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Katsi V, Georgiopoulos G, Magkas N, Oikonomou D, Virdis A, Nihoyannopoulos P, Toutouzas K, Tousoulis D. The Role of Arterial Hypertension in Mitral Valve Regurgitation. Curr Hypertens Rep 2019; 21:20. [PMID: 30820680 DOI: 10.1007/s11906-019-0928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW To review medical literature for evidence of association between hypertension and mitral regurgitation (MR) and summarize potential favorable effects of antihypertensive drugs on MR natural history and treatment. RECENT FINDINGS Hypertension and MR are common diseases affecting a large proportion of the general population. Contemporary evidence suggests that hypertension may worsen the progression and prognosis of MR through augmented mechanical stress and increased regurgitation volume. Renin-angiotensin axis inhibitors, beta-blockers, and vasodilators have been tested in order to prevent or decrease primary or secondary MR. Although antihypertensive agents may improve hemodynamic parameters and left ventricular remodeling in primary MR, there is no strong evidence of benefit on clinical outcomes. On the other hand, a beneficial effect of these drugs on secondary MR is better established. Moreover, there are no studies evaluating a possible benefit of lower blood pressure targets in MR. Randomized controlled trials are warranted to elucidate the precise role of antihypertensive therapy on treatment of MR.
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Affiliation(s)
- Vasiliki Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece.
| | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Petros Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
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Periodontal disease is an independent predictor of intracardiac calcification. BIOMED RESEARCH INTERNATIONAL 2013; 2013:854340. [PMID: 24106721 PMCID: PMC3784081 DOI: 10.1155/2013/854340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease. HYPOTHESIS We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis. METHODS Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification. RESULTS Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In unadjusted analysis, a significant relationship between periodontal score and cardiac calcification (Spearman rho = 0.4, P = 0.001) was noted, with increases in mean calcification score seen across increasing levels of periodontal disease. On multivariate logistic regression, adjusted for age, gender, race, glomerular filtration rate, and traditional risk factors, this association remained significant (P = 0.024). There was no significant interaction by study site, race, or gender. CONCLUSIONS In a multiracial population, we found a significant association between the degree of periodontal disease, a chronic inflammatory condition, and cardiac calcification. Further, higher periodontal scores were associated with greater degrees of calcification.
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Sakai H, Hayashi K, Origasa H, Kusunoki T. An application of meta-analysis techniques in the evaluation of adverse experiences with antihypertensive agents. Pharmacoepidemiol Drug Saf 2004; 8:169-77. [PMID: 15073926 DOI: 10.1002/(sici)1099-1557(199905/06)8:3<169::aid-pds416>3.0.co;2-f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE To investigate the profiles of adverse events (AEs) in randomized controlled trials of antihypertensive agents therapy with the technique of meta-analysis. METHODS A total of 620 articles were selected from MEDLINE, EMBASE, JAPIC-DOC, JMEDICINE and manual searching. Two independent reviewers examined the 620 selected articles according to the following criteria: (1) the methods of randomization, (2) making for allocating treatments, (3) therapeutic class of drugs, (4) sample sizes, (5) duration of the treatment, (6) primary endpoint, (7) reporting method for all adverse events, (8) method of monitoring AEs, and (9) incidence rates of all reported AEs. To combine the risk difference and risk ratios of incidence between CCBs and beta blockers or diuretics, the method of DerSimonian and Laird based on random effect model was applied. RESULTS A total of 3073 patients were included in this meta-analysis of serious adverse events (SAEs). There was no significant difference in the total incidence of SAEs between CCBs and diuretics or between CCBs and beta blockers. We found that patients treated with CCBS had 0.14% fewer SAEs compared with the patients treated with diuretics. Contrarily, the patients treated with CCBs had 0.29% more SAEs compared with the patients treated with beta blockers. There was a significant difference between the patients treated with CCBs and those treated with diuretics in the symptoms with headache and oedema. With respect to the comparison between CCBs and beta blockers, flushing occurred 8.75% more frequently in the CCBs group than in the beta blockers group. CONCLUSION A meta-analysis can be applied to safety analyses of data obtained in clinical trials if all of the RCT articles used include a complete description of adverse experiences.
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Affiliation(s)
- H Sakai
- Department of Pharmacoepidemiology, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan
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Tenenbaum A, Fisman EZ, Shemesh J, Adler Y, Shenkman T, Swissa-Cohen L, Boyko V, Motro M. Combined coronary and mitral annulus calcium detection in the non-invasive diagnosis of coronary artery disease in patients with systemic hypertension. Coron Artery Dis 2002; 13:113-7. [PMID: 12004263 DOI: 10.1097/00019501-200204000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the presence of coronary calcium (CC) on fast spiral computed tomography (FSCT) is a powerful predictor of coronary artery disease (CAD), both the specificity and positive predictive value (PPV) of CC in CAD diagnosis are modest. Since previous studies have shown an association between mitral annular calcification (MAC) and coronary atherosclerosis, we aimed to investigate whether combined coronary and MAC detection could improve the non-invasive diagnosis of CAD. DESIGN AND METHODS Our study comprised 522 patients (284 men and 238 women, age ranged from 52-80 years, mean 65 +/- 6 years) who underwent FSCT of the coronaries as well as echo-Doppler examination. Among them, 97 patients had prior diagnosis of prevalent proven CAD (CAD group) while 425 patients were without clinically manifested CAD (the No CAD group). RESULTS The prevalence of CC in the CAD group was 95 versus 68% in the No CAD group (P = 0.001). The prevalence of MAC in CAD group was 63 versus 51% in No CAD group (P = 0.03). Sensitivity and negative predictive value (NPV) of CC as a predictor of CAD were 95 and 96% respectively, but specificity and PPV were low: 32 and 24% respectively. Sensitivity and NPV of MAC as predictors of CAD were 63 and 85% respectively; specificity and PPV, 49 and 22% respectively. Using of combined CC and MAC evaluation in the prediction led to some specificity improvement at the expense of a similar sensitivity reduction, without a considerable gain in the total accuracy of the method. CONCLUSIONS Coronary calcium detection on FSCT in hypertensive patients yields excellent sensitivity and NPV but relatively low specificity and PPV for clinically manifested CAD. Mitral annular calcification assessment yields a low sensitivity and specificity and its addition to CC evaluation does not improve non-invasive diagnosis of CAD.
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Affiliation(s)
- Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Tenenbaum A, Fisman EZ, Pines A, Shemesh J, Shapira I, Adler Y, Frenkel Y, Boyko V, Motro M. Gender paradox in cardiac calcium deposits in middle-aged and elderly patients: mitral annular and coronary calcifications interrelationship. Maturitas 2000; 36:35-42. [PMID: 10989240 DOI: 10.1016/s0378-5122(00)00120-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES mitral annular calcification (MAC) occurs mainly in middle-aged and elderly patients and can lead to serious clinical consequences. Male predominance in the prevalence of coronary disease is well-established. Paradoxically, the prevalence of MAC, which is theoretically based on the same etiological mechanisms as coronary atherosclerosis, seems to be predominant in postmenopausal women. The goal of this work was to investigate gender influences on interrelationship between MAC and coronary calcifications (CC) in the same population of middle-aged and elderly patients with increased cardiovascular risk. METHODS the study comprised 522 patients (284 men and 238 postmenopausal women, aged 52-80 years, mean 65+/-6), who were recruited to the International Nifedipine GITS Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) study in our region. They underwent both fast spiral computed tomography of the heart and echo-Doppler. MAC was defined as advanced when its thickness was > or =5mm; otherwise it was defined as trivial. RESULTS there were 37 (16%) women and 25 (9%) men with advanced MAC (AMAC), 97 (41%) women and 118 (42%) men with trivial MAC and 104 (44%) women and 141 (50%) men without MAC. The prevalence of any type of CC was significantly higher among men (P=0. 001). In sharp contrast to the distinct male predominance in coronary disease, AMAC was more prevalent among women. In patients without CC prevalence was 9 and 4%, increasing to 16 and 8% in those with nonsevere CC and to 38 and 14% in patients with severe CC, respectively (P=0.001). Multivariate analysis showed that AMAC can predict the presence of severe CC in women and men, with OR of 4.1 and 2.6 (CI 1.2-14.8 and 1.0-10.6) and coronary disease with OR of 2. 5 and 2.5 (CI 0.6-10.6 and 1.0-6.4), respectively. CONCLUSIONS AMAC signifies a high probability of coronary atherosclerosis in patients of both genders. The inverted gender predominance in the prevalence of annular calcification and CC could be explained by additional etiological (likely osteoporotic) mechanisms of MAC development among postmenopausal women.
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Affiliation(s)
- A Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Israel.
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Tenenbaum A, Shemesh J, Fisman EZ, Motro M. Advanced mitral annular calcification is associated with severe coronary calcification on fast dual spiral computed tomography. Invest Radiol 2000; 35:193-8. [PMID: 10719829 DOI: 10.1097/00004424-200003000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Mitral annular calcification (MAC) may be a form of atherosclerosis and can lead to serious clinical consequences. The possible linkage between the presence and extent of MAC and coronary calcium score on CT is unknown. The goal of the present study was to investigate whether an association between MAC and coronary calcification (CC) exists in hypertensive patients with increased cardiovascular risk. METHODS Five hundred twenty-two patients (284 men and 238 women, age range 52-80 years, mean 65+/-6 years), who were recruited to the INSIGHT study in the authors' region, underwent fast spiral CT of the heart as well as an echo Doppler examination. MAC was defined as advanced when the thickness of the calcium deposit was 5 mm or more; it was defined as trivial otherwise. RESULTS The advanced MAC group comprised 62 patients, the trivial MAC group 215 patients, and the control group (without MAC) 245 patients. The prevalence of nonsevere CC was similar among the study groups, whereas the prevalence of severe CC (total calcium score >300) and the prevalence of proven coronary artery disease were associated with the presence and extent of MAC: respectively, 12% and 15% in control patients, 18% and 20% in patients with trivial MAC, and 29% and 29% in patients with advanced MAC. Multivariate analysis identified advanced MAC as an independent variable associated with severe CC and proved coronary artery disease. CONCLUSIONS The results of this study demonstrated an association of advanced MAC and severe CC on spiral CT and proved coronary artery disease on the clinical level. Thus, advanced but not trivial MAC makes the noninvasive diagnosis of coronary atherosclerosis more likely and presumably could be considered as a new indication for further coronary evaluation in high-risk patients.
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Affiliation(s)
- A Tenenbaum
- Cardiac Rehabilitation Institute, the Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Stason WB, Schmid CH, Niedzwiecki D, Whiting GW, Luo D, Ross SD, Chalmers TC. Safety of Nifedipine in Patients With Hypertension. Hypertension 1997. [DOI: 10.1161/hyp.30.1.7/a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William B. Stason
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Christopher H. Schmid
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Donna Niedzwiecki
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Gregory W. Whiting
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Donghan Luo
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Susan D. Ross
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
| | - Thomas C. Chalmers
- From the Harvard School of Public Health (W.B.S.); MetaWorks, Inc (W.B.S., D.N., G.W.W., D.L., S.D.R., T.C.C.); Tufts University/New England Medical Center (C.H.S.); and Tufts University (T.C.C.), Boston, Mass
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Stason WB, Schmid CH, Niedzwiecki D, Whiting GW, Caubet JF, Luo D, Ross SD, Chalmers TC. Safety of nifedipine in patients with hypertension: a meta-analysis. Hypertension 1997; 30:7-14. [PMID: 9231814 DOI: 10.1161/01.hyp.30.1.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our objective was to compare cardiovascular event rates in patients with mild or moderate hypertension who received nifedipine with active drug controls. We performed a MEDLARS search using the MeSH heading "hypertension" and the text word "nifedipine" to identify all articles that were published between 1966 and August 1995 in English, French, German, Italian, and Spanish languages and that involved human subjects. The computerized search was supplemented by a manual search of article bibliographies. Review of 1880 citations revealed 98 randomized controlled clinical trials that met protocol criteria. Articles were extracted independently by two doctors who were blinded for author, institution, and treatment regimen, using a structured, pretested extraction form. Differences of opinion were resolved by consensus. Fourteen events occurred in 5198 exposures (0.27%) to nifedipine and 24 events in 5402 exposures (0.44%) to other active drug controls. Unadjusted odds ratios for nifedipine versus controls were 0.49 (95% confidence interval [CI], 0.22-1.09) for definitive events (death, nonfatal myocardial infarction or stroke, revascularization procedure) and 0.61 (95% CI, 0.31-1.17) for all events (definitive plus increased angina). The odds ratio for nifedipine monotherapy (sustained- or extended-release in 91% of exposures) was nonsignificantly higher for definitive and all events (odds ratio, 1.40; 95% CI, 0.49-4.03 and odds ratio, 1.39; 95% CI, 0.59-3.32, respectively). The odds ratio for nifedipine in combination with another drug was significantly lower for definitive and all events (odds ratio, 0.09; 95% CI, 0.01-0.66 and odds ratio, 0.15; 95% CI, 0.03-0.65, respectively). Differences in odds ratio for nifedipine monotherapy and combined therapy were statistically significant (P=.02 for definitive events and P=.001 for all events). Results support the safety of sustained- and extended-release nifedipine in the treatment of mild or moderate hypertension when it is used in combination with other drugs.
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Affiliation(s)
- W B Stason
- Harvard School of Public Health, Boston, Mass., USA
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