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Kartaler F, Şahin M, Turan OE, Kutlu M. The Relationship Between the Dipping Pattern and Coronary Artery Disease Severity Assessed by the SYNTAX Score in Patients With Hypertension. Cureus 2023; 15:e36057. [PMID: 37065383 PMCID: PMC10096864 DOI: 10.7759/cureus.36057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background The morbidity and mortality rates related to hypertension (HT) are still high despite the developments in this area. Nondipper hypertension (NDHT) is related to worse clinical outcomes. But the dipping pattern of HT is not still used for treatment targets. In this study, we investigated the effect of dipping patterns on coronary artery disease (CAD) complexity evaluated by the SYNTAX score (SS). Methodology Patients with stable CAD and HT were included in the study. All patients were monitored with 24-hour ambulatory monitoring, and dipping patterns were evaluated. Coronary artery complexity was determined by SS for all patients and compared along with different dipping patterns. Results A total of 331 patients with HT and stable CAD were evaluated in the study. The mean age of the patients was 62.6 ± 9.9 years, and 172 (52%) were male. The number and percentage of patients with dipper HT (DHT), NDHT, over-dipper HT (ODHT), and reverse-dipper HT (RDHT) were 89 (26%), 143 (43%), 11 (3%), and 88 (26%), respectively. When the groups were compared according to SS, the SS of the patients with RDHT were significantly higher (the SS were 6.33, 4.99, 3.09, and 2.7 for RDHT, ODHT, NDHT, and DHT, respectively, P = 0.003). The mean SS between the DHT group and the NDHT group (P = 0.03) and between the DHT group and the RDHT group (P = 0.01) was significantly different. The less decrease or increase in mean blood pressure (MnBP) values was significantly correlated with high SS. Conclusions NDHT, especially the reverse dipping pattern, is closely related to complex CAD. Meticulous consideration of dipping patterns can identify high-risk patients and improve clinical outcomes.
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Affiliation(s)
| | - Mürsel Şahin
- Cardiology, Medical School, Karadeniz Technical University, Trabzon, TUR
| | - Oğuzhan E Turan
- Cardiology, Medical School, Dokuz Eylül University, İzmir, TUR
| | - Merih Kutlu
- Cardiology, Medical School, Karadeniz Technical University, Trabzon, TUR
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2
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Park JB, Avolio A. Arteriosclerosis and Atherosclerosis Assessment in Clinical Practice: Methods and Significance. Pulse (Basel) 2023; 11:1-8. [PMID: 37404379 PMCID: PMC10315159 DOI: 10.1159/000530616] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/24/2023] [Indexed: 07/06/2023] Open
Abstract
Alongside cancer, cardiovascular disease (CVD) exhibits the highest rates of morbidity and mortality globally, in western society as well as in Asian countries. Aging is a serious problem for the Asian population as progression toward a super-aged society is moving at a remarkably high rate. This increased rate of aging leads to increased CVD risk and, consequently, high CVD incidence. However, aging is not the only deleterious factor of vascular problems; hypertension, hypercholesterolemia, diabetes mellitus, and kidney disease may induce atherosclerosis and arteriosclerosis (i.e., arterial stiffening), and the progression of these diseases ultimately leads to cardiovascular, cerebrovascular, chronic kidney, or peripheral artery disease. Despite the existence of several guidelines on the treatment of risk factors such as hypertension and CVD, there is still an ongoing debate regarding the clinical need for assessment of arteriosclerosis and atherosclerosis, which act as a bridge between cardiovascular risk factors and CVD. In other words, although arteriosclerosis and atherosclerosis are essential to our understanding of vascular diseases, the need for additional tests beyond the conventional diagnosis method remains disputed. This is presumably due to insufficient discussion on how to apply such tests in clinical practice. This study aimed to fill this gap.
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Affiliation(s)
- Jeong Bae Park
- JB Lab and Clinic and Department of Precision Medicine and Biostatistics, Yonsei University, Wonju College of Medicine, Seoul, Republic of Korea
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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3
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Nadinskaia M, Maevskaya M, Ivashkin V, Kodzoeva K, Pirogova I, Chesnokov E, Nersesov A, Kaibullayeva J, Konysbekova A, Raissova A, Khamrabaeva F, Zueva E. Ursodeoxycholic acid as a means of preventing atherosclerosis, steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease. World J Gastroenterol 2021; 27:959-975. [PMID: 33776366 PMCID: PMC7968130 DOI: 10.3748/wjg.v27.i10.959] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/30/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Weight loss is a key factor for successful NAFLD and CVD therapy. Ursodeoxycholic acid (UDCA), which is one of the first-line therapeutic agents for treatment of NAFLD, is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties. AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests, lipid profile, hepatic steatosis and fibrosis, atherogenesis, and ASCVD risk in men and women with NAFLD, as well as to assess the impact of > 5% weight reduction on these parameters. METHODS An open-label, multicenter, international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise. The efficacy criteria were liver enzymes, lipid profile, fatty liver index (FLI), noninvasive liver fibrosis tests (nonalcoholic fatty liver disease fibrosis score and liver fibrosis index), carotid intima-media thickness (CIMT), and ASCVD risk score. To test statistical hypotheses, the Wilcoxon test, paired t-test, Fisher's exact test, and Pearson's chi-squared test were used. RESULTS The alanine aminotransferase (ALT) level changed by -14.1 U/L (-31.0; -5.3) from baseline to 3 mo and by -6.5 U/L (-14.0; 0.1) from 3 to 6 mo. The magnitude of ALT, aspartate transaminase, and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo (P < 0.001, P < 0.01, P < 0.001, respectively). At 6 mo, in the total sample, we observed a statistically significant decrease in body weight and levels of FLI: 84.9 ± 10.4 vs 72.3 ± 17.6, P < 0.001, total cholesterol: 6.03 ± 1.36 vs 5.76 ± 1.21, Р < 0.001, low-density lipoprotein: 3.86 ± 1.01 vs 3.66 ± 0.91, Р < 0.001, and triglyceride: 3.18 (2.00; 4.29) vs 2.04 (1.40; 3.16), Р < 0.001. No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found. The CIMT decreased significantly in the total sample (0.985 ± 0.243 vs 0.968 ± 0.237, P = 0.013), whereas the high-density lipoprotein (Р = 0.036) and 10-year ASCVD risk (Р = 0.003) improved significantly only in women. Fifty-four patients (31%) achieved > 5% weight loss. At the end of the study, the FLI decreased significantly in patients with (88.3 ± 10.2 vs 71.4 ± 19.6, P < 0.001) and without > 5% weight loss (83.5 ± 10.3 vs 72.8 ± 16.7, P < 0.001). The changes in ALT, aspartate transaminase, glutamyltransferase, total cholesterol, and low-density lipoprotein levels were similar between the subgroups. CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment, improves lipid profile and hepatic steatosis independent of weight loss, and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.
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Affiliation(s)
- Maria Nadinskaia
- Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
| | - Marina Maevskaya
- Vasilenko Clinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital №2, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
| | - Vladimir Ivashkin
- Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
| | - Khava Kodzoeva
- Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
| | - Irina Pirogova
- LLC MC “Lotus”, Center for Gastroenterology and Hepatology, Chelyabinsk 454092, Russia
| | - Evgeny Chesnokov
- Department of Hospital Therapy with the Course of Endocrinology and Clinical Pharmacology, Tyumen State Medical University, Tyumen 625003, Russia
| | - Alexander Nersesov
- Department of Gastroenterology, S. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Jamilya Kaibullayeva
- Department of Gastroenterology, S. Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan
| | - Akzhan Konysbekova
- Functional and Ultrasound Diagnostics, Scientific and Research Institute of Cardiology and Internal Diseases, Almaty 050000, Kazakhstan
| | - Aigul Raissova
- Department of Internal Diseases, Scientific and Research Institute of Cardiology and Internal Diseases, Almaty 050000, Kazakhstan
| | - Feruza Khamrabaeva
- Faculty of Therapy, Tashkent Institute of Advanced Medical Studies, Tashkent 100007, Uzbekistan
| | - Elena Zueva
- Department of Therapy № 1 with Training General Practitioners, Tashkent Medical Academy, Tashkent 100109, Uzbekistan
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4
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Ernst ME, Chowdhury EK, Beilin LJ, Margolis KL, Nelson MR, Wolfe R, Tonkin AM, Ryan J, Woods RL, McNeil JJ, Reid CM. Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly. Hypertension 2020; 76:1945-1952. [PMID: 33131315 DOI: 10.1161/hypertensionaha.120.16209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration- URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01038583; URL: https://www.isrctn.com; Unique identifiers: ISRCTN83772183.
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Affiliation(s)
- Michael E Ernst
- From the Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City (M.E.E.)
| | - Enayet K Chowdhury
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia (L.J.B.)
| | | | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmani, Hobart, Australia (M.R.N.)
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.)
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia (E.K.C., R.W., A.M.T., J.R., R.L.W., J.J.M., C.M.R.).,School of Public Health, Curtin University, Perth, WA, Australia (E.K.C., C.M.R.)
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5
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Kato Y, Iwata A, Futami M, Yamashita M, Shigemoto E, Kuwano T, Sugihara M, Miura SI. Impact of visit-to-visit variability in blood pressure on coronary plaque as assessed by integrated backscatter intravascular ultrasound. Clin Exp Hypertens 2020; 42:608-613. [PMID: 32316781 DOI: 10.1080/10641963.2020.1756315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Visit-to-visit variability (VVV) in blood pressure (BP) has been reported to be a strong predictor of cardiovascular disease. However, the association between VVV in BP and coronary plaque composition has not been fully elucidated. METHODS One hundred-two consecutive patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) using integrated backscatter (IB) intravascular ultrasound (IVUS), and who had at least six clinic visits a year before PCI were included. We measured systolic and diastolic BP (SBP and DBP) at each visit and determined VVV in BP expressed as the standard deviation of the average BP. Grayscale and IB IVUS examinations were performed for the culprit lesion of a coronary artery just before PCI. RESULTS There were no significant associations between the average SBP or DBP and various IVUS parameters. However, VVV in SBP was positively correlated with both the percentage (%) of atheroma volume (β = 0.23, p = .02) and % lipid volume (β = 0.53, p < .0001). VVV in DBP was positively correlated with % lipid volume (β = 0.24, p = .01), while there was no significant correlation between VVV in DBP and % atheroma volume. A multivariable linear regression analysis showed that VVV in SBP was independently associated with % atheroma volume (p = .04) and % lipid volume (p < .001). CONCLUSIONS Larger VVV in SBP was significantly associated with an increased plaque burden and lipid composition at the culprit lesion of a coronary artery in CAD patients. The improvement of VVV in SBP may contribute to the regression and stabilization of coronary plaques.
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Affiliation(s)
- Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Makito Futami
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Motoki Yamashita
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Eiji Shigemoto
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine , Fukuoka, Japan
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6
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Nwabuo CC, Yano Y, Moreira HT, Appiah D, Vasconcellos HD, Aghaji QN, Viera AJ, Rana JS, Shah RV, Murthy VL, Allen NB, Schreiner PJ, Lloyd-Jones DM, Lima JAC. Long-Term Blood Pressure Variability in Young Adulthood and Coronary Artery Calcium and Carotid Intima-Media Thickness in Midlife: The CARDIA Study. Hypertension 2020; 76:404-409. [PMID: 32594795 DOI: 10.1161/hypertensionaha.120.15394] [Citation(s) in RCA: 10] [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
Recent evidence links long-term (visit-to-visit) blood pressure (BP) variability to the risk of cardiovascular disease, independent of mean BP levels. Potential associations between long-term BP variability and cardiovascular disease risk may be reflected in early life course alterations in coronary artery calcium (CAC) and carotid intima-media thickness. We evaluated 2482 CARDIA study (Coronary Artery Risk Development in Young Adults) participants (mean [SD] age at the year 20 exam [2005-2006] was 45.4 [3.6] years, 43.2% men, and 41.3% black). We included participants with BP assessments across 20-years (year 0, 2, 5, 7, 10, 15, 20 exams) and carotid intima-media thickness and CAC data at the year 20 exam. BP variability was assessed using variability independent of the mean and SD. Adjusted multivariable linear or logistic regression models (as appropriate) were used to assess associations between long-term BP variability measures and carotid intima-media thickness. and CAC (ln [CAC+1] and prevalent CAC). Long-term systolic BP variability independent of the mean (per 1 SD) was positively associated with carotid intima-media thickness (β=10 μm, SE=3, P=0.002). Similarly, long-term diastolic BP variability independent of the mean was associated with carotid intima-media thickness (β=10 μm, SE (3), P=0.001). Long-term BP variability was not associated with either ln [CAC+1] or prevalent CAC. Long-term systolic and diastolic BP variability across early adulthood was positively associated with modest adverse midlife alterations in carotid intima-media thickness but not to CAC. Our findings provide further insights into pathophysiologic mechanisms that link long-term BP variability to cardiovascular disease.
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Affiliation(s)
- Chike C Nwabuo
- From the Johns Hopkins University, Baltimore, MD (C.C.N., H.T.M., H.D.V., Q.N.A., J.A.C.L.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.)
| | - Henrique T Moreira
- From the Johns Hopkins University, Baltimore, MD (C.C.N., H.T.M., H.D.V., Q.N.A., J.A.C.L.)
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center (D.A.)
| | | | - Queen N Aghaji
- From the Johns Hopkins University, Baltimore, MD (C.C.N., H.T.M., H.D.V., Q.N.A., J.A.C.L.)
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, NC (Y.Y., A.J.V.)
| | - Jamal S Rana
- Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland (J.S.R.)
| | | | | | - Norrina B Allen
- Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A., D.M.L.-J.)
| | | | - Donald M Lloyd-Jones
- Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A., D.M.L.-J.)
| | - João A C Lima
- From the Johns Hopkins University, Baltimore, MD (C.C.N., H.T.M., H.D.V., Q.N.A., J.A.C.L.)
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7
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Clark D, Nicholls SJ, St John J, Elshazly MB, Ahmed HM, Khraishah H, Nissen SE, Puri R. Visit-to-Visit Blood Pressure Variability, Coronary Atheroma Progression, and Clinical Outcomes. JAMA Cardiol 2020; 4:437-443. [PMID: 30969323 DOI: 10.1001/jamacardio.2019.0751] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular events, but mechanisms and therapeutic implications underlying this association are not well understood. Objective To examine the association of intraindividual BPV, coronary atheroma progression, and clinical outcomes using serial intravascular ultrasonography. Design, Setting, and Participants Post hoc patient-level analysis of 7 randomized clinical trials conducted from 2004 to 2016 involving 3912 patients in multicenter, international, clinic-based primary and tertiary care centers. Adult patients with coronary artery disease who underwent serial intravascular ultrasonography in the setting of a range of medical therapies were included. Data were analyzed between November 2017 and March 2019. Exposures Visit-to-visit BPV measured using intraindividual standard deviation over 3, 6, 12, 18, and 24 months. Main Outcomes and Measures Percent atheroma volume (PAV) progression and major adverse cardiovascular events (defined as death, myocardial infarction, stroke, urgent revascularization for acute coronary syndrome, and hospitalization for unstable angina). Results Of 3912 patients, the mean (SD) age was 58 (9) years, 1093 (28%) were women, and 3633 (93%) were white . Continuous change in PAV was significantly associated with systolic BPV (β, .049; 95% CI, 0.021-0.078; P = .001), diastolic BPV (β, .031; 95% CI, 0.002-0.059; P = .03), and pulse pressure variability (β, .036; 95% CI, 0.006-0.067; P = .02), without a signal for differential effect greater than or less than a mean BP of 140/90 mm Hg. The PAV progression as a binary outcome was significantly associated with systolic BPV (odds ratio, 1.09; 95% CI, 1.01-1.17; P = .02) but not diastolic BPV (odds ratio, 1.04; 95% CI, 0.97-1.11; P = .30) or pulse pressure variability (odds ratio, 1.03; 95% CI, 0.96-1.10; P = .47). Survival curves revealed a significant stepwise association between cumulative major adverse cardiovascular events and increasing quartiles of systolic BPV (Kaplan-Meier estimates for quartiles 1-4: 6.1% vs 8.5% vs 10.1% vs 12.0%, respectively; log-rank P <.001). These distinct stepwise associations were not seen with diastolic BPV or pulse pressure variability. Conclusions and Relevance Greater BPV, particularly systolic BPV, is significantly associated with coronary atheroma progression and adverse clinical outcomes. These data suggest maintaining stable blood pressure levels may be important to further improve outcomes in patients with coronary disease.
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Affiliation(s)
- Donald Clark
- Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Julie St John
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed B Elshazly
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College-Qatar, Education City, Doha, Qatar
| | - Haitham M Ahmed
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Haitham Khraishah
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
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Ponikowski P, Spoletini I, Coats AJS, Piepoli MF, Rosano GMC. Heart rate and blood pressure monitoring in heart failure. Eur Heart J Suppl 2019; 21:M13-M16. [PMID: 31908609 PMCID: PMC6937500 DOI: 10.1093/eurheartj/suz217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It has been long known that incessant tachycardia and severe hypertension can cause heart failure (HF). In recent years, it has also been recognized that more modest elevations in either heart rate (HR) or blood pressure (BP), if sustained, can be a risk factor both for the development of HF and for mortality in patients with established HF. Heart rate and BP are thus both modifiable risk factors in the setting of HF. What is less clear is the question whether routine systematic monitoring of these simple physiological parameters to a target value can offer clinical benefits. Measuring these parameters clinically during patient review is recommended in HF management in most HF guidelines, both in the acute and chronic phases of the disease. More sophisticated systems now allow long-term automatic or remote monitoring of HR and BP and whether this more detailed patient information can improve clinical outcomes will require prospective RCTs to evaluate. In addition, analysis of patterns of both HR and BP variability can give insights into autonomic function, which is also frequently abnormal in HF. This window into autonomic dysfunction in our HF patients can also provide further independent prognostic information and may in itself be target for future interventional therapies. This article, developed during a consensus meeting of the Heart Failure Association of the ESC concerning the role of physiological monitoring in the complex multi-morbid HF patient, highlights the importance of repeated assessment of HR and BP in HF, and reviews gaps in our knowledge and potential future directions.
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Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | | | - Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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9
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Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Press Cardiovasc Prev 2019; 26:353-359. [PMID: 31559570 PMCID: PMC6825020 DOI: 10.1007/s40292-019-00339-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/31/2019] [Indexed: 12/18/2022] Open
Abstract
Blood pressure (BP) is characterized by continuous dynamic and spontaneous oscillations occurring over lifetime and defining the so-called blood pressure variability (BPV). BPV has been associated with target organ damage, cardiovascular (CV) risk and death, suggesting the use of BPV as a new target in hypertension management in addition to mean BP values lowering. The purpose of the review is to focus on the therapeutic implications of BPV and summarize the effects of different drug classes on various types of BPV. Despite most first-line antihypertensive medications contribute to reduce both short and long term BPV, calcium channel blockers (CCBs) as monotherapy or fixed-combination therapy appear to be the most effective on BPV control. Further randomized interventional trials are needed to investigate which drug combinations are most appropriate according to patient CV risk stratification, in order to improve their CV outcomes.
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Noninvasive central systolic blood pressure, not peripheral systolic blood pressure, independently predicts the progression of carotid intima-media thickness in a Chinese community-based population. Hypertens Res 2018; 42:392-399. [DOI: 10.1038/s41440-018-0175-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/20/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023]
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Tedla YG, Yano Y, Thyagarajan B, Kalhan R, Viera AJ, Rosenberg S, Greenland P, Carnethon MR. Peak lung function during young adulthood and future long-term blood pressure variability: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Atherosclerosis 2018; 275:225-231. [PMID: 29957459 PMCID: PMC7702294 DOI: 10.1016/j.atherosclerosis.2018.06.816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Long-term blood pressure variability (BPV) is associated with cardiovascular events independent of mean blood pressure (BP); however, little is known about its predictors. METHODS Using data from the CARDIA study, we investigated the association between peak lung-function and long-term BPV in 2917 individuals (mean age 24.8 years, 45.3% males, 58.6% whites) who were not taking antihypertensive medications. Lung-function was measured using forced vital capacity (FVC) and forced expiratory volume in 1-s (FEV1) at years 0, 2, 5, 10 and 20 and the maximum score attained was considered as peak lung-function. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify BPV since achieving peak lung-function across 9 visits over 30 years. RESULTS In a multivariate linear regression models, individuals in the 2nd (-0.64 mmHg; 95% CI: -1.06, -0.19), 3rd (-0.96; -1.47, -0.45), and 4th (-0.85: -1.53, -0.17) quartiles of FVC had lower VIM of systolic BP than the those in quartile 1 (p-trend = 0.005). CV of systolic BP was also lower by -0.58 (-0.98, -0.19), -0.92 (-1.42, -0.43), and -0.74 (-1.40, -0.08) percentage points, in the three progressively higher quartiles of FVC compared to quartile 1 (p-trend = 0.008). Similar findings were observed when the outcome was diastolic BPV. There was no association of FEV1 and FEV1-to-FVC ratio with BPV. CONCLUSIONS These findings suggest that smaller lung volume or restrictive lung disease during young adulthood, which result in lower peak FVC, may independently increase the risk of higher long-term BPV during middle adulthood.
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Affiliation(s)
- Yacob G Tedla
- Center for Health Information Partnership, Feinberg School of Medicine, Northwestern University, USA.
| | - Yuichiro Yano
- University of Mississippi Medical Center, University of Mississippi, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, USA
| | - Ravi Kalhan
- Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Anthony J Viera
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA; Department of Family Medicine, University of North Carolina at Chapel Hill, USA
| | - Sharon Rosenberg
- Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
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Jeffers B, Zhou D. Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension. Kidney Blood Press Res 2017; 42:697-707. [DOI: 10.1159/000484103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/06/2017] [Indexed: 11/19/2022] Open
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Nagai M, Dote K, Kato M, Sasaki S, Oda N. Visit-to-visit blood pressure variability: an epiphenomenon or a risk for the progression of carotid artery remodelling? EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:90. [PMID: 28025217 DOI: 10.1093/ehjcvp/pvw039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Singh RB, Hristova K, Bjørklund G, Fedacko J, Chirumbolo S, Pella D. Extended consensus on blood pressure variability beyond blood pressure for management of hypertension. ACTA ACUST UNITED AC 2017; 11:6-9. [PMID: 28040405 DOI: 10.1016/j.jash.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/10/2016] [Accepted: 11/16/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Ram B Singh
- Halberg Hospital and Research Institute, Moradabad, India
| | - Krasimira Hristova
- Division of Echocardiography Imaging, National Heart Hospital, Sofia, Bulgaria
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway.
| | - Jan Fedacko
- Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
| | - Salvatore Chirumbolo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Daniel Pella
- Faculty of Medicine, Pavol Jozef Šafárik University, Kosice, Slovakia
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Atar D. European Heart Journal-Cardiovascular Pharmacotherapy in 2016: entering a new level of international recognition. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:3-4. [PMID: 28062654 DOI: 10.1093/ehjcvp/pvw024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Dan Atar
- Department of Cardiology B, Oslo University Hospital and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, N - 0407 Oslo, Norway
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Cardiovascular pharmacotherapy. Int J Cardiol 2016; 224:412-415. [PMID: 27690338 DOI: 10.1016/j.ijcard.2016.09.065] [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: 08/31/2016] [Accepted: 09/16/2016] [Indexed: 11/21/2022]
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