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Kjeldsen SE, Egan BM, Burnier M, Narkiewicz K, Kreutz R, Mancia G. Highlights of the 2023 European Society of Hypertension Guidelines: what has changed in the management of hypertension in patients with cardiac diseases? Blood Press 2024; 33:2329571. [PMID: 38555859 DOI: 10.1080/08037051.2024.2329571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, University of Oslo Ullevaal Hospital, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of SC, Greenville, SC, USA
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-University Medicine, Berlin, Germany
| | - Giuseppe Mancia
- Department of Medicine, University of Milan-Bicocca, Milan, Italy
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2
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Schoenenberger-Berzins R, Messerli FH. Blood Pressure Lowering in Patients with Left Ventricular Hypertrophy - Navigating between Scylla and Charybdis. J Pharmacol Exp Ther 2024; 390:1-3. [PMID: 38906565 DOI: 10.1124/jpet.123.002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/30/2024] [Indexed: 06/23/2024] Open
Affiliation(s)
- Renate Schoenenberger-Berzins
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (R.S.-B.) and Faculty of Medicine, University of Bern, Bern, Switzerland (F.H.M.)
| | - Franz H Messerli
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland (R.S.-B.) and Faculty of Medicine, University of Bern, Bern, Switzerland (F.H.M.)
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Lembo M, Trimarco V, Izzo R, Manzi MV, Rozza F, Gallo P, Morisco C, Bardi L, Esposito G, Forzano I, Santulli G, Trimarco B. Achieving a Systolic Blood Pressure Below 130 mmHg Reduces the Incidence of Cardiovascular Events in Hypertensive Patients with Echocardiographic Left Ventricular Hypertrophy. J Pharmacol Exp Ther 2024; 390:4-10. [PMID: 38135511 PMCID: PMC11192578 DOI: 10.1124/jpet.123.001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Background: Recent reports have evidenced an increased mortality rate in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) achieving systolic blood pressure (SBP) <130 mmHg. However, to the best of our knowledge, the actual effects of blood pressure reduction to the ≤130/80 mmHg target on the incidence of cardiovascular (CV) events have never been determined in hypertensive patients with a diagnosis of left ventricular hypertrophy based on echocardiographic criteria (Echo-LVH). Methods: To fill this long-standing knowledge gap, we harnessed a population of 9511 hypertensive patients, followed-up for 33.6 [interquartile range 7.9-72.7] months. The population was divided into six groups according to the average SBP achieved during the follow-up (≤130, 130-139, and ≥140 mmHg) and absence/presence of Echo-LVH. The primary endpoint was a composite of fatal or nonfatal myocardial infarction and stroke, sudden cardiac death, heart failure requiring hospitalization, revascularization, and carotid stenting. Secondary endpoints included atrial fibrillation and transient ischemic attack. Results: During the follow-up, achieved SBP and diastolic blood pressure (DBP) were comparable between patients with and without Echo-LVH. Strikingly, the rates of primary and secondary endpoints were significantly higher in patients with Echo-LVH and SBP >130 mmHg, reaching the highest values in the Echo-LVH group with SBP ≥140 mmHg. By separate Cox multivariable regressions, after adjusting for potential confounders, both primary and secondary endpoints were significantly associated with SBP ≥140 mmHg and Echo-LVH. Instead, DBP reduction ≤80 mmHg was associated with a significant increased rate of secondary events. Conclusions: In hypertensive patients with Echo-LVH, achieving an average in-treatment SBP target ≤130 mmHg has a beneficial prognostic impact on incidence of CV events. SIGNIFICANCE STATEMENT: Contrary to recent findings, achieving in-treatment SBP ≤130 mmHg lowers the incidence of CV events in hypertensive patients with Echo-LVH. However, reducing DBP ≤80 mmHg is linked to increased CV complications. Cox multivariable regression models, considering potential confounders, reveal that the rate of hard and soft CV events is significantly associated with Echo-LVH and SBP ≥140 mmHg. Our data indicate that therapeutic strategies for Echo-LVH patients should target SBP ≤130 mmHg while avoiding lowering DBP ≤80 mmHg.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Valentina Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Francesco Rozza
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
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Wang H, He S, Wang J, An Y, Wang X, Li G, Sun N, Gong Q. Does high-normal blood pressure lead to excess cardiovascular disease events and deaths in Chinese people? A post-hoc analysis of the 30-year follow-up of the Da Qing IGT and Diabetes Study. Diabetes Obes Metab 2024; 26:871-877. [PMID: 38012837 DOI: 10.1111/dom.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
AIM Whether systolic/diastolic blood pressure (SBP/DBP) values of 130-139/80-89 mmHg should be defined as hypertension has been debated for decades. We aimed to characterize the effect of high-normal BP on cardiovascular disease (CVD) events and deaths. METHODS In total, 1726 individuals from the original Da Qing IGT and Diabetes Study were enrolled, and divided into the normal BP group (SBP <130 mmHg and DBP <80 mmHg), high-normal BP group (SBP 130-139 mmHg and/or DBP 80-89 mmHg) and hypertension group (SBP ≥140 mmHg and/or DBP ≥90 mmHg). CVD events and their components were assessed from 1986 to 2016. RESULTS During the 30-year follow-up, the high-normal BP group was not at higher risk for CVD events [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.84-1.30, p = .68], coronary heart disease (HR 1.12, 95% CI 0.77-1.63, p = .57), stroke (HR 1.05, 95% CI 0.82-1.34, p = .71), or CVD deaths (HR 1.15, 95% CI 0.82-1.60, p = .41) compared with the normal BP group, after adjusting for covariates. However, the hypertension group exhibited significantly increased cardiovascular risk (CVD events, HR 1.91, 95% CI 1.48-2.46, p < .0001; coronary heart disease, HR 1.73, 95% CI 1.12-2.67, p = .01; stroke, HR 1.90, 95% CI 1.43-2.52, p < .0001; CVD deaths, HR 2.07, 95% CI 1.43-3.01, p = .0001) than the normal BP group. Subgroup analyses showed that, regardless of the presence of diabetes, high-normal BP did not increase CVD events compared with normal BP. CONCLUSIONS This post-hoc study provided no evidence that the high-normal BP increased cardiovascular risk in the Da Qing study population, suggesting that it was reasonable to continue to define hypertension at 140/90 mmHg in China.
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Affiliation(s)
- Haixu Wang
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyao He
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Wang
- Department of Cardiology, Da Qing First Hospital, Daqing, China
| | - Yali An
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuan Wang
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwei Li
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China-Japan Friendship Hospital, Beijing, China
| | - Ningling Sun
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Qiuhong Gong
- Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Rist A, Sevre K, Wachtell K, Devereux RB, Aurigemma GP, Smiseth OA, Kjeldsen SE, Julius S, Pitt B, Burnier M, Kreutz R, Oparil S, Mancia G, Zannad F. The current best drug treatment for hypertensive heart failure with preserved ejection fraction. Eur J Intern Med 2024; 120:3-10. [PMID: 37865559 DOI: 10.1016/j.ejim.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
More than 90 % of patients developing heart failure (HF) have hypertension. The most frequent concomitant conditions are type-2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and non-steroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). Subsequently, they have been investigated in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) of mostly hypertensive etiology, and with modest benefits largely assessed on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Patients with HFpEF may have diastolic dysfunction but also systolic dysfunction visualized by lack of longitudinal shortening. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.
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Affiliation(s)
- Aurora Rist
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kaja Sevre
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Wachtell
- Weill-Cornell Medicine, Division of Cardiology, New York City, NY, USA
| | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan School of Medicine, Worcester, MA, USA
| | - Otto A Smiseth
- Institute for Surgical Research and Department of Cardiology, University of Oslo, Rikshospitalet, Oslo, Norway
| | - Sverre E Kjeldsen
- Medical School and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Ullevaal Hospital, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bertram Pitt
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michel Burnier
- Centre Hospitalier Universitaire Vaudois, Service of Nephrology and Hypertension, Lausanne, Switzerland
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA
| | | | - Faiez Zannad
- Inserm, Centre d'Investigations Cliniques-1433 and F-CRIN INI CRCT, Universite de Lorraine, Nancy, France
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Sevre K, Rist A, Wachtell K, Devereux RB, Aurigemma GP, Smiseth OA, Kjeldsen SE, Julius S, Pitt B, Burnier M, Kreutz R, Oparil S, Mancia G, Zannad F. What Is the Current Best Drug Treatment for Hypertensive Heart Failure With Preserved Ejection Fraction? Review of the Totality of Evidence. Am J Hypertens 2024; 37:1-14. [PMID: 37551929 PMCID: PMC10724525 DOI: 10.1093/ajh/hpad073] [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: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. METHODS HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. RESULTS For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. CONCLUSIONS Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.
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Affiliation(s)
- Kaja Sevre
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
| | - Aurora Rist
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
| | - Kristian Wachtell
- Weill-Cornell Medicine, Division of Cardiology, New York City, New York, USA
| | - Richard B Devereux
- Weill-Cornell Medicine, Division of Cardiology, New York City, New York, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMassChan School of Medicine, Worcester, Massachusetts, USA
| | - Otto A Smiseth
- University of Oslo, Institute for Surgical Research and Department of Cardiology, Rikshospitalet, Oslo, Norway
| | - Sverre E Kjeldsen
- University of Oslo, Medical School and Institute of Clinical Medicine, Oslo, Norway
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Stevo Julius
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Bertram Pitt
- University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Reinhold Kreutz
- Charité – Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Suzanne Oparil
- University of Alabama at Birmingham, Vascular Biology and Hypertension Program, Department of Medicine, Birmingham, Alabama, USA
| | | | - Faiez Zannad
- Universite de Lorraine, Inserm, Centre d’Investigations Cliniques-1433 and F-CRIN INI CRCT, Nancy, France
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7
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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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8
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Kjeldsen SE, Egan BM, Narkiewicz K, Kreutz R, Burnier M, Oparil S. Thirty years with LIFE-a randomized clinical trial with more than 200 published articles on clinical aspects of left ventricular hypertrophy. Blood Press 2022; 31:125-128. [PMID: 35674494 DOI: 10.1080/08037051.2022.2083578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Sverre E Kjeldsen
- Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, Oslo, Norway
| | - Brent M Egan
- American Medical Association, University of South Carolina, Greenville, SC, USA
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Reinhold Kreutz
- Charité, Institute of Clinical Pharmacology and Toxicology, Medical University of Berlin, Berlin, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, University of Lausanne, Lausanne, Switzerland
| | - Suzanne Oparil
- Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 997] [Impact Index Per Article: 249.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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N-terminal pro B-type natriuretic peptide (NT-proBNP): a possible surrogate of biological age in the elderly people. GeroScience 2020; 43:845-857. [PMID: 32780292 PMCID: PMC8110633 DOI: 10.1007/s11357-020-00249-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
NT-proB-type natriuretic peptide (NT-proBNP) increases with age and is associated with all-cause mortality. With this study, we assessed its possible utilization as a marker of biological age in comparison with other variables. The study included 1079 non-institutionalized elderly subjects (mean age 72.8 ± 5.5 years, 561 women). Baseline measurements were performed of serum NT-proBNP and of some laboratory variables previously utilized to estimate biological age (creatinine, albumin, C-reactive protein, cholesterol, blood glucose, leukocytes, lymphocytes, hemoglobin, mean cell volume). During 7 years of follow-up, 114 all-cause deaths occurred. The logarithm of NT-proBNP was the most age-related parameter (r = 0.35, P < 0.0001). Its relationship with mortality, according to Cox regression and ROC curve (AUC = 0.707, 95% CI 0.654-0.759), was stronger than that of all other variables, including age. In multivariate analysis, only NT-proBNP and age remained independently associated with mortality. The regression lines between age and NT-proBNP (pg/ml) allowed a separate estimation of biological age ("proBNPage") for men (= [log(NT-proBNP) + 1.2068]/0.0827) and for women (= [log(NT-proBNP) - 1.5258]/0.0478). The hazard ratio of all-cause mortality for the fifth quintile of proBNP age (≥ 85 years) compared with the first quintile (< 61 years) was 7.9 (95% CI 3.6-17.5). Similarly, the difference between pro-BNPage and chronological age was associated with a hazard ratio of 3.5 in the fifth quintile (95% CI 1.9-6.4) and was associated with disease count (P for trend = 0.0002). In conclusion, NT-proBNP was the best indicator of biological age, which can be estimated by simple formulas and might be used for prognostic purposes or as a surrogate end point in epidemiological and intervention studies.
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Adams J, Hosseini M, Peng W, Sibbritt D. Health care utilisation and out-of-pocket expenditure associated with hypertension: an analysis of Australian adults from the 45 and Up Study. J Hum Hypertens 2020; 34:833-840. [DOI: 10.1038/s41371-020-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022]
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12
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The relationship of all-cause mortality to average on-treatment systolic blood pressure is significantly related to baseline systolic blood pressure: implications for interpretation of the Systolic Blood Pressure Intervention Trial study. J Hypertens 2019; 36:916-923. [PMID: 29176391 DOI: 10.1097/hjh.0000000000001620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The SPRINT study demonstrated that targeting systolic blood pressure (SBP) less than 120 mmHg was associated with lower cardiovascular event and mortality rates. In the LIFE study, however, a lower achieved SBP was associated with increased mortality. Mean baseline SBP in SPRINT was 140 mmHg and a third of the population had a baseline SBP 132 mmHg or less, raising the question of whether the lower baseline SBP in SPRINT could in part account for these differences. METHODS All-cause mortality during 4.8 ± 0.9 years follow-up was examined in relation to tertiles of achieved on-treatment average SBP in patients with baseline SBP of 25th percentile or less versus greater than 25th percentile value of 164 mmHg in 7998 nondiabetic hypertensive patients with ECG left ventricular hypertrophy randomly assigned to losartan-based or atenolol-based treatment. Average on-treatment SBP less than 142 mmHg (lowest tertile) and average SBP 142 mmHg to less than 152 mmHg (middle tertile) were compared with average SBP at least 152 mmHg (highest tertile and reference group). RESULTS In the overall population, there was a significant interaction between baseline SBP 164 mmHg or less and average on-treatment SBP less than 142 mmHg in Cox analysis (χ = 15.48, P < 0.001). Among patients with baseline SBP greater than 164 mmHg, in multivariate Cox analyses adjusting for other potential predictors of mortality and a propensity score for having baseline SBP 164 mmHg or less and compared with average on-treatment SBP at least 152 mmHg, average on-treatment SBP less than 142 mmHg was associated with 32% higher mortality (hazard ratio 1.32, 95% CI 1.01-1.65), whereas average SBP of 142 mmHg to less than 152 mmHg was associated with 24% lower mortality (hazard ratio 0.76, 95% CI 0.59-0.98). In contrast, among patients with baseline SBP 164 mmHg or less, both average on-treatment SBP less than 142 mmHg (hazard ratio 0.60, 95% CI 0.36-0.99) and average SBP of 142 mmHg to less than 152 mmHg (hazard ratio 0.51, 95% CI 0.30-0.89) were associated with significantly lower mortality compared with average SBP of at least 152 mmHg. CONCLUSION Achievement of an average SBP less than 142 mmHg was associated with reduced mortality in patients with baseline SBP 164 mmHg or less but with increased mortality in those with higher baseline SBP in LIFE. These findings suggest that the lower mortality associated with a lower targeted SBP in SPRINT may not be applicable to patients with considerably higher baseline SBP than SPRINT patients. Further study is necessary to better understand these findings. CLINICAL TRIALS REGISTRATION http://clinicaltrials.gov/ct/show/NCT00338260?order=1.
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Robles NR, Fici F, Grassi G. J-shaped curve for cardiovascular mortality: systolic or diastolic blood pressure? J Nephrol 2018; 32:347-353. [PMID: 30225803 DOI: 10.1007/s40620-018-0535-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/31/2018] [Indexed: 12/21/2022]
Abstract
Aggressive reduction of blood pressure (BP) may increase cardiovascular events (the J-curve phenomenon) in certain populations. There is a high number of available studies of antihypertensive treatment that provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main cardiovascular outcomes. Nonetheless, most available studies were observational, and randomized trials might not have or lost their statistical power in post-hoc analysis. Contrariwise, most of prospective trial to demonstrate the benefits of intensive blood pressure control were inconclusive. Therefore, further studies are still necessary in order to clarify this issue.
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Affiliation(s)
- Nicolás Roberto Robles
- Unidad de Hipertensión, Hospital Infanta Cristina, Carretera de Portugal s/n, 06070, Badajoz, Spain. .,University of Salamanca School of Medicine, Salamanca, Spain.
| | - Francesco Fici
- Unidad de Hipertensión, Hospital Infanta Cristina, Carretera de Portugal s/n, 06070, Badajoz, Spain.,University of Salamanca School of Medicine, Salamanca, Spain.,University of Salamanca School of Medicine, Salamanca, Spain
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Milan, Italy.,IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Which Target Blood Pressure in Year 2018? Evidence from Recent Clinical Trials. High Blood Press Cardiovasc Prev 2018; 25:151-158. [DOI: 10.1007/s40292-018-0258-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/23/2018] [Indexed: 12/31/2022] Open
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15
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Di Nora C, Cioffi G, Iorio A, Rivetti L, Poli S, Zambon E, Barbati G, Sinagra G, Di Lenarda A. Systolic blood pressure target in systemic arterial hypertension: Is lower ever better? Results from a community-based Caucasian cohort. Eur J Intern Med 2018; 48:57-63. [PMID: 28893522 DOI: 10.1016/j.ejim.2017.08.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/05/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extensive evidence exists about the prognostic role of systolic blood pressure (SBP) reduction ≤140mmHg. Recently, the SPRINT trial successfully tested the strategy of lowering SBP<120mmHg in patients with arterial hypertension (AH). AIM To assess whether the SPRINT results are reproducible in a real world community population. METHODS Cross-sectional, population-based study analyzing data of 24,537 Caucasian people with AH from the Trieste Observatory of CV disease, 2010 to 2015. We selected and divided 2306 subjects with AH according to the SPRINT trial criteria; similarly, SPRINT clinical outcomes were considered. RESULTS Study patients median age was 75±8years, two third male, one third had ischemic heart disease. They were older, with lower body mass index, higher SBP and Framingham CV risk score than the SPRINT patients. Three-hundred-sixty-eight patients (16%) had SBP<120mmHg. During 48 [36-60] months of follow-up, 751 patients (32%) experienced a major adverse cardiac event (MACE). The SBP <120mmHg group had higher incidence of MACE, CV deaths and all-cause death than SBP≥120mmHg group (37% vs 31%; 10% vs 4%; 19% vs 10%, all p<0.05). The condition of SBP<120mmHg was an independent predictor of MACE in multivariate Cox analysis together with older age, male gender, higher Charlson score. CONCLUSIONS In our experience, the SBP<120mmHg condition is associated with worse clinical outcomes, suggesting the SPRINT results are not reproducible tout court in Caucasian community populations. These differences should be taken as a warning against aggressive reducing of SBP<120mmHg.
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Affiliation(s)
| | - Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital, Trento, Italy
| | | | - Luigi Rivetti
- Cardiovascular Department, Ospedali Riuniti, Trieste, Italy
| | - Stefano Poli
- Cardiovascular Department, Ospedali Riuniti, Trieste, Italy
| | - Elena Zambon
- Cardiovascular Department, Ospedali Riuniti, Trieste, Italy
| | - Giulia Barbati
- Cardiovascular Department, Ospedali Riuniti, Trieste, Italy
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Moraes AAI, Baena CP, Muka T, Bano A, Buitrago-Lopez A, Zazula A, Erbano BO, Schio NA, Guedes MH, Bramer WM, Franco OH, Faria-Neto JR. Achieved systolic blood pressure in older people: a systematic review and meta-analysis. BMC Geriatr 2017; 17:279. [PMID: 29207946 PMCID: PMC5717809 DOI: 10.1186/s12877-017-0672-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment. METHODS We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design. RESULTS Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg. CONCLUSIONS Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.
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Affiliation(s)
- Aline A. I. Moraes
- Pós Graduação de Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
| | - Cristina P. Baena
- Pós Graduação de Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
| | - Taulant Muka
- Department of Epidemiology, Erasmus MC, Erasmus MC, University Medical Center Rotterdam Office Na 29-16, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Arjola Bano
- Department of Epidemiology, Erasmus MC, Erasmus MC, University Medical Center Rotterdam Office Na 29-16, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Adriana Buitrago-Lopez
- Universidad Javeriana. Pontificia Universidad Javeriana, Carrera 7 No. 40 – 62, Bogotá D.C., Colombia
| | - Ana Zazula
- Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
| | - Bruna O. Erbano
- Escola de Medicina, Faculdade Evangélica do Paraná, Rua Padre Anchieta, 2770, Curitiba, Paraná CEP80730-000 Brazil
| | - Nicolle A. Schio
- Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
| | - Murilo H. Guedes
- Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
| | - Wichor M. Bramer
- Medical Library Erasmus MC, University Medical Center Rotterdam Office Na 29-16, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, Erasmus MC, University Medical Center Rotterdam Office Na 29-16, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - José Rocha Faria-Neto
- Pós Graduação de Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155 – Parque Tecnológico 06, Curitiba, Paraná CEP: 80.215-901 Brazil
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Charan J, Chaudhari M, Mulla S, Reljic T, Mhaskar R, Kumar A. Pharmacotherapy for resistant hypertension in adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd012769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jaykaran Charan
- All India Institute of Medical Sciences Jodhpur; Department of Pharmacology; Basni Phase II Jodhpur Rajasthan India 342005
| | - Mayur Chaudhari
- Govt. Medical College; Department of Pharmacology; Outside Majura gate Surat Gujarat India 395001
| | - Summaiya Mulla
- Govt. Medical College; Department of Microbiology; Outside Majura gate Surat Gujarat India 395001
| | - Tea Reljic
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Rahul Mhaskar
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
| | - Ambuj Kumar
- University of South Florida; Center for Evidence Based Medicine and Health Outcomes Research; 12901 Bruce B. Downs Blvd., MDC27 Tampa Florida USA 33612
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18
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Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Tugcu A, Sacco RL, Di Tullio MR. Association of Blood Pressure Control Level With Left Ventricular Morphology and Function and With Subclinical Cerebrovascular Disease. J Am Heart Assoc 2017; 6:JAHA.117.006246. [PMID: 28757483 PMCID: PMC5586460 DOI: 10.1161/jaha.117.006246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Left ventricular (LV) hypertrophy and subclinical cerebrovascular disease are early manifestations of cardiac and brain target organ damage caused by hypertension. This study aimed to investigate whether intensive office systolic blood pressure (SBP) control has beneficial effects on LV morphology and function and subclinical cerebrovascular disease in elderly patients with hypertension. Methods and Results We examined 420 patients treated for hypertension without history of heart failure and stroke from the CABL (Cardiovascular Abnormalities and Brain Lesions) study. All patients underwent 2‐dimensional echocardiographic examination and brain magnetic resonance imaging. Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume. Patients were divided into 3 groups: SBP <120 mm Hg (intensive control); SBP 120 to 139 mm Hg (less intensive control); and SBP ≥140 mm Hg (uncontrolled). Prevalence of LV hypertrophy and diastolic dysfunction were lowest in the intensive control, intermediate in the less intensive control, and highest in the uncontrolled groups (12.8%, 31.8%, and 44.7%, respectively [P<0.001], for LV hypertrophy; 46.8%, 61.7%, and 72.6%, respectively [P=0.003], for diastolic dysfunction). Patients with less intensive SBP control had greater risk of LV hypertrophy than those with intensive control (adjusted odds ratio, 3.26; P=0.013). A similar trend was observed for LV diastolic dysfunction but did not reach statistical significance (adjusted odds ratio, 1.65; P=0.144). Conversely, intensive SBP control was not significantly associated with reduced risk of silent brain infarcts and white matter hyperintensity volume compared with less intensive control. Conclusions Compared with less intensive control, intensive SBP control may have a stronger beneficial effect on cardiac than cerebral subclinical disease.
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Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL.,Department of Human Genetics, Miller School of Medicine, University of Miami, FL
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Abstract
SPRINT is the first randomized, controlled trial showing that a systolic blood-pressure goal of <120 mmHg can be attained with cardiovascular benefits in a select group of patients with hypertension and an elevated cardiovascular risk with different origins. Although the patient population with characteristics like those in SPRINT makes up only 20-30% of the total hypertensive population, SPRINT is a landmark study that highlights the need to consider lower blood- pressure goals in the treatment of hypertension. Extending this study to include other patient populations and geographical areas is the next step for evaluating the benefits of strict blood-pressure targets and the generalizability of the SPRINT results. Importantly, the blood-pressure measurement method used in SPRINT differs from previous clinical trials, and raises the issue of whether a more accurate method should be used in clinical trials and if such method is feasible in clinical practice. This Perspectives article provides an analysis of the SPRINT data, focusing on patient characteristics, blood-pressure measurement method, and applicability of the SPRINT findings for future management guidelines.
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20
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Svensson MK, Afghahi H, Franzen S, Björk S, Gudbjörnsdottir S, Svensson AM, Eliasson B. Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register. Diab Vasc Dis Res 2017; 14:226-235. [PMID: 28467201 DOI: 10.1177/1479164116683637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. AIMS To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. PATIENTS AND METHODS A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. RESULTS A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13-1.40 and hazard ratio: 1.26, 1.17-1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32). CONCLUSION Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.
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Affiliation(s)
- Maria K Svensson
- 1 Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Henri Afghahi
- 2 Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Stefan Franzen
- 3 Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Staffan Björk
- 3 Centre of Registers Västra Götaland, Gothenburg, Sweden
| | | | | | - Björn Eliasson
- 4 Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán M. Cardiopatía isquémica crónica en el anciano. Semergen 2017; 43:109-122. [DOI: 10.1016/j.semerg.2016.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 01/09/2023]
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Okin PM, Kjeldsen SE, Devereux RB. Impact of achieved systolic blood pressure on renal function in hypertensive patients. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:271-276. [PMID: 29474712 DOI: 10.1093/ehjqcco/qcw017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/04/2016] [Indexed: 01/13/2023]
Abstract
Aims There is strong evidence for the association of high blood pressure (BP) with depressed renal function. Although high BP at baseline is associated with greater progression of chronic kidney disease (CKD), randomized trials in CKD patients have found no significant relationship between more intensive BP control and glomerular filtration rate (GFR) decline. However, the relationship of GFR and change in GFR over time to lower achieved systolic BP (SBP) in hypertensive patients undergoing treatment is unclear. Methods and results Baseline estimated GFR (eGFR) and change in eGFR during follow-up were examined in relation to average on-treatment SBP in 8778 hypertensive patients with ECG left ventricular hypertrophy (LVH) randomly assigned to losartan- or atenolol-based treatment. GFR was estimated using the Modification of Diet in Renal Disease study equation. Patients with average on-treatment SBP ≤130 mmHg (lowest quintile at last measurement) and average SBP between 131 and 141 mmHg were compared with patients with average SBP ≥142 mmHg (median SBP at last measurement). Patients with an average on-treatment SBP ≤130 mmHg had significantly lower baseline eGFR than those with average SBP between 131 and 141 or average SBP ≥142 mmHg (65.5 ± 14.3 vs. 69.3 ± 14.3 vs. 69.0 ± 14.5 mL/min/1.73 m2, P < 0.001 using analysis of covariance adjusting for age, sex, race, randomized treatment, prior antihypertensive treatment, history of diabetes, myocardial infarction, ischaemic heart disease or heart failure, smoking status, baseline serum glucose, total and HDL cholesterol, albuminuria, and baseline LVH by Cornell product and Sokolow-Lyon voltage). However, the decrease in eGFR between baseline and Year 4 was significantly lower among patients with average SBP ≤130 mmHg (-6.3 ± 10.3 vs. -7.9 ± 11.1 vs. -9.2 ± 10.6 mL/min/1.73 m2, P = 0.001 when adjusting for the same variables and for change in Cornell product and Sokolow-Lyon voltage between baseline and Year 4). These differences in eGFR change persisted even after adjusting for baseline eGFR, and there were no significant interactions with randomized treatment, sex, race, or baseline presence of proteinuria. Conclusion Lower average on-treatment SBP (≤130 mmHg) was associated with a lower baseline eGFR but with a slower reduction in eGFR during 4-year follow-up in hypertensive patients with ECG LVH, independent of other possible risk factors for decreased GFR. Further study is necessary to determine whether randomized treatment to lower SBP goals is more protective of renal function than treatment to standard SBP goals. Clinical trial registration http://clinicaltrials.gov/ct/show/NCT00338260?order=1; unique identifier: NCT00338260.
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Affiliation(s)
- Peter M Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065,USA
| | - Sverre E Kjeldsen
- University of Oslo, Ullevål Hospital, Oslo, Norway.,University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065,USA
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Ewen S, Lobo MD, Pathak A, Schmieder RE, Tsioufis C, Wijns W, Mahfoud F. Will SPRINT change my practice? SPRINT: a randomised trial of intensive versus standard blood-pressure control. EUROINTERVENTION 2016; 12:809-12. [PMID: 27542797 DOI: 10.4244/eijv12i6a132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Kang YY, Wang JG. The J-Curve Phenomenon in Hypertension. Pulse (Basel) 2016; 4:49-60. [PMID: 27493904 DOI: 10.1159/000446922] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/18/2016] [Indexed: 12/27/2022] Open
Abstract
Almost immediately after antihypertensive therapy was proven effective in preventing cardiovascular events, the J-curve issue emerged as a hot topic. The Hypertension Optimal Treatment (HOT) trial attempted to address this question (diastolic blood pressure <80, <85, and <90 mm Hg) but ended up with a post hoc analysis indicating a nadir of 138.5 mm Hg systolic and 82.6 mm Hg diastolic blood pressure. Nevertheless, this observational finding was supported by the results of observational studies in the general population and by post hoc analyses of antihypertensive treatment trials. The currently ongoing Systolic Hypertension Optimal Treatment (SHOT) trial investigates whether the relationship between systolic blood pressure and stroke recurrence is linear or J-shaped by treating systolic blood pressure to <125, <135, and <145 mm Hg in patients with a history of recent stroke. This trial may provide additional but probably inconclusive evidence, because optimal blood pressure might differ between individuals and across outcomes. Nevertheless, a universal beneficial, instead of optimal, level of blood pressure for antihypertensive treatment may exist approximating 130/80 mm Hg and should be investigated by comparing 130/80 mm Hg with 140/90 mm Hg as a target blood pressure in hypertensive patients with the simultaneous use of modern blood pressure measuring techniques, such as home and ambulatory blood pressure monitoring.
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Affiliation(s)
- Yuan-Yuan Kang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. [Chronic ischaemic heart disease in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:170-179. [PMID: 27102136 DOI: 10.1016/j.regg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging.
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Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, España.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, España
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, España
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología (SEGG), Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. Cardiopatía isquémica crónica en el anciano. Med Clin (Barc) 2016; 146:372.e1-372.e10. [DOI: 10.1016/j.medcli.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
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Abstract
Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed.
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Affiliation(s)
- Neil R Poulter
- International Centre for Circulatory Health, Imperial College London, London, UK.
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India
| | - Mark Caulfield
- William Harvey Research Institute and NIHR Biomedical Research Unit in Cardiovascular Disease at Barts, Queen Mary University of London, London, UK
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Okin PM, Hille DA, Larstorp ACK, Wachtell K, Kjeldsen SE, Dahlöf B, Devereux RB. Effect of Lower On-Treatment Systolic Blood Pressure on the Risk of Atrial Fibrillation in Hypertensive Patients. Hypertension 2015; 66:368-73. [PMID: 26056336 DOI: 10.1161/hypertensionaha.115.05728] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Peter M. Okin
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Darcy A. Hille
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Anne Cecilie K. Larstorp
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Kristian Wachtell
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Sverre E. Kjeldsen
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Björn Dahlöf
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
| | - Richard B. Devereux
- From Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., K.W., R.B.D.); Section on Biostatistics, Merck Research Labs, West Point, PA (D.A.H.); Department of Medical Biochemistry (A.C.K.L.), Department of Cardiology (S.E.K.), University of Oslo, Ullevål Hospital, Oslo, Norway; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark (K.W.); Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden (K.W
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Okin PM, Kjeldsen SE, Devereux RB. Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients. Stroke 2015; 46:2113-8. [PMID: 26089332 DOI: 10.1161/strokeaha.115.009592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear. METHODS All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. RESULTS During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. CONCLUSIONS Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/. Unique identifier: NCT00338260.
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Affiliation(s)
- Peter M Okin
- From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.).
| | - Sverre E Kjeldsen
- From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.)
| | - Richard B Devereux
- From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.)
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Abstract
Stroke remains to be a leading cause of disability. However, optimal strategies can prevent up to 80% of strokes. A large body of evidence supports many strategies for primary and secondary prevention of stroke. The purpose of this paper is to highlight recent major advances for management of modifiable medical and behavioral risk factors of stroke. Specific studies are highlighted, including those related to atrial fibrillation (AF), hypertension, revascularization, hyperlipidemia, antiplatelets, smoking, diet, and physical activity. Effective strategies include the use of novel oral anticoagulants for AF, antiplatelet therapy, and intensive lowering of atherosclerosis risk factors.
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Affiliation(s)
- Ayesha Z Sherzai
- Departments of Neurology and Epidemiology, Columbia University Medical Center, New York, New York
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 987] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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Suzuki H, Shimada K, Fujiwara K. Antihypertensive effectiveness of combination therapy with losartan/hydrochlorothiazide for 'real world' management of isolated systolic hypertension. Ther Adv Cardiovasc Dis 2014; 9:10-8. [PMID: 25367171 DOI: 10.1177/1753944714558244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The guidelines for hypertension require the presence of compelling indications for pharmacological management of hypertension associated with various diseases. Data mainly obtained through randomized controlled trials have provided evidence supporting effectiveness of the combination of losartan (Lo) and hydrochlorothiazide (HCTZ) for management of hypertensive patients. However, there have been few reports discussing the effectiveness of Lo/HTCZ (losartan 50 mg/hydrochlorothizide 12.5 mg) in the 'real world' in the management of isolated systolic hypertension (ISH). This study was designed to investigate the 'real world' effectiveness of Lo/HTCZ-based treatment of ISH associated with various diseases. METHODS This was a retrospective, uncontrolled analysis of data derived from a large, cross-sectional web-based clinical database collected by physicians. RESULTS Of 24,825 eligible patients, 20,726 were followed during a 6-month period. Among these, subjects for analysis included those with systolic blood pressure (SBP) >140 mmHg and diastolic BP (DBP) <90 mmHg; patients with diabetes mellitus and chronic kidney disease were excluded. A total of 15,846 patients were analysed. Among the various complications, hypercholesterolemia was the most frequent concomitant cardiovascular (CV) risk factor (48.1%), followed by obesity (16.3%). Associated clinical conditions were cerebrovascular diseases (9.6%), ischemic heart disease (7.9%) and left ventricular hypertrophy (4.6%). Total numbers of patients exhibiting any type of complications were 62% (≤64 years old), 69% (65-74 years old) and 67% (≥75 years old) (stratification of age). Mean SBP/DBP measurements (mm Hg) were 156/78 at the start, 140/72 at 1 month and 134/72 at 6 months. Blood pressure (BP) reductions associated with various diseases were similar among patients. Laboratory data including serum levels of total cholesterol, uric acid, hemoglobin A1c and serum potassium did not change during the study. Adverse effects such as orthostatic hypotension and considerable reductions in BP (>30 mmHg SBP) were rare. CONCLUSIONS Lo/HTCZ is safe and effective in reducing and improving BP control in a 'real world' setting. Treatment with Lo/HTCZ enabled a substantial proportion of hypertensive patients with associated diseases to achieve the recommended goal of <140 mm Hg.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University 38 Morohonngo, Moroyama machi, Iruma gun, Saitama 350-0495, Japan
| | - Kazuyuki Shimada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline. J Hypertens 2014; 32:1741-50. [DOI: 10.1097/hjh.0000000000000253] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2014; 31:1281-357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc] [Citation(s) in RCA: 3277] [Impact Index Per Article: 327.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Castilla-Guerra L, del Carmen Fernandez-Moreno M. Lessons from the SPS3 trial. Lancet 2014; 383:512. [PMID: 24506904 DOI: 10.1016/s0140-6736(14)60181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Muscari A, Bianchi G, Forti P, Giansante C, Giovagnoli M, Magalotti D, Pandolfi P, Perlangeli V, Zorzi V, Zoli M. A comparison of risk factors as predictors of cardiovascular and non-cardiovascular mortality in the elderly people--relevance of N-terminal pro-B-type natriuretic peptide and low systolic blood pressure. Int J Clin Pract 2013; 67:1182-91. [PMID: 24165431 DOI: 10.1111/ijcp.12195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/20/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many risk factors are known to predict ischaemic events and mortality in the elderly people, but their ranking of importance remains uncertain. This study was designed to identify and compare the main predictors of total mortality (TM), cardiovascular mortality (CVM) and non-cardiovascular mortality (NCVM) in older adults. METHODS Nine hundred and seventy-nine community resident adults aged ≥ 65 years, free of previous heart failure and cardiovascular events, participated in the study. The univariate and multivariate (Cox regression) relationships of baseline cardiovascular risk factors, treatments and laboratory data with TM, CVM and NCVM were assessed after a median follow up of 6.7 years. RESULTS Overall, there were 104 deaths (30 because of CVM and 74 to NCVM). In multivariate analysis, the following factors remained independently associated with mortality: NT pro-B-type natriuretic peptide (NT-proBNP) upper quintile (≥ 237 pg/ml for men, ≥ 280 pg/ml for women): hazard ratio (HR) vs. the rest of the population (95% confidence interval) 2.34 (1.52-3.60), p < 0.001 for TM; HR 5.41 (2.32-12.65), p < 0.001 for CVM; systolic blood pressure lower quintile (≤ 130 mmHg): HR 3.06 (1.80-5.21), p < 0.001 for NCVM; diabetes: HR 2.46 (1.29-4.72), p = 0.007 for NCVM; erythrocyte sedimentation rate (ESR) upper decile (≥ 41 mm/h): HR 2.33 (1.16-4.69), p = 0.02 for NCVM; platelet count lower quintile (≤ 177 × 10(9) /l): HR 2.09 (1.20-3.64), p = 0.009 for NCVM; ever-smoker status: HR 2.08 (1.23-3.52), p = 0.007 for NCVM. CONCLUSIONS In elderly community dwellers, NT-proBNP was the strongest predictor of TM and CVM, while especially low systolic blood pressure, together with diabetes, ESR, reduced platelet count and ever-smoker status, were the main predictors of NCVM.
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Affiliation(s)
- A Muscari
- Department of Medical and Surgical Sciences, University of Bologna and S.Orsola-Malpighi Hospital, Bologna, Italy
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Campbell DJ, McGrady M, Prior DL, Coller JM, Boffa U, Shiel L, Liew D, Wolfe R, Stewart S, Reid CM, Krum H. Most individuals with treated blood pressures above target receive only one or two antihypertensive drug classes. Intern Med J 2013; 43:137-43. [PMID: 22909211 DOI: 10.1111/j.1445-5994.2012.02927.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/28/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND A significant proportion of individuals taking antihypertensive therapies fail to achieve blood pressures <140/90 mmHg. In order to develop strategies for improved treatment of blood pressure, we examined the association of blood pressure control with antihypertensive therapies and clinical and lifestyle factors in a cohort of adults at increased cardiovascular risk. METHODS A cross-sectional study of 3994 adults from Melbourne and Shepparton, Australia enrolled in the SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study. Inclusion criteria were age ≥60 years with one or more of self-reported ischaemic or other heart disease, atrial fibrillation, cerebrovascular disease, renal impairment or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known heart failure or cardiac abnormality on echocardiography or other imaging. The main outcome measures were the proportion of participants receiving antihypertensive therapy with blood pressures ≥140/90 mmHg and the association of blood pressure control with antihypertensive therapies and clinical and lifestyle factors. RESULTS Of 3623 participants (1975 men and 1648 women) receiving antihypertensive therapy, 1867 (52%) had blood pressures ≥140/90 mmHg. Of these 1867 participants, 1483 (79%) were receiving only one or two antihypertensive drug classes. Blood pressures ≥140/90 mmHg were associated with increased age, male sex, waist circumference and log amino-terminal-pro-B-type natriuretic peptide levels. CONCLUSIONS Most individuals with treated blood pressures above target receive only one or two antihypertensive drug classes. Prescribing additional antihypertensive drug classes and lifestyle modification may improve blood pressure control in this population of individuals at increased cardiovascular risk.
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Affiliation(s)
- D J Campbell
- St Vincent's Institute of Medical Research, Melbourne, Victoria, Australia.
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Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159-219. [PMID: 23771844 DOI: 10.1093/eurheartj/eht151] [Citation(s) in RCA: 3168] [Impact Index Per Article: 288.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Giuseppe Mancia
- Centro di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Milano, Italy.
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Okin PM, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Persistence of left ventricular hypertrophy is associated with increased cardiovascular morbidity and mortality in hypertensive patients with lower achieved systolic pressure during antihypertensive treatment. Blood Press 2013; 23:71-80. [DOI: 10.3109/08037051.2013.791414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhang K, Chen J, Liu Y, Wang T, Wang L, Wang J, Huang H. Diastolic blood pressure reduction contributes more to the regression of left ventricular hypertrophy: a meta-analysis of randomized controlled trials. J Hum Hypertens 2013; 27:698-706. [DOI: 10.1038/jhh.2013.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/21/2013] [Accepted: 02/11/2013] [Indexed: 11/09/2022]
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Slany J. J-Kurve. Internist (Berl) 2013; 54:376-82. [DOI: 10.1007/s00108-012-3232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The blood pressure (BP) J-curve debate started in 1979, and we still cannot definitively answer all the questions. However, available studies of antihypertensive treatment provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main outcomes in the general population of hypertensive patients, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and elderly patients. However, further studies are still necessary in order to clarify this issue. This is connected to the fact that most available studies were observational, and randomized trials did not have or lost their statistical power and were inconclusive. Perhaps only the Systolic Blood Pressure Intervention Trial (SPRINT) and Optimal Blood Pressure and Cholesterol Targets for Preventing Recurrent Stroke in Hypertensives (ESH-CHL-SHOT) will be able to finally answer all the questions. According to the current state of knowledge, it seems reasonable to suggest lowering BP to values within the 130-139/80-85 mmHg range, possibly close to the lower values in this range, in all hypertensive patients and to be very careful with further BP level reductions, especially in high-risk hypertensive patients.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland.
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Suzuki H, Shimada Y, Fujiwara K. Combination therapy with losartan/hydrochlorothiazide for blood pressure reduction and goal attainment in a real-world clinical setting in Japan. Ther Adv Cardiovasc Dis 2012; 6:237-244. [DOI: 10.1177/1753944712464285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Objective: When physicians prescribe a new antihypertensive drug, they do not know the extent of the drug’s effect on lowering blood pressure. To resolve this dilemma, a Web-based program was constructed for real-time entry and analysis of treatment. This observational study evaluated the efficacy of losartan/hydrochlorothiazide (Lo/HCTZ) in lowering blood pressure (BP) and achieving BP target values. Methods: Physicians prescribed Lo/HCTZ for patients with hypertension who failed to achieve target BP values of < 140/90 mmHg and < 130/80 mmHg in patients with diabetes or chronic kidney disease, respectively, with antihypertensive drugs including an angiotensin receptor blocker. Results: From December 2006 to December 2009, the data of 88,254 patients were entered into this database, and the data of 24,825 subjects were analyzed. At the first visit, a total of 88,254 patients received a first prescription of Lo/HCTZ daily. Among these, at the end of the present analysis, 24,825 (28%) outpatients had a follow-up visit at 1 month and 20,726 (23%) outpatients had a follow-up visit at 6 months. The prevalence of hypertensive patients achieving systolic blood pressure (SBP) control (< 140 mmHg) increased over time from 6.9% to 54.3% in females and 6.1% to 52.3% in males ( p < 0.05). At the start of the study, the levels of SBP were significantly highest in the eldest patients (≥ 75 years) followed by the group of 65–75 years and lowest in the youngest patients (≤ 64 years). However, at the end of the study, there were no differences in levels of SBP among the three groups. Conclusions: This Web-based system may provide useful information when a new drug is first released into the market. Treatment with Lo/HCTZ enabled a substantial proportion of hypertensive patients to achieve the recommended goal of < 140/90 mmHg.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University, 38 Morohonngo, Moroyama machi, Iruma gun, Saitama, 350-0495, Japan
| | - Yukio Shimada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Abstract
The relationship between blood pressure and cardiovascular disease risk among treated hypertensives is J-shaped: risk is increased at high levels of blood pressure, falls in parallel with blood pressure reduction and increases again when blood pressure falls below a nadir (the point at which blood pressure is too low to maintain perfusion of vital organs). Randomized controlled trials of antihypertensive treatment have identified J-shaped relationships between achieved systolic and diastolic blood pressures and all-cause mortality, as well as fatal and nonfatal cardiovascular events, but not stroke or renal outcomes, in the general population of hypertensives and high-risk prehypertensives, particularly in subgroups such as the elderly and those with coronary artery disease, chronic kidney disease, diabetes, left ventricular hypertrophy, and high cardiovascular risk because of multiple comorbidities and concomitant risk factors. Blood pressure targets <130-140/70-85 mm Hg were not beneficial for any outcome except stroke and chronic kidney disease.
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Affiliation(s)
- Tanja Dudenbostel
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA, 933 19th Street S, Community Health Services Building (CHSB), Room 115, Birmingham, AL 35294-2041, USA
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA
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