypertension identifies persons at elevated risk for future cardiovascular outcome. METHODS In a Danish prospective cardiovascular study, 19,721 white men and women aged 20-98 years were examined up to five occasions between 1976 and 2015. The population was followed until December 2018. The ACC/AHA definition of the BP levels were applied: Normal: SBP <120 mmHg and DBP <80 mmHg, Elevated: SBP 120-129 mmHg and DBP <80 mmHg, Stage 1: SBP 130-139 mmHg or DBP 80-89 mmHg, Stage 2: SBP ≥140 mmHg or DBP ≥90 mmHg. Absolute 10-year risk was calculated taking repeated examinations, covariates, and competing risk into account. RESULTS For all outcomes, the 10-year risk in stage 1 hypertension did not differ significantly from risk in subjects with normal BP: The 10-year risk of cardiovascular events in stage 1 hypertension was 14.1% [95% CI 13.2;15.0] and did not differ significantly from the risk in normal BP at 12.8% [95% CI 11.1;14.5] (p = 0.19). The risk was highest in stage 2 hypertension 19.4% [95% CI 18.9;20.0] and differed significantly from normal BP, elevated BP, and stage 1 hypertension (p < 0.001). The 10-year risk of cardiovascular death was 6.6% [95% CI 5.9;7.4] in stage 1 hypertension and did not differ significantly from the risk in normal BP at 5.7% [95% CI 4.1;7.3] (p = 0.33). CONCLUSIONS Stage 1 hypertension as defined by the ACC/AHA guidelines has the same risk for future cardiovascular events as normal BP. In contrast, the definition of hypertension as suggested by ESC/ESH identifies patients with elevated risk of cardiovascular events.
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Affiliation(s)
- Gowsini Joseph
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Vi Thanh Pham
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Gentofte, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Eva Prescott
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospitals, Frederiksberg, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Raittio E, Baelum V. Justification for the 2017 periodontitis classification in the light of the Checklist for Modifying Disease Definitions: A narrative review. Community Dent Oral Epidemiol 2023; 51:1169-1179. [PMID: 36951361 DOI: 10.1111/cdoe.12856] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Once a while, disease classifications have needed revision because new knowledge has accumulated, and new technologies and better treatments have emerged. Changes made to disease classifications should be trustworthy and openly justified. The periodontitis definition and classification system was changed in 2017 by the 'World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions'. The workshop, comprising clinicians and researchers, resulted in the production of a 23-article special issue that introduced the new definitions and classifications of periodontitis. In this narrative review, we critically review how the changes made to the periodontitis definition and classification were justified in the light of the Checklist for Modifying Disease Definitions. Under each of the eight items of the checklist, we have discussed how the item was or could have been considered in the light of the checklist and its guidance. In our view, the new definition and classification of periodontitis was presented in an understandable way, even though the changes from the previous definition were not made visible. However, the issues of (1) estimated changes in prevalence or incidence, (2) triggers for the change, (3) prognostic ability, (4) repeatability or reproducibility, (5) incremental benefits, (6) incremental harms or (7) net benefits and harms related to the introduction of new classification were not considered in the way suggested in the checklist. Thereby, a balanced assessment of potential benefits and harms associated with the new periodontitis classification system was not presented, and to a large extent it remains unknown if the use of the new classification system will provide more net benefits to patients and to the community than previous systems. It is our view that patients and societies deserve transparent and balanced assessments of the potential benefits and harms associated with the periodontitis classification. Importantly, these should reflect the values and preferences also of the patients and the wider community and consider the impact on resource usage.
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Affiliation(s)
- Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Vibeke Baelum
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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A novel methodological framework was described for detecting and quantifying overdiagnosis. J Clin Epidemiol 2022; 148:146-159. [PMID: 35483550 DOI: 10.1016/j.jclinepi.2022.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Methods to quantify overdiagnosis of screen detected cancer have been developed, but methods for quantifying overdiagnosis of non-cancer conditions (whether symptomatic or asymptomatic) have been lacking. We aimed to develop a methodological framework for quantifying overdiagnosis that may be used for asymptomatic or symptomatic conditions, and used Gestational Diabetes Mellitus as an example of how it may be applied. STUDY DESIGN AND SETTING We identify two earlier definitions for overdiagnosis, a narrower prognosis-based definition, and a wider utility-based definition. Building on the central importance of the concepts of prognostic information and clinical utility of a diagnosis, we consider the following questions: within a target population, do people found to have a disease using one diagnostic strategy but found not to have the disease using another diagnostic strategy (so called 'additional diagnoses'), have an increased risk of adverse clinical outcomes without treatment (prognosis evidence), and/or a decreased risk of adverse outcomes with treatment (utility evidence)? RESULTS Using Causal Directed Acyclic Graphs and Fair Umpires, we illuminate the relationships between diagnostics strategies and the frequency of overdiagnosis. We then use the example of Gestational Diabetes Mellitus to demonstrate how the Fair Umpire framework may be applied to estimate overdiagnosis. CONCLUSION Our framework may be used to quantify overdiagnosis in non-cancer conditions (and in cancer conditions), as well as to guide further studies on this topic.
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Gyuricza JV, Brodersen J, Machado LBM, D'Oliveira AFPL. ‘People say it is dangerous’. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Mild hypertension is a common asymptomatic condition present in people at low risk of future cardiovascular events. These people represent approximately two-thirds of those diagnosed with hypertension. The best available evidence does not support pharmacological treatment for mild hypertension to reduce cardiovascular mortality. Additionally, overdetection of hypertension also occurs, and this practice is supported by public awareness campaigns, screening, easy access to testing, and poor clinical practice, enhancing the overdiagnosis potential. Moreover, sparse qualitative patient-oriented evidence that diagnosing hypertension has harmful consequences is observed. Therefore, evidence regarding the potential for unintended psychosocial effects of diagnosing mild hypertension is required. Objective: The aim of this study was to investigate if diagnosing low-risk people with mild hypertension has unintended psychosocial consequences. Methods: Eleven semi-structured single interviews and four focus groups were conducted in São Paulo, Brazil, among people diagnosed with mild hypertension without comorbidities. Informants were selected among the general population from a list of patients, a primary healthcare clinic, or a social network. The informants had a broad range of characteristics, including sex, age, education level, race/skin colour, and time from diagnosis. Data were subjected to qualitative thematic content analysis by three of the authors independently, followed by discussions, to generate categories and themes. Results: The informants confirmed that the hypertension diagnosis was a label for psychosomatic reactions to stress, medicalised illness experiences, and set a biographical milestone. We observed unintended consequences of the diagnosis in a broad range of psychosocial dimensions, for example, fear of death, disabilities, or ageing; pressure and control from significant others; and guilt, shame, and anxiety regarding work and leisure. Although informants had a broad range of characteristics, they shared similar stories, understandings, and labelling effects of the diagnosis. Conclusion: The diagnosis of hypertension is a significant event and affects daily life. Most of the impact is regarded as negative psychosocial consequences or harm; however, sometimes the impact might be ambiguous. Patients’ explanatory models are key elements in understanding and changing the psychosocial consequences of the diagnosis, and healthcare providers must be aware of explanatory models and psychosocial consequences when evaluating blood pressure elevations.
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Sepanlou S, Najafi F, Poustchi H, Parsaeian M, Ahmadi A, Somi M, Moradpour F, Alizadeh-Navaei R, Gohari A, Zamani B, Esmaeilinadimi A, Rezaianzadeh A, Mansour-Ghanaei F, Bahramali E, Ansari-Moghaddam A, Hamzeh B, Zanganeh Yousefabadi E, Zare Sakhvidi MJ, Mohebbi I, Fattahi MR, Nejatizadeh A, Marioryad H, Motamed-Gorji N, Roozafzai F, Eghtesad S, Mohammadi Z, Shayanrad A, Sharafkhah M, Etemadi A, Kamangar F, Juraschek SP, Malekzadeh R. Prevalence, awareness, treatment, and control of hypertension based on ACC/AHA versus JNC7 guidelines in the PERSIAN cohort study. Sci Rep 2022; 12:4057. [PMID: 35260709 PMCID: PMC8904851 DOI: 10.1038/s41598-022-07896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/28/2022] [Indexed: 02/08/2023] Open
Abstract
In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35-70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran.
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Affiliation(s)
- Sadaf Sepanlou
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Department of Epidemiology and Biostatistics, Modeling in Health Research Center, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Gohari
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Bijan Zamani
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Esmaeilinadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elham Zanganeh Yousefabadi
- Department of Internal Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Zare Sakhvidi
- Occupational Health Research Centre, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Roozafzai
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amaneh Shayanrad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, North Kargar Ave., Tehran, 14117-13135, Iran.
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Affiliation(s)
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - Jacob Bülow
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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Muscat DM, Morris GM, Bell K, Cvejic E, Smith J, Jansen J, Thomas R, Bonner C, Doust J, McCaffery K. Benefits and Harms of Hypertension and High-Normal Labels: A Randomized Experiment. Circ Cardiovasc Qual Outcomes 2021; 14:e007160. [PMID: 33813855 DOI: 10.1161/circoutcomes.120.007160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], <140/90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiovascular disease. METHODS We conducted a randomized experiment using a national sample of Australians (n=1318) 40 to 50 years of age recruited from an online panel. Participants were randomized to 1 of 3 hypothetical scenarios where a general practitioner told them they had a BP reading of 135/85 mm Hg, using either hypertension/high-normal BP/control (general BP description) labels. Participants were then randomized to receive an additional absolute risk description or nothing. Primary outcomes were willingness to change diet and worry. Secondary outcomes included exercise/medication intentions, risk perceptions, and other psychosocial outcomes. RESULTS There was no difference in willingness to change diet across label groups (P=0.22). The hypertension label (mean difference [MD], 0.74 [95% CI, 0.41-1.06]; P<0.001) and high-normal BP label (MD, 0.45 [95% CI, 0.12-0.78]; P=0.008) had increased worry about cardiovascular disease risk compared with control. There was no evidence that either label increased willingness to exercise (P=0.80). However, the hypertension (MD, 0.20 [95% CI, 0.04-0.36]; P=0.014), but not high-normal label (MD, 0.06 [95% CI, -0.10 to 0.21]; P=0.49), increased willingness to accept BP-lowering medication compared with control. Psychosocial differences including lower control, higher risk perceptions, and more negative affect were found for the hypertension and high-normal labels compared with control. Providing absolute risk information decreased willingness to change diet (MD, 0.25 [95% CI, 0.10-0.41]; P=0.001) and increase exercise (MD, 0.28 [95% CI, 0.11-0.45]; P=0.001) in the hypertension group. CONCLUSIONS Neither hypertension nor high-normal labels motivated participants to change their diet or exercise more than control, but both labels had adverse psychosocial outcomes. Labeling people with systolic BP of 130 to 140 mm Hg, who are otherwise at low risk of cardiovascular disease, may cause harms that outweigh benefit. Registration: URL: http://www.anzctr.org.au/; Unique identifier: ACTRN12618001700224.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Georgina May Morris
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Katy Bell
- Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney School of Public Health (G.M.M., K.B., E.C.), The University of Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Rae Thomas
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Queensland, Australia (R.T., J.D.)
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., E.C., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia.,Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health (D.M.M., J.S., J.J., C.B., K.M.), The University of Sydney, New South Wales, Australia
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Bell K, Doust J, McGeechan K, Horvath AR, Barratt A, Hayen A, Semsarian C, Irwig L. The potential for overdiagnosis and underdiagnosis because of blood pressure variability: a comparison of the 2017 ACC/AHA, 2018 ESC/ESH and 2019 NICE hypertension guidelines. J Hypertens 2021; 39:236-242. [PMID: 32773652 PMCID: PMC7810411 DOI: 10.1097/hjh.0000000000002614] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the extent that BP measurement variability may drive over- and underdiagnosis of 'hypertension' when measurements are made according to current guidelines. METHODS Using data from the National Health and Nutrition Examination Survey and empirical estimates of within-person variability, we simulated annual SBP measurement sets for 1 000 000 patients over 5 years. For each measurement set, we used an average of multiple readings, as recommended by guidelines. RESULTS The mean true SBP for the simulated population was 118.8 mmHg with a standard deviation of 17.5 mmHg. The proportion overdiagnosed with 'hypertension' after five sets of office or nonoffice measurements using the 2017 American College of Cardiology guideline was 3-5% for people with a true SBP less than 120 mmHg, and 65-72% for people with a true SBP 120-130 mmHg. These proportions were less than 1% and 14-33% using the 2018 European Society of Hypertension and 2019 National Institute for Health and Care Excellence guidelines (true SBP <120 and 120-130 mmHg, respectively). The proportion underdiagnosed with 'hypertension' was less than 3% for people with true SBP at least 140 mmHg after one set of office or nonoffice measurements using the 2017 American College of Cardiology guideline, and less than 18% using the other two guidelines. CONCLUSION More people are at risk of overdiagnosis under the 2017 American College of Cardiology guideline than the other two guidelines, even if nonoffice measurements are used. Making clinical decisions about cardiovascular prediction based primarily on absolute risk, minimizes the impact of blood pressure variability on overdiagnosis.
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Affiliation(s)
- Katy Bell
- School of Public Health, Faculty of Medicine and Health, The University of Sydney
| | - Jenny Doust
- New South Wales Health Pathology, Department of Clinical Chemistry and Endocrinology
| | - Kevin McGeechan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney
| | | | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, The University of Sydney
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, University of Technology Sydney (UTS)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Les Irwig
- School of Public Health, Faculty of Medicine and Health, The University of Sydney
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9
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Leite-Santos NC, de Melo DO, Mantovani-Silva RA, Gabriel FC, Fornasari GS, Dórea EL, Molino CDGRC, Ribeiro E. Guidelines for hypertension management in primary care: is local adaptation possible? J Hypertens 2020; 38:2059-2073. [PMID: 32890283 DOI: 10.1097/hjh.0000000000002516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypertension affects more than one billion people worldwide. There has been much discussion about clinical practice guidelines (CPGs) following the proposal of lower thresholds for starting pharmacological treatment. Some smaller groups or institutions could benefit from adapting CPGs to their local context, a process that requires high-quality CPGs with few points of conflict in their recommendations. To address this issue, we have compared high-quality hypertension CPGs and highlighted conflicting recommendations. METHODS CPGs were searched in MEDLINE, Embase, the Cochrane Library, as well as specific websites. Only CPGs published between 2016 and 2019 were included. We defined CPGs as high-quality if the 'rigor of development' and 'editorial independence' AGREE II domains were scored at least 60%. We compared recommendations made by high-quality CPGs and highlighted areas of conflict (defined as disagreements between more than two CPGs). RESULTS Nineteen CPGs were identified. The highest scoring domain was 'scope and purpose' (74.3%) and the lowest scoring was 'applicability' (40.0%). Eight CPGs were rated as high quality. Most CPG recommendations on the management of hypertension were consistent. Conflicting recommendations were regarding blood pressure (BP) levels to initiate pharmacotherapy and therapeutic goals, particularly in patients with low cardiovascular risk and older patients. CONCLUSION It is possible to adapt hypertension CPGs once high-quality documents have been identified with agreement between most recommendations. Guideline developers can focus on the adaption process and concentrate efforts on implementation.
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Affiliation(s)
| | - Daniela O de Melo
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo
| | - Rafael A Mantovani-Silva
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo
| | - Franciele C Gabriel
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo
| | - Guido S Fornasari
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Egídio L Dórea
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline de G R C Molino
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - Eliane Ribeiro
- Departamento de Farmácia, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo
- Departamento de Farmácia e Laboratório Clínico do Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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10
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Peng Y. The impact of 2017 ACC/AHA guideline on the prevalence of hypertension in Australia. J Hum Hypertens 2020; 35:104-106. [PMID: 32741962 DOI: 10.1038/s41371-020-0390-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Yang Peng
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia. .,Queensland Centre for Gynaecological Cancer Research, UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
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11
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Blood pressure control and complex health conditions in older adults: impact of recent hypertension management guidelines. J Hum Hypertens 2020; 35:280-289. [PMID: 32346124 DOI: 10.1038/s41371-020-0334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/08/2022]
Abstract
The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure (BP) thresholds to 130/80 mmHg to define hypertension while the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg. Both guidelines recommend adapting management for older patients with complex health conditions, without however clear indications on how to adapt. Our aims were to assess the impact of lowering BP thresholds on the prevalence of elevated BP and BP control, as well as the proportion of participants with a complex health condition across these BP categories. We used data from 3210 participants in the Lausanne cohort Lc65+ aged between 67 and 80 years. Hypertension diagnosis and antihypertensive medication use were self-reported. BP was measured three times at one visit. Some 51% of participants reported having hypertension and 44% reported taking antihypertensive medication. Compared with ESC/ESH thresholds, the prevalence of measured elevated BP was 24% percentage points higher and BP control was 24% percentage points lower using ACC/AHA thresholds. About one out of two participants with elevated BP and four out of five participants with uncontrolled BP had a complex health condition, i.e., frailty, multimorbidity, or polypharmacy. To comply with ACC/AHA guidelines, considerable effort would be required to reach BP control. This is a serious challenge because a large share of hypertensive older adults has complex health conditions, a type of patients for whom there is no strong evidence on how to manage hypertension.
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Affiliation(s)
- Jenny A Doust
- Centre for Longitudinal and Life Course Research, The University of Queensland School of Public Health, Herston, Queensland, Australia
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Sydney Medical School Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Gyuricza JV, d'Oliveira AFPL, Machado LBM, Brodersen J. Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling. J Patient Rep Outcomes 2019; 4:2. [PMID: 31893320 PMCID: PMC6938526 DOI: 10.1186/s41687-019-0168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Hypertension is the most prevalent risk factor for cardiovascular disease globally. Roughly one-third of the adult population has hypertension. However, most people diagnosed with hypertension do not benefit from blood pressure control with pharmacologic interventions: they are overdiagnosed and overtreated and might experience negative psychosocial consequences of being labelled. These consequences are relevant outcomes that need to be assessed and validly measured to identify all benefits and harms related to interventions designed to prevent cardiovascular disease. Objectives To develop a pool of items with high content validity for a draft version of a condition-specific questionnaire to measure the psychosocial consequences of being labelled with mild hypertension. Methods We selected relevant items from existing Consequences of Screening (COS) questionnaires. These items belonged to two groups: COS core items and potential condition-specific items. All items were originally in Danish and were translated into Brazilian Portuguese using the dual-panel method. Individual and group interviews were conducted with people with mild hypertension and low risk for cardiovascular disease, and were designed to test the translated items for face and content validity and were also used to generate new relevant items. Structured individual interviews were conducted to categorise all the items into domains. Results The Brazilian Portuguese dual-panel translation of both groups of items was found to be relevant for adults diagnosed with hypertension. We generated 52 new items to achieve high content validity. The result was a set of 132 items divided into 22 domains in 2 parts. Part I was directed at the general population, whereas part II was directed only at people diagnosed with hypertension and it consisted of 38 items in 8 domains. Twelve items remained as single items. High content validity was achieved with the pool of 132 items divided into 22 domains in 2 parts. Discussion High content validity was achieved for a condition-specific questionnaire measuring the psychosocial consequences of being labelled with mild hypertension. This instrument encompassed 132 items divided into 22 domains in 2 parts. Thereby, a draft of the Consequneces of Hypertension questionnaire (COH) was developed. The psychometric properties of this questionnaire will be discussed in a diferent paper.
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Affiliation(s)
- János Valery Gyuricza
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2o andar. CEP, São Paulo, SP, 01246-903, Brazil.
| | - Ana Flávia Pires Lucas d'Oliveira
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2o andar. CEP, São Paulo, SP, 01246-903, Brazil
| | - Lucas Bastos Marcondes Machado
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 225. CEP, São Paulo, SP, 05403-010, Brazil
| | - John Brodersen
- Forskningsenheden for Almen Praksis, Center for Sundhed og Samfund, Københavns Universitet, Øster Farimagsgade, Bygning 24. Postboks 2099, 1014, København K, Denmark
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Porcher R, Tran VT, Blacher J, Ravaud P. Potential of Stratified Medicine for High Blood Pressure Management: A Modeling Study Using NHANES Survey Data. Hypertension 2019; 74:1420-1427. [PMID: 31679427 DOI: 10.1161/hypertensionaha.119.13749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 2017 American College of Cardiology/American Heart Association hypertension guidelines lowered the thresholds for defining and treating hypertension. However, the SPRINT trial showed substantial heterogeneity in benefits and harms of intensive antihypertensive treatment depending on patients' characteristics. We aimed at illustrating the potential gains of personalizing intensive antihypertensive treatment. Using the US National Health and Nutrition Examination Survey 2011 to 2014 (n=2067), and prediction models derived from the SPRINT trial, we computed expected benefits and harms of intensive antihypertensive treatment for individuals aged 50 or more. We compared 2 interventions: (1) intensive antihypertensive treatment for all individuals meeting the 2017 American College of Cardiology/American Heart Association thresholds and (2) a stratified medicine strategy excluding from intensive treatment individuals with predicted unfavorable benefit-risk. Outcome measures were model-predicted 5-year risk of cardiovascular events or death (myocardial infarction, acute coronary, stroke, acute decompensated heart failure, and cardiovascular-related death), and severe adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, and acute kidney injury). Per 2017 American College of Cardiology/American Heart Association guidelines, 40.1 million (39.2%) US individuals aged 50 or more should initiate or intensify antihypertensive treatment, thereby preventing cardiovascular events for 795 000 individuals and inducing severe adverse events for 848 000 over 5 years. A stratified treatment strategy could decrease the number of individuals treated by 21.2 million (52.9%) and reduce the number of individuals with severe adverse events by 38.3%, with 11.7% fewer individuals with cardiovascular events prevented. Personalizing antihypertensive treatment according to predicted benefits and harms could spare treatment for more than half individuals while reducing harms 3× more than benefits.
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Affiliation(s)
- Raphaël Porcher
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.).,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.)
| | - Viet-Thi Tran
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.)
| | - Jacques Blacher
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.).,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Centre de Diagnostic et de Thérapeutique, Paris, France (J.B.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team EREN, Bobigny, France (J.B.)
| | - Philippe Ravaud
- From the Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France (R.P., V.-T.T., P.R.).,INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), Team METHODS, Paris, France (R.P., V.-T.T., P.R.).,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France (R.P., J.B., P.R.).,Columbia University, Mailman School of Public Health, Department of Epidemiology, NY (P.R.)
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16
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Gérvas J, Oliver LL, Pérez-Fernandez M. Family and Community Medicine and its role in preventing health overuse (preventive, diagnostic, therapeutic and rehabilitative). CIENCIA & SAUDE COLETIVA 2019; 25:1233-1240. [PMID: 32267426 DOI: 10.1590/1413-81232020254.30082019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more than required is offered, and everything that is unnecessary is not avoided. This is a nonsystematic review with a teaching objective that reviews the general issue in primary care and suggests ways to avoid overuse and shortcomings concerning preventive, diagnostic, therapeutic, and rehabilitative interventions. Knowing not to do is science and art that is hardly taught and practiced less. The overuse that harm are an almost daily part of clinical practice in prevention, diagnosis, treatment, and rehabilitation. It is essential to promote "the art and science of not doing".
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Affiliation(s)
- Juan Gérvas
- Equipo CESCA. Pradillo 68.28002 Madrid España.
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17
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Moynihan R, Brodersen J, Heath I, Johansson M, Kuehlein T, Minué-Lorenzo S, Petursson H, Pizzanelli M, Reventlow S, Sigurdsson J, Stavdal A, Treadwell J, Glasziou P. Reforming disease definitions: a new primary care led, people-centred approach. BMJ Evid Based Med 2019; 24:170-173. [PMID: 30962252 DOI: 10.1136/bmjebm-2018-111148] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ray Moynihan
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | | | - Iona Heath
- Royal College of General Practitioners, London, UK
| | | | | | | | | | | | | | | | | | | | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (crebp.net.au), Robina, Queensland, Australia
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18
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Bi C, Wang L, Sun C, Sun M, Zheng P, Xue Z, Shen L, Pan P, Li J, Lv Y, Zhang A, Li B, Zhang X, Yao Y, Jin L. Association between normal triglyceride and insulin resistance in US adults without other risk factors: a cross-sectional study from the US National Health and Nutrition Examination Survey, 2007-2014. BMJ Open 2019; 9:e028652. [PMID: 31401596 PMCID: PMC6701626 DOI: 10.1136/bmjopen-2018-028652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Traditionally, the absence of insulin resistance risk factors (IRRFs) was considered a low risk for insulin resistance (IR). However, IR also existed in certain individuals without IRRFs; thus this study aims to explore predictors of IR targeted at the population without IRRFs. DESIGN Cross-sectional survey. SETTING National Health and Nutrition Examination Survey. PARTICIPANTS Participants without regular IRRFs (IRRF-Free, n=2478) and a subgroup without optimal IRRFs (IRRF-Optimal, n=1414) were involved in this study. PRIMARY AND SECONDARY OUTCOME MEASURE IRRFs and the optimal cut-off value of triglyceride (TG) to predict IR. RESULTS Overall, the prevalence of IR was 6.9% and 5.7% in the IRRF-Free group and the IRRF-Optimal group, respectively. TG and waist circumference were independently associated with the prevalence of IR in both the groups (OR=1.010 to 10.20; p<0.05 for all), where TG was positively associated with IR. The area under the receiver operating characteristic curve of TG was 0.7016 (95% CI: 0.7013 to 0.7018) and 0.7219 (95% CI: 0.7215 to 0.7222), and the optimal cut-off value of TG to predict IR was 79.5 mg/dL and 81.5 mg/dL in the IRRF-Free group and the IRRF-Optimal group, respectively. CONCLUSION There is an association between TG and IR even in the normal range of TG concentration. Therefore, normal TG could be used as an important indicator to predict the prevalence of IR in the absence of IRRFs.
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Affiliation(s)
- Chunli Bi
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Lijuan Wang
- Department of Neurology, The Neuroscience Center, The First Hospital of Jilin University, Jilin University First Hospital, Changchun, China
| | - Chong Sun
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Mengzi Sun
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Pingping Zheng
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Zhiqiang Xue
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Li Shen
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Pan Pan
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Jiagen Li
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Yaogai Lv
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Anning Zhang
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Bo Li
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Xinyao Zhang
- Department of Social Medicine and Health Management, Jilin University School of Public Health, Changchun, China
| | - Yan Yao
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
| | - Lina Jin
- Key Laboratory of Zoonosis Research & Department of Epidemiology and Biostatistics, Jilin University School of Public Health, Changchun, China
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Kesel N. Nephro Update Europe 2018. KIDNEY DISEASES (BASEL, SWITZERLAND) 2019; 5:173-181. [PMID: 31259179 PMCID: PMC6587211 DOI: 10.1159/000499822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Nina Kesel
- med update europe GmbH, Wiesbaden, Germany
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20
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Bakris G, Ali W, Parati G. ACC/AHA Versus ESC/ESH on Hypertension Guidelines. J Am Coll Cardiol 2019; 73:3018-3026. [DOI: 10.1016/j.jacc.2019.03.507] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
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Abstract
Recent guidelines on diagnosis and management of high blood pressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with high BP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals, and a different approach to resistant hypertension. Finally, differences among guidelines, the persistent controversies that have led to them, and their implications for clinical practice are discussed.
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Affiliation(s)
| | - Robert D Brook
- University of Michigan, Ann Arbor, Michigan (J.B.B., R.D.B.)
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22
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23
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Touyz RM. Hypertension Guidelines: Effect of Blood Pressure Targets. Can J Cardiol 2019; 35:564-569. [PMID: 31030859 DOI: 10.1016/j.cjca.2019.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022] Open
Abstract
There has been an abundance of hypertension guidelines over the years. Their purpose is to convey evidence-based findings from clinical trials to clinicians so that best medical choices can be made for the diagnosis and treatment of patients with hypertension. Over the past 3 years new hypertension guidelines have been published in the United States, Canada, Europe, and elsewhere with new or refined recommendations made regarding diagnosis, therapy, and intensity of treatment. Previous national guidelines were generally well aligned. However, there are major differences in the current North American and European recommendations in terms of the classification of hypertension and treatment goals, with the diagnosis of hypertension starting at 140/90 mm Hg for the European guidelines and 130/80 mm Hg for the American and Canadian guidelines. An important controversial aspect in the updated guidelines relates to a lowered threshold (130/80 mm Hg) at which hypertension is diagnosed and treated, because growing evidence indicates that individuals at low cardiovascular risk might be exposed to incremental harm because of overtreatment with antihypertensive drugs. However, these concerns need to be weighed against the robust evidence from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) study and numerous meta-analyses, which clearly showed that intensive blood pressure-lowering aimed at a systolic blood pressure of 120-130 mm Hg causes ̴a significant, > 25% reduction in cardiovascular morbidity and mortality. This review highlights some of the important discrepancies between the major current guidelines, with a focus on definitions and treatment goals of hypertension. The effect of lower blood pressure targets and intensive antihypertensive treatment on cardiovascular benefit and risk is also discussed.
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Affiliation(s)
- Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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24
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Luo DH, Tseng WYI, Chang YL. White matter microstructure disruptions mediate the adverse relationships between hypertension and multiple cognitive functions in cognitively intact older adults. Neuroimage 2019; 197:109-119. [PMID: 31029871 DOI: 10.1016/j.neuroimage.2019.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/01/2023] Open
Abstract
Although hypertension is a prominent vascular risk factor for late-life cognitive decline, the underlying pathophysiological mechanism remains unclear. Accordingly, the aim of this study was to examine the role of white matter microstructural integrity in hypertension-related cognitive detriments. We recruited 66 cognitively normal older adults, comprising 41 hypertensive patients and 25 normotensive controls. All participants underwent a comprehensive neuropsychological battery. White matter microstructural integrity was assessed using a tract-based automatic analysis approach derived from diffusion spectrum imaging. Mediating effects of white matter integrity were evaluated using structural equation modeling analyses. The results revealed that hypertensive older adults displayed poorer processing speed, executive function, and memory encoding. Lower white matter microstructural integrity was observed in the hypertensive elderly patients, primarily in long-range association fiber bundles. In particular, low microstructural integrity in specific tract bundles connecting frontal and posterior cerebral regions was found to underlie the adverse relationships between hypertension and multiple cognitive domains, including processing speed, executive function, memory encoding, and memory retention. Our findings suggest that hypertension may impair multiple cognitive functions by undermining white matter microstructures, even in cognitively intact older adults, thus further highlighting the necessity of monitoring vascular health to prevent cognitive decline.
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Affiliation(s)
- Di-Hua Luo
- Department of Psychology, College of Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Wen-Yih Isaac Tseng
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan; Graduate Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan; Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10048, Taiwan
| | - Yu-Ling Chang
- Department of Psychology, College of Science, National Taiwan University, Taipei, 10617, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan; Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, 10617, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 10048, Taiwan.
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Asgari S, Khaloo P, Khalili D, Azizi F, Hadaegh F. Status of Hypertension in Tehran: Potential impact of the ACC/AHA 2017 and JNC7 Guidelines, 2012-2015. Sci Rep 2019; 9:6382. [PMID: 31011156 PMCID: PMC6476880 DOI: 10.1038/s41598-019-42809-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 04/09/2019] [Indexed: 01/19/2023] Open
Abstract
This study aimed to determine the prevalence of hypertension, the recommended anti-hypertensive therapy and the percentage of hypertensive patients who had achieved the blood pressure (BP) target according to 2017 American College of Cardiology/American Heart Association (ACC/AHA) versus JNC7 and 8 guidelines, among Iranian population. Data of participants aged ≥20 years from the fifth phase (2012-2015) of the Tehran lipid and glucose study (N = 10,576) were analyzed, using survey analysis. The weighted prevalence of hypertension among those not on anti-hypertensive medications was 42.7 and 12.6%, applying the ACC/AHA and JNC7 guideline definitions, respectively; the corresponding values with including BP-lowering medication in definition of hypertension were 47.1% and 20.4%, respectively. However, 90% of these hypertensive people were found to have a 10-year cardiovascular disease risk of <10%. Applying the ACC/AHA guideline, anti-hypertensive medication was recommended for 21.9% of Tehranians, compared to 19.3 and 12.2% according to the JNC7 and 8 guidelines, respectively. Among Tehranians taking anti-hypertensive medication, 20% achieved the BP goal according to the ACC/AHA guideline, compared to the 42.1 and 53.6%, using JNC7 and 8 guidelines, respectively. Despite the tremendous increase in the prevalence of hypertension, most of the newly identified cases did not belong to the high-risk group.
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Affiliation(s)
- Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Fernandes M, Olde Rikkert MGM. The new US and European guidelines in hypertension: A multi-dimensional analysis. Contemp Clin Trials 2019; 81:44-54. [PMID: 31002956 DOI: 10.1016/j.cct.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/30/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) compared the clinical outcomes between target systolic blood pressure (SBP) levels between 140 and 120 mmHg or lower. Both,the 2017 ACC/AHA and the 2018 ESC/ESH guidelines in hypertension are derived from the SPRINT trial and advise initiation and/or intensification of treatment at lower blood pressure thresholds. The ACC/AHA guidance supersedes the 2014 Eight Joint National Committee guideline (JNC-8) which advised initiation of treatment when the BP was 140/90 mmHg or higher; in adults 60 years or over, the target was 150/90 mmHg. Compared to JNC-8, the new guidelines lower the SBP target by 10 mmHg in patients under age of 60 years, and by 20 mmHg in the elderly. We performed a qualitative multi-dimensional analysis in order to answer two key questions: will the new guidelines deliver the stated benefits? and, will translation to the clinic be simple, risk-free, and affordable? A major investment by national healthcare administrations will be necessary for the initiation and support of this program but this decision can only be justified by a valid expectation of clinical benefit. At this time, a definitive answer is not available and a "wait and see" attitude appears appropriate and reasonable. In the interim, efforts are best directed to the immediate problem of untreated hypertension worldwide.
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Okubadejo NU, Ozoh OB, Ojo OO, Akinkugbe AO, Odeniyi IA, Adegoke O, Bello BT, Agabi OP. Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults in Nigeria: a comparative analysis based on recent guideline recommendations. Clin Hypertens 2019; 25:7. [PMID: 31016027 PMCID: PMC6463661 DOI: 10.1186/s40885-019-0112-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/06/2019] [Indexed: 01/07/2023] Open
Abstract
Background Hypertension is the major risk factor for cardiovascular diseases and prevalence rates are critical to understanding the burden and envisaging health service requirements and resource allocation. We aimed to provide an update of the current prevalence of hypertension and blood pressure profiles of adults in urban Nigeria. Methods Cross sectional population-based survey in Lagos, Nigeria. Participants were selected using stratified multistage sampling. Relevant sections of the World Health Organization STEPwise approach to chronic disease risk factor surveillance were utilized for data collection. Blood pressures were categorized based on both the current American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines and the pre-existing Joint National Committee on Hypertension 7 (JNC7) (2003) categories. Results There were 5365 participants (51.8% female), age range of 16–92 years, and mean age ± SD 37.6 ± 13.1. The mean ± SD systolic and diastolic blood pressures were 126.8 ± 18.6 and 80.6 ± 13.2 respectively. There was significant correlation between both systolic and diastolic blood pressures and age (Pearson correlation 0.372 and 0.357 respectively and p = 0.000 in both instances). The prevalence of hypertension was 55.0% (3003) and 27.5% (1473) based on the ACC/AHA 2017 guideline and the JNC7 2003 guidelines respectively. Body mass index was positively correlated with systolic and diastolic BP (p = 0.000). Conclusions Over half of the adult population in this major Nigerian city are classified to have hypertension by the recent guideline. There is an urgent need to develop and implement strategies for primordial prevention of hypertension (and obesity) and to restructure our healthcare delivery systems to adequately cater for the current and emerging hypertensive population.
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Affiliation(s)
- Njideka U Okubadejo
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Obianuju B Ozoh
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Oluwadamilola O Ojo
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Ayesha O Akinkugbe
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Ifedayo A Odeniyi
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Oluseyi Adegoke
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Babawale T Bello
- 1Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos State, 100254 Nigeria.,2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Osigwe P Agabi
- 2Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
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Affiliation(s)
- Christoffer Bjerre Haase
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - János Valery Gyuricza
- Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - John Brodersen
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
- Primary Health Care Research Unit, Zealand Region, Denmark
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Kramer HJ, Townsend RR, Griffin K, Flynn JT, Weiner DE, Rocco MV, Choi MJ, Weir MR, Chang TI, Agarwal R, Beddhu S. KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline. Am J Kidney Dis 2019; 73:437-458. [PMID: 30905361 PMCID: PMC6740329 DOI: 10.1053/j.ajkd.2019.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
Hypertension is a modifiable risk factor for cardiovascular morbidity and mortality and reduction of elevated blood pressure (BP) remains an important intervention for slowing kidney disease progression. Over the past decade, the most appropriate BP target for initiation and titration of BP-lowering medications has been an area of intense research and debate within the clinical community. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) in conjunction with several other professional societies released new hypertension guidelines based on data from a systematic review of clinical trials and observational data. While many of the recommendations in the ACC/AHA hypertension guideline are relevant to nephrology practice, BP targets and management strategies for patients receiving dialysis are not discussed. This Kidney Disease Outcomes Quality Initiative (KDOQI) commentary focuses largely on recommendations from the ACC/AHA hypertension guidelines that are pertinent to individuals at risk of chronic kidney disease or with non-dialysis-dependent chronic kidney disease. This KDOQI commentary also includes a brief discussion of the consensus statement regarding hypertension diagnosis and management for adults receiving maintenance dialysis published by the European Renal and Cardiovascular Medicine Working Group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Overall, we support the vast majority of the ACC/AHA recommendations and highlight select areas in which best diagnosis and treatment options remain controversial.
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Affiliation(s)
- Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood; Hines VA Medical Center, Hines, IL.
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Karen Griffin
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood; Hines VA Medical Center, Hines, IL
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
| | | | - Michael V Rocco
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael J Choi
- Department of Medicine, Johns Hopkins School of Medicine
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Tara I Chang
- Department of Medicine, Stanford Medical School, Palo Alto, CA
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Bakris G. Similarities and Differences Between the ACC/AHA and ESH/ESC Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Circ Res 2019; 124:969-971. [PMID: 30920926 DOI: 10.1161/circresaha.118.314664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- George Bakris
- From the Department of Medicine, AHA Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, IL
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Page A, Etherton-Beer C. Undiagnosing to prevent overprescribing. Maturitas 2019; 123:67-72. [PMID: 31027680 DOI: 10.1016/j.maturitas.2019.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Health care focuses on controlling symptoms and managing risk factors to improve survival by avoiding future complications. Diagnoses describe a group of signs and symptoms, often implying specific aetiologies and underlying pathophysiological disease processes. The diagnosis provides a tool for the health professional to conceptualise and classify a presentation, and thus manage the condition, and can provide the patient with an explanation or validation of their experience. Not every diagnosis holds significant clinical implications. There are diagnosed conditions that do not require treatment and, moreover, where treatment has the potential for harm without the potential for benefit. Promoting investigations and diagnoses can lead to overdiagnosis related to vested interests in increased services, use of devices or therapeutics. Multiple factors drive this issue, including broadening disease definitions and cultural factors that encourage tests and treatments, as well as medicolegal factors. While the traditional medicine review process typically involved cross-referencing medicines used with current diagnoses, a more sophisticated version of this process critically reviews the medicines and associated diagnosis, giving less emphasis to diagnoses that are no longer relevant. Known as undiagnosis, this process facilitates the withdrawal of corresponding medicines used to manage those conditions. Systematically reviewing diagnoses regularly and the associated medicine management strategies could reduce prescribing. The novel ERASE process can help clinicians Evaluate diagnoses to consider Resolved conditions, Ageing normally and Selecting appropriate targets to Eliminate unnecessary diagnoses and their corresponding medicines.
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Affiliation(s)
- Amy Page
- Alfred Health, 55 Commercial Rd, Australia; Monash University, Centre for Medicine Use and Safety, Melbourne, Australia; University of Western Australia, School of Allied Health, Centre for Medicines Optimisation, Perth, Australia.
| | - Christopher Etherton-Beer
- University of Western Australia, Western Australian Centre for Health and Ageing, Australia; Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
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Moynihan RN, Clark J, Albarqouni L. Media Coverage of the Benefits and Harms of the 2017 Expanded Definition of High Blood Pressure. JAMA Intern Med 2019; 179:272-273. [PMID: 30592488 PMCID: PMC6439645 DOI: 10.1001/jamainternmed.2018.6201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study examines the media coverage of the expanded definition of hypertension associated with the new guidelines from the American College of Cardiology and the American Heart Association.
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Affiliation(s)
- Raymond Noel Moynihan
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia, 4229
| | - Justin Clark
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia, 4229
| | - Loai Albarqouni
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia, 4229
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Adji A. Eye Clinic as a Potential Site to Measure Blood Pressure. Am J Hypertens 2019; 32:12-14. [PMID: 30403791 DOI: 10.1093/ajh/hpy161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/26/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Audrey Adji
- Department of Cardiology, St Vincent’s Clinic, Sydney, Australia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Vasan RS. High Blood Pressure in Young Adulthood and Risk of Premature Cardiovascular Disease: Calibrating Treatment Benefits to Potential Harm. JAMA 2018; 320:1760-1763. [PMID: 30398583 DOI: 10.1001/jama.2018.16068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
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Poulter NR, Castillo R, Charchar FJ, Schlaich MP, Schutte AE, Tomaszewski M, Touyz RM, Wang JG. Are the American Heart Association/American College of Cardiology High Blood Pressure Guidelines Fit for Global Purpose?: Thoughts From the International Society of Hypertension. Hypertension 2018; 72:260-262. [PMID: 29967044 DOI: 10.1161/hypertensionaha.118.11452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Neil R. Poulter
- From the Imperial Clinical Trials Unit, Imperial College London, United Kingdom (N.R.P.)
| | - Rafael Castillo
- Section of Cardiovascular Medicine, Faculty of Medicine, Adventist University of the Philippines and Manila Doctors’ Hospital (R.C.)
| | - Fadi J. Charchar
- Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria (F.J.C.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, University of Western Australia-Royal Perth Hospital (M.P.S.)
| | - Aletta E. Schutte
- Hypertension in Africa Research Team (HART), SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.)
| | - Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.M.T.)
| | - Ji-Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
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