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Tatavarthy M, Stathopoulos J, Oktay AA. Prevention and treatment of hypertensive left ventricular hypertrophy. Curr Opin Cardiol 2024; 39:251-258. [PMID: 38603529 DOI: 10.1097/hco.0000000000001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Left ventricular (LV) hypertrophy (LVH) is a well recognized target organ adaptation to longstanding uncontrolled hypertension and other cardiovascular risk factors. It is also a strong and independent predictor of many cardiovascular disorders. RECENT FINDINGS This focused review explores the current concepts in screening, diagnosis, prevention, and treatment of LVH in patients with hypertension. Currently, the primary screening and diagnostic tools for LVH are ECG and 2D echocardiography. Implementing machine learning in the diagnostic modalities can improve sensitivity in the detection of LVH. Lifestyle modifications, blood pressure control with antihypertensive therapy, and management of comorbidities aid in preventing and reversing LV remodeling. SUMMARY LVH is a common and often silent complication of hypertension. Prevention and reversal of LV remodeling are crucial for cardiovascular risk reduction in patients with hypertension.
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Affiliation(s)
| | | | - Ahmet Afşin Oktay
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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2
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Hu J, Zhou Y. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: a meta-analysis of randomized trials. Blood Press 2023; 32:2242501. [PMID: 37652401 DOI: 10.1080/08037051.2023.2242501] [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: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Successful antihypertensive management can limit left ventricular hypertrophy (LVH) and improve the clinical prognosis. However, it remains unclear whether intensive blood pressure (BP) lowering has a greater effect on the occurrence and regression of LVH compared to standard BP lowering. METHODS We searched the electronic databases of PubMed, EMBASE and Web of Science from inception to 2 June 2023. Relevant and eligible studies were included. A random-effects model was used to estimate the pooled odds ratio (OR) and 95% confidence intervals (CI). RESULT Four RCTs including 20,747 patients met our inclusion criteria. The results demonstrated that intensive BP lowering was associated with a significantly lower rate of LVH (OR 0.85; 95%CI: 0.78-0.93; I2 48.6%) in patients with hypertension compared to standard BP lowering. Subgroup analysis revealed that the effect of intensive BP lowering on LVH was more pronounced in patients with high cardiovascular disease (CVD) risk factors (OR 0.82; 95%CI: 0.72-0.93; I2 57.9%). In addition, intensive BP lowering led to significant regression of LVH (OR 0.68; 95%CI: 0.52-0.88; I2 45.5%). CONCLUSIONS Our study suggests that intensive BP lowering should be instigated as soon as possible for optimal control of BP and to prevent regression of LVH, especially in patients with high risk of CVD. However, caution is warranted when treating hypertensive patients with LVH to systolic blood pressure (SBP) targets below 130 mm Hg.
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Affiliation(s)
- Jingjing Hu
- Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China
| | - Yidan Zhou
- Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China
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Xie B, Li L, Lin M, Nanna M, Su Y, Hua C, Leng C, Gan Q, Xi XY, Wang Y, Yao D, Wang L, Yu L, Zhao L, Zhang YP, Dou K, Su P, Lv X, Jia B, Yang MF. 99mTc-HFAPi imaging identifies early myocardial fibrosis in the hypertensive heart. J Hypertens 2023; 41:1645-1652. [PMID: 37642593 DOI: 10.1097/hjh.0000000000003517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND This study aimed to explore whether 99mTc-radiolabeled fibroblast activation protein inhibitor (99mTc-HFAPi) imaging can detect early myocardial fibrosis in the hypertensive heart. METHODS In the experimental model, spontaneously hypertensive rats (SHRs) and age-matched Wistar Kyoto rats (WKYs) were randomly divided into three groups (8, 16, and 28 weeks). The animals underwent 99mTc-HFAPi imaging and echocardiography. Autoradiography and histological analyses were performed in the left ventricle. The mRNA and protein expression level of the fibroblast activation protein (FAP) and collagen I were measured using quantitative PCR and western blot. In the clinical investigation, a total of 106 patients with essential hypertension and 20 gender-matched healthy controls underwent 99mTc-HFAPi imaging and echocardiography. RESULTS In-vivo and in-vitro autographic images demonstrated diffusely enhanced 99mTc-HFAPi uptake in the SHR heart starting at week 8, before irreversible collagen deposition. The mRNA and protein levels of FAP in SHRs began to increase from week 8, whereas changes in collagen I levels were not detected until week 28. In the clinical investigation, even in hypertensive patients with normal diastolic indicators, normal left ventricular geometry, and normal global longitudinal strain (GLS), the prevalence of increased 99mTc-HFAPi uptake reached 34, 41, and 20%, respectively, indicating that early fibrogenesis precedes structural and functional myocardial abnormalities. CONCLUSION In hypertension, 99mTc-HFAPi imaging can detect early fibrotic process before myocardial functional and structural changes.
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Affiliation(s)
- Boqia Xie
- Department of Cardiology, Cardiovascular Imaging Center
| | - Lina Li
- Department of Nuclear Medicine
| | - Mingming Lin
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Michele Nanna
- Department of Medicine, Albert Einstein College of Medicine, The Bronx, New York, USA
| | - Yao Su
- Department of Nuclear Medicine
| | - Cuncun Hua
- Department of Cardiology, Cardiovascular Imaging Center
| | - Chenlei Leng
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | | | - Yidan Wang
- Department of Cardiology, Cardiovascular Imaging Center
| | | | - Li Wang
- Department of Nuclear Medicine
| | - Liping Yu
- Department of Cardiology, Cardiovascular Imaging Center
| | - Lei Zhao
- Department of Cardiology, Cardiovascular Imaging Center
| | - Ye-Ping Zhang
- Department of Cardiology, Cardiovascular Imaging Center
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Pixiong Su
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University
| | - Xiuzhang Lv
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bing Jia
- Medical Isotopes Research Center and Department of Radiation Medicine, State Key Laboratory of Natural and Biomimetic Drugs, School of Basic Medical Sciences, Peking University, Beijing, China
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Egbe AC, Miranda WR, Jain CC, Connolly HM. On-treatment blood pressure and cardiovascular mortality in adults with repaired coarctation of aorta. Am Heart J 2023; 255:22-30. [PMID: 36220358 DOI: 10.1016/j.ahj.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although, hypertension is common in adults with repaired coarctation of aorta (COA), there are no data about on-treatment blood pressure (BP), and its relationship to outcomes in this population. The purpose of this study was to determine the relationship between on-treatment BP and cardiovascular mortality in adults with repaired COA. METHODS Retrospective study of adults with repaired COA on antihypertensive therapy (n = 461, age 39 ± 11). All BP measurements obtained within the first 3 years were averaged to determine the on-treatment BP, and the patients were stratified into BP quartiles using the cut-off points from the guidelines. RESULTS Being in the upper systolic BP (SBP) quartiles (SBP 120-129, 130-139 and ≥140) was associated with higher risk of cardiovascular mortality (HR 1.05, 95%CI 1.01-1.07, HR 1.12, 95%CI 1.04 to 1.15 and HR 1.39, 95%CI 1.13 to 1.59), as compared to being the lowest SBP quartile. We observed a 7% increase in the risk of cardiovascular mortality for every 5 mmHg increase in SBP, and a 4% increase in risk of cardiovascular mortality for every 5 mmHg increase in DBP. CONCLUSIONS Collectively, these data suggest that even s less severe form of hypertension SBP (120-129 mmHg) was not benign, and perhaps should be considered for antihypertensive therapy. A randomized controlled clinical trial is required to determine whether this group of patients (SBP 120 to 129 mmHg) would benefit from antihypertensive therapy, and to determine the optimal type and intensity of antihypertensive therapy in this population.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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5
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Ascher SB, de Lemos JA, Lee M, Wu E, Soliman EZ, Neeland IJ, Kitzman DW, Ballantyne CM, Nambi V, Killeen AA, Ix JH, Shlipak MG, Berry JD. Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy. J Am Coll Cardiol 2022; 80:1516-1525. [PMID: 36229087 PMCID: PMC9982833 DOI: 10.1016/j.jacc.2022.08.735] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) combined with elevations in cardiac biomarkers reflecting myocardial injury and neurohormonal stress (malignant LVH) is associated with a high risk for heart failure and death. OBJECTIVES The aim of this study was to determine the impact of intensive systolic blood pressure (SBP) control on the prevention of malignant LVH and its consequences. METHODS A total of 8,820 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were classified into groups based on the presence or absence of LVH assessed by 12-lead ECG, and elevations in biomarker levels (high-sensitivity cardiac troponin T ≥14 ng/L or N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) at baseline. The effects of intensive vs standard SBP lowering on rates of acute decompensated heart failure (ADHF) events and death and on the incidence and regression of malignant LVH were determined. RESULTS Randomization to intensive SBP lowering led to similar relative reductions in ADHF events and death across the combined LVH/biomarker groups (P for interaction = 0.68). The absolute risk reduction over 4 years in ADHF events and death was 4.4% (95% CI: -5.2% to 13.9%) among participants with baseline malignant LVH (n = 449) and 1.2% (95% CI: 0.0%-2.5%) for those without LVH and nonelevated biomarkers (n = 4,361). Intensive SBP lowering also reduced the incidence of malignant LVH over 2 years (2.5% vs 1.1%; OR: 0.44; 95% CI: 0.30-0.63). CONCLUSIONS Intensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death among SPRINT participants with baseline malignant LVH.
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Affiliation(s)
- Simon B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California-San Francisco, San Francisco, California, USA; Division of Hospital Medicine, University of California-Davis, Sacramento, California, USA.
| | - James A de Lemos
- Divison of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elaine Wu
- Divison of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ian J Neeland
- University Hospitals Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dalane W Kitzman
- Sections of Cardiology and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Christie M Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA
| | - Vijay Nambi
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA; Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA; Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California-San Francisco, San Francisco, California, USA
| | - Jarett D Berry
- Department of Internal Medicine, University of Texas at Tyler Health Science Center, Tyler, Texas, USA
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Yano Y, Kim HC, Lee H, Azahar N, Ahmed S, Kitaoka K, Kaneko H, Kawai F, Mizuno A, Viera AJ. Isolated Diastolic Hypertension and Risk of Cardiovascular Disease: Controversies in Hypertension - Pro Side of the Argument. Hypertension 2022; 79:1563-1570. [PMID: 35861749 DOI: 10.1161/hypertensionaha.122.18459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated diastolic hypertension (IDH), defined as diastolic blood pressure in the hypertensive range but systolic blood pressure not in the hypertensive range, is not uncommon (<20%) among adults with hypertension. IDH often manifests in concurrence with other cardiovascular risk factors. Individuals with IDH tend to have lower awareness of their hypertension compared with those with both systolic and diastolic hypertension. IDH appears to be a largely underrated risk factor for cardiovascular disease events, which may be explained by inconsistent association of IDH with cardiovascular disease events. The inconsistency suggests that IDH is heterogeneous. One size does not seem to fit all in the clinical management of individuals with IDH. Rather than treating IDH as a monolithic low-risk condition, detailed phenotyping in the context of individual comprehensive cardiovascular risk would seem to be most useful to assess an individual's expected net benefit from therapy. In this review, we highlight that the clinical relevance of IDH differs by individual clinical characteristics, and elucidate groups of individuals with IDH that should be wary of cardiovascular disease risks.
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Affiliation(s)
- Yuichiro Yano
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.).,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (Y.Y.).,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (Y.Y., H.C.K., H.L.)
| | - Nazar Azahar
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Malaysia (N.A.)
| | - Sabrina Ahmed
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Kaori Kitaoka
- Department of Advanced Epidemiology Noncommunicable Disease (NCD) Epidemiology Research Center (Y.Y., N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (N.A., S.A., K.K.), Shiga University of Medical Science, Otsu, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine and the Department of Advanced Cardiology, Departments of Cardiovascular Medicine (H.K.), The University of Tokyo, Japan.,Advanced Cardiology (H.K.), The University of Tokyo, Japan
| | - Fujimi Kawai
- Library, Center for Academic Resources (F.K.), St. Luke's International University, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan (A.M.).,Department of Cardiovascular Medicine (A.M.), St. Luke's International University, Tokyo, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.)
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Tadic M, Cuspidi C, Marwick TH. Phenotyping the hypertensive heart. Eur Heart J 2022; 43:3794-3810. [DOI: 10.1093/eurheartj/ehac393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
Abstract
Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling—especially LV hypertrophy—is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm , Albert-Einstein Allee 23, 89081 Ulm , Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca , Milano 20126 , Italy
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute , Melbourne, VIC 3004 , Australia
- Baker Department of Cardiometabolic Health, University of Melbourne , VIC 3004 , Australia
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Imtiaz Ahmad M, Mendys PM, Kelly SP, Chen LY, Soliman EZ. Relationship Between High Blood Pressure, Atrial Cardiopathy, and Mortality in the General Population. Am J Hypertens 2022; 36:33-41. [PMID: 35861252 PMCID: PMC9793894 DOI: 10.1093/ajh/hpac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 07/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Atrial cardiopathy is associated with an increased risk of mortality. However, it is unclear whether this association is modified by hypertension, a risk factor for both atrial cardiopathy and mortality. METHODS This analysis included 8,023 participants from the Third National Health and Nutrition Examination Survey. Electrocardiographic deep terminal negativity of P-wave in V1 ≥100 µV defined atrial cardiopathy. National Death Index was used to identify the date and cause of death. Cox proportional hazard analysis was used to examine the association of atrial cardiopathy with mortality among participants stratified by hypertension status. RESULTS In total 2.7% of the participants had atrial cardiopathy. Over a median follow-up of 14 years, 2,922 all-cause deaths occurred, of which 1,058 were CVD. All-cause death rates were almost double among participants with concomitant atrial cardiopathy and elevated blood pressure (BP) (120-129/<80), stage 1 (130-139/80-89), or stage 2 hypertension (≥140/≥90) compared to their counterparts in the same hypertension stages without atrial cardiopathy (47.8, 61.3, and 80.2 vs. 23, 24.7, and 44.8 per 1,000 person-years (PY), respectively). In multivariable-adjusted models, a stronger association between atrial cardiopathy and all-cause mortality was observed in the presence compared to the absence of hypertension (HR (95% CI): 1.59 (1.25-2.01) vs. 0.67 (0.41-1.10), respectively, interaction P-value = 0.009). Similarly, an association between atrial cardiopathy and cardiovascular disease (CVD) mortality was observed in the presence compared to the absence of hypertension (HR (95% CI): 1.64 (1.08-2.47) vs. 0.63 (0.20-2.00), respectively, interaction P-value = 0.20). CONCLUSIONS Concomitant presence of high BP and atrial cardiopathy carries a higher risk of mortality, and the risk increases with higher BP levels.
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Affiliation(s)
| | - Phil M Mendys
- Global Medical Epidemiology, Worldwide Medical and Safety, Pfizer, New York, New York, USA
| | - Scott P Kelly
- Global Medical Epidemiology, Worldwide Medical and Safety, Pfizer, New York, New York, USA
| | - Lin Y Chen
- Department of Internal Medicine, Cardiology Section, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Ren J, Liu D, Li G, Duan J, Dong J, Liu Z. Prediction and Risk Stratification of Cardiovascular Disease in Diabetic Kidney Disease Patients. Front Cardiovasc Med 2022; 9:923549. [PMID: 35811691 PMCID: PMC9263287 DOI: 10.3389/fcvm.2022.923549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDiabetic kidney disease (DKD) patients are facing an extremely high risk of cardiovascular disease (CVD), which is a major cause of death for DKD patients. We aimed to build a deep learning model to predict CVD risk among DKD patients and perform risk stratifying, which could help them perform early intervention and improve personal health management.MethodsA retrospective cohort study was conducted to assess the risk of the occurrence of composite cardiovascular disease, which includes coronary heart disease, cerebrovascular diseases, congestive heart failure, and peripheral artery disease, in DKD patients. A least absolute shrinkage and selection operator (LASSO) regression was used to perform the variable selection. A deep learning-based survival model called DeepSurv, based on a feed-forward neural network was developed to predict CVD risk among DKD patients. We compared the model performance with the conventional Cox proportional hazards (CPH) model and the Random survival forest (RSF) model using the concordance index (C-index), the area under the curve (AUC), and integrated Brier scores (IBS).ResultsWe recruited 890 patients diagnosed with DKD in this retrospective study. During a median follow-up of 10.4 months, there are 289 patients who sustained a subsequent CVD. Seven variables, including age, high density lipoprotein (HDL), hemoglobin (Hb), systolic blood pressure (SBP), smoking status, 24 h urinary protein excretion, and total cholesterol (TC), chosen by LASSO regression were used to develop the predictive model. The DeepSurv model showed the best performance, achieved a C-index of 0.767(95% confidence intervals [CI]: 0.717–0.817), AUC of 0.780(95%CI: 0.721–0.839), and IBS of 0.067 in the validation set. Then we used the cut-off value determined by ROC (receiver operating characteristic) curve to divide the patients into different risk groups. Moreover, the DeepSurv model was also applied to develop an online calculation tool for patients to conduct risk monitoring.ConclusionA deep-learning-based predictive model using seven clinical variables can effectively predict CVD risk among DKD patients and perform risk stratification. An online calculator allows its easy implementation.
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Affiliation(s)
- Jingjing Ren
- Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
- Clinical Research Center of Big-data, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongwei Liu
- Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
| | - Guangpu Li
- Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
- Clinical Research Center of Big-data, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiayu Duan
- Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
- Clinical Research Center of Big-data, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Jiayu Duan
| | - Jiancheng Dong
- Clinical Research Center of Big-data, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Jiancheng Dong
| | - Zhangsuo Liu
- Department of Integrated Traditional and Western Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China
- Henan Province Research Center for Kidney Disease, Zhengzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China
- *Correspondence: Zhangsuo Liu
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McCullough SA, Goff DC, Okin PM. On-Treatment Hypertension Control in a Real-World Cohort: Lower Blood Pressure Remains Better. J Am Coll Cardiol 2021; 78:1496-1498. [PMID: 34620405 DOI: 10.1016/j.jacc.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- S Andrew McCullough
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
| | - David C Goff
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter M Okin
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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