1
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Sharp AS, Sanderson A, Hansell N, Reddish K, Miller P, Moss J, Schmieder RE, McCool R. Renal denervation for uncontrolled hypertension: a systematic review and meta-analysis examining multiple subgroups. J Hypertens 2024; 42:1133-1144. [PMID: 38634457 PMCID: PMC11139244 DOI: 10.1097/hjh.0000000000003727] [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: 12/20/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
This systematic review and meta-analysis was conducted to assess the randomized controlled trial (RCT) evidence available for renal denervation (RDN) in uncontrolled arterial hypertension. Twenty-five RCTs met the eligibility criteria for the systematic review, and 16 RCTs were included in the meta-analysis. The results of the random effects meta-analysis estimated a mean difference of -8.5 mmHg [95% confidence interval (CI) -13.5 to -3.6] for office SBP, -3.6 mmHg (95% CI -5.2 to -2.0) for 24 h SBP and -3.9 mmHg (95% CI -5.6 to -2.2) for ambulatory daytime SBP in favour of RDN compared with control (medication and/or sham-only) at primary follow-up. Similarly favourable results were observed across a range of prespecified subgroup analyses, including treatment-resistant hypertension. This meta-analysis suggests that the use of RDN in uncontrolled hypertension leads to consistent reductions in blood pressure. Reductions appear to be statistically consistent in the presence or absence of medications and in populations resistant to the use of three medications.
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Affiliation(s)
| | - Alice Sanderson
- York Health Economics Consortium Ltd, York Science Park, York, UK
| | - Neil Hansell
- York Health Economics Consortium Ltd, York Science Park, York, UK
| | - Katie Reddish
- York Health Economics Consortium Ltd, York Science Park, York, UK
| | - Paul Miller
- York Health Economics Consortium Ltd, York Science Park, York, UK
| | - Joe Moss
- York Health Economics Consortium Ltd, York Science Park, York, UK
| | - Roland E. Schmieder
- Department of Nephrology and Hypertension University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany
| | - Rachael McCool
- York Health Economics Consortium Ltd, York Science Park, York, UK
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2
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Yi J, Wang L, Song J, Liu Y, Liu J, Zhang H, Lu J, Zheng X. Development of a machine learning-based model for predicting individual responses to antihypertensive treatments. Nutr Metab Cardiovasc Dis 2024; 34:1660-1669. [PMID: 38555240 DOI: 10.1016/j.numecd.2024.02.014] [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: 12/13/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS Personalized antihypertensive drug selection is essential for optimizing hypertension management. The study aimed to develop a machine learning (ML) model to predict individual blood pressure (BP) responses to different antihypertensive medications. METHODS AND RESULTS We used data from a pragmatic, cluster-randomized trial on hypertension management in China. Each patient's multiple visit records were included, and two consecutive visits were paired as the index and subsequent visits. The least absolute shrinkage and selection operator method was used to select index visit variables for predicting subsequent BP. The dataset was randomly divided into training and test sets in a 7:3 ratio. Model performance was evaluated using mean absolute error (MAE) and R-square in the test set. A total of 19,013 hypertension management visit records (6282 patients) were included. The mean age of the study population was 63.9 years, and 2657 (42.3%) were females. A total of 12 phenotypical features (age, sex, smoking within seven days, body mass index, waist circumference, index visit systolic BP, diastolic BP, heart rate, comorbidities of diabetes, dyslipidemia, coronary heart disease, and stroke), together with currently taking any prescribed antihypertensive medication regimens and visits time interval were selected to build the model. The Extreme Gradient Boost model performed best among all candidate algorithms, with an MAE of 8.57 mmHg and an R2 = 0.28 in the test set. CONCLUSION The ML techniques exhibit significant potential for predicting individual responses to antihypertensive treatments, thereby aiding clinicians in achieving optimal BP control safely and efficiently. TRIAL REGISTRATION ClinicalTrials.gov, NCT03636334. Registered July 3, 2018, https://clinicaltrials.gov/study/NCT03636334.
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Affiliation(s)
- Jiayi Yi
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lili Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiali Song
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yanchen Liu
- National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China.
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3
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Zhuang Z, Li Y, Zhao Y, Huang N, Wang W, Xiao W, Du J, Dong X, Song Z, Jia J, Liu Z, Clarke R, Qi L, Huang T. Genetically determined blood pressure, antihypertensive drug classes, and frailty: A Mendelian randomization study. Aging Cell 2024; 23:e14173. [PMID: 38725159 PMCID: PMC11258474 DOI: 10.1111/acel.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 07/21/2024] Open
Abstract
Observational studies have suggested that the use of antihypertensive drugs was associated with the risk of frailty; however, these findings may be biased by confounding and reverse causality. This study aimed to explore the effect of genetically predicted lifelong lowering blood pressure (BP) through different antihypertensive medications on frailty. One-sample Mendelian randomization (MR) and summary data-based MR (SMR) were applied. We utilized two kinds of genetic instruments to proxy the antihypertensive medications, including genetic variants within or nearby drugs target genes associated with systolic/diastolic BP, and expression level of the corresponding gene. Among 298,618 UK Biobank participants, one-sample MR analysis observed that genetically proxied BB use (relative risk ratios, 0.76; 95% CI, 0.65-0.90; p = 0.001) and CCB use (0.83; 0.72-0.95; p = 0.007), equivalent to a 10-mm Hg reduction in systolic BP, was significantly associated with lower risk of pre-frailty. In addition, although not statistically significant, the effect directions of systolic BP through ACEi variants (0.72; 0.39-1.33; p = 0.296) or thiazides variants (0.74; 0.53-1.03; p = 0.072) on pre-frailty were also protective. Similar results were obtained in analyses for diastolic BP. SMR of expression in artery showed that decreased expression level of KCNH2, a target gene of BBs, was associated with lower frailty index (beta -0.02, p = 2.87 × 10-4). This MR analysis found evidence that the use of BBs and CCBs was potentially associated with reduced frailty risk in the general population, and identified KCNH2 as a promising target for further clinical trials to prevent manifestations of frailty.
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Affiliation(s)
- Zhenhuang Zhuang
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Yueying Li
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Yimin Zhao
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Ninghao Huang
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Wenxiu Wang
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Wendi Xiao
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Jie Du
- National Institute for Nutrition and HealthChinese Center for Diseases Control and PreventionBeijingChina
| | - Xue Dong
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Zimin Song
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Jinzhu Jia
- Department of Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Zhonghua Liu
- Department of BiostatisticsColumbia UniversityNew YorkNew YorkUSA
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical MedicineTulane UniversityNew OrleansLouisianaUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
- Key Laboratory of Epidemiology of Major Diseases (Peking University)Ministry of EducationBeijingChina
- Center for Intelligent Public Health, Academy for Artificial IntelligencePeking UniversityBeijingChina
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4
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Bos P, Wouters E, Danhieux K, van Olmen J, Remmen R, Klipstein-Grobusch K, Boateng D, Buffel V. Unravelling the Belgian cascade of hypertension care and its determinants: insights from a cross-sectional analysis. BMC Public Health 2024; 24:1559. [PMID: 38872180 DOI: 10.1186/s12889-024-19010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease and all-cause mortality worldwide. Despite the widespread availability of effective antihypertensives, blood pressure (BP) control rates remain suboptimal, even in high-income countries such as Belgium. In this study, we used a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management. METHODS Using cross-sectional data from the 2018 Belgian Health Interview Survey and the Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression models were estimated to identify individual risk factors for being unlinked to hypertension care, untreated and not followed up appropriately. RESULTS The prevalence of hypertension based on self-reported and measured high BP was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% were diagnosed. Furthermore, 53.4% were linked to care, 49.8% were in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Among those diagnosed with hypertension, males, those of younger age, without comorbidities, and smokers, were more likely to be unlinked to care. Once in care, younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, among those treated for hypertension, females, those of younger age, and without comorbidities were more likely to receive no adequate follow-up. CONCLUSION Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are thus needed to improve the accurate and timely diagnosis of hypertension. Once diagnosed, the Belgian health system retains patients fairly well along the continuum of hypertension care, yet targeted health interventions to improve hypertension management for high-risk groups remain necessary, especially with regard to improving treatment rates.
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Affiliation(s)
- Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium.
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Daniel Boateng
- Julius Global Health, Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Veerle Buffel
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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5
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Pathan N, Deng WQ, Di Scipio M, Khan M, Mao S, Morton RW, Lali R, Pigeyre M, Chong MR, Paré G. A method to estimate the contribution of rare coding variants to complex trait heritability. Nat Commun 2024; 15:1245. [PMID: 38336875 PMCID: PMC10858280 DOI: 10.1038/s41467-024-45407-8] [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: 10/28/2022] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
It has been postulated that rare coding variants (RVs; MAF < 0.01) contribute to the "missing" heritability of complex traits. We developed a framework, the Rare variant heritability (RARity) estimator, to assess RV heritability (h2RV) without assuming a particular genetic architecture. We applied RARity to 31 complex traits in the UK Biobank (n = 167,348) and showed that gene-level RV aggregation suffers from 79% (95% CI: 68-93%) loss of h2RV. Using unaggregated variants, 27 traits had h2RV > 5%, with height having the highest h2RV at 21.9% (95% CI: 19.0-24.8%). The total heritability, including common and rare variants, recovered pedigree-based estimates for 11 traits. RARity can estimate gene-level h2RV, enabling the assessment of gene-level characteristics and revealing 11, previously unreported, gene-phenotype relationships. Finally, we demonstrated that in silico pathogenicity prediction (variant-level) and gene-level annotations do not generally enrich for RVs that over-contribute to complex trait variance, and thus, innovative methods are needed to predict RV functionality.
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Affiliation(s)
- Nazia Pathan
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - Wei Q Deng
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohammad Khan
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Shihong Mao
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Robert W Morton
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - Ricky Lali
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Marie Pigeyre
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Michael R Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada.
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Canada.
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6
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Snyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V, Borghi C. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens 2024; 42:136-142. [PMID: 37728093 PMCID: PMC10712996 DOI: 10.1097/hjh.0000000000003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
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Affiliation(s)
- Jacques R. Snyman
- Forte Research (Pty ltd) and Private Practice South Africa, Pretoria, South Africa
| | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Valentina Perrone
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy
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7
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Stanton AM, Heydarpour M, Williams JS, Williams GH, Adler GK. CACNA1D Gene Polymorphisms Associate With Increased Blood Pressure and Salt Sensitivity of Blood Pressure in White Individuals. Hypertension 2023; 80:2665-2673. [PMID: 37846579 PMCID: PMC10843263 DOI: 10.1161/hypertensionaha.123.21229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Disease-causing mutations in CACNA1D gene occur in aldosterone-producing adenomas and familial hyperaldosteronism. We determined whether single nucleotide polymorphisms in CACNA1D gene associate with higher aldosterone resulting in salt sensitivity of blood pressure (BP) and increased BP in men and women. METHODS Data were obtained from the HyperPATH (International Hypertension Pathotypes) cohort, where participants completed a cross-over intervention of liberal and restricted sodium diets. Multi-Ethnic Genotyping Array identified 104 CACNA1D single nucleotide polymorphisms that met quality control. Single nucleotide polymorphism is rs7612148 strongly associated with systolic BP and was selected for study in 521 White participants in 3 scenarios ([1] hypertensives; [2] normotensives; [3] total population=hypertensives+normotensives) using multivariate regression analysis. RESULTS In the total population and hypertensives, but not normotensives, risk allele carriers (CC, GC), as compared with nonrisk allele homozygotes (GG), exhibited higher salt sensitivity of BP and, on liberal sodium diet, higher systolic BP, lower baseline and angiotensin II-stimulated aldosterone, and lower plasma renin activity. On restricted sodium diet, BP was similar across genotypes, suggesting sodium restriction corrected/neutralized the genotype effect on BP. Because increased aldosterone did not seem to drive the increased salt sensitivity of BP and increased BP on liberal sodium diet, we assessed renal plasma flow. Renal plasma flow increase from restricted to liberal sodium diets was blunted in risk allele homozygotes in the total population and in hypertensives. A replication study in another cohort HyperPATH B (International Hypertension Pathotypes Cohort B) confirmed BP-genotype associations. CONCLUSIONS CACNA1D rs7612148 risk allele associated with increased BP and salt sensitivity of BP, likely due to an impaired ability to increase renal plasma flow in response to a liberal sodium diet and not to excess aldosterone.
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Affiliation(s)
- Ana Maria Stanton
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Jonathan S. Williams
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Gordon H. Williams
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Gail K. Adler
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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8
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Kanki M, Nath AP, Xiang R, Yiallourou S, Fuller PJ, Cole TJ, Cánovas R, Young MJ. Poor sleep and shift work associate with increased blood pressure and inflammation in UK Biobank participants. Nat Commun 2023; 14:7096. [PMID: 37925459 PMCID: PMC10625529 DOI: 10.1038/s41467-023-42758-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
Disrupted circadian rhythms have been linked to an increased risk of hypertension and cardiovascular disease. However, many studies show inconsistent findings and are not sufficiently powered for targeted subgroup analyses. Using the UK Biobank cohort, we evaluate the association between circadian rhythm-disrupting behaviours, blood pressure (SBP, DBP) and inflammatory markers in >350,000 adults with European white British ancestry. The independent U-shaped relationship between sleep length and SBP/DBP is most prominent with a low inflammatory status. Poor sleep quality and permanent night shift work are also positively associated with SBP/DBP. Although fully adjusting for BMI in the linear regression model attenuated effect sizes, these associations remain significant. Two-sample Mendelian Randomisation (MR) analyses support a potential causal effect of long sleep, short sleep, chronotype, daytime napping and sleep duration on SBP/DBP. Thus, in the current study, we present a positive association between circadian rhythm-disrupting behaviours and SBP/DBP regulation in males and females that is largely independent of age.
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Affiliation(s)
- Monica Kanki
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine (Alfred Health), Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Artika P Nath
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ruidong Xiang
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Stephanie Yiallourou
- Turner Institute for Brain and Mental Health, Department of Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Peter J Fuller
- Centre of Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Timothy J Cole
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Rodrigo Cánovas
- Cambridge-Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Health and Biosecurity, Australian e-Health Research Centre, CSIRO, Melbourne, VIC, Australia
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.
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9
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Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, O'Driscoll JM. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med 2023; 57:1317-1326. [PMID: 37491419 DOI: 10.1136/bjsports-2022-106503] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. DESIGN Systematic review and network meta-analysis. DATA SOURCES PubMed (Medline), the Cochrane library and Web of Science were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. RESULTS 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. CONCLUSION Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Algis H P Deenmamode
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Megan Griffiths
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Oliver Arnold
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jonathan D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
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10
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Serrano JCE, Castro-Boqué E, García-Carrasco A, Morán-Valero MI, González-Hedström D, Bermúdez-López M, Valdivielso JM, Espinel AE, Portero-Otín M. Antihypertensive Effects of an Optimized Aged Garlic Extract in Subjects with Grade I Hypertension and Antihypertensive Drug Therapy: A Randomized, Triple-Blind Controlled Trial. Nutrients 2023; 15:3691. [PMID: 37686723 PMCID: PMC10490347 DOI: 10.3390/nu15173691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/28/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The use of garlic (Allium sativum) for treating arterial hypertension has been recognized as effective for several decades. However, tolerance to treatment is low, and several technological modifications have been developed to improve its tolerability, such as the aging process at controlled temperature and humidity. This study aims to validate the antihypertensive effects of an optimized extract of aged black garlic with low doses of s-allyl-cysteine (SAC) in a Grade I hypertensive population with drug treatment. A randomized, triple-blind, placebo-controlled parallel trial was developed, where a daily supplementation with 0.25 mg/day of SAC for 12 weeks was performed. A reduction in systolic and diastolic blood pressure of 1.8 mmHg (0.7 to 4.1 95% CI) and 1.5 mmHg (0.3 to 3.0 95% CI), respectively, was observed. Similarly, an increase in blood nitric oxide (10.3 µM, 1.1 to 19.5 95% CI) and antioxidant capacity (7 × 10-3 µM TE/min, (1.2 to 13 × 10-3 95% CI) and a reduction in uric acid levels (-0.3 mg/dL, -0.5 to -0.001 95% CI) and ACE activity (-9.3 U/L; -18.4 to -0.4 95% CI) were observed. No changes in endothelial function and inflammatory cytokines were observed. It was concluded that low-dose SAC supplementation in an optimized black-garlic extract allows for an extra-significant reduction in blood pressure in a Grade I hypertensive population receiving drug treatment.
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Affiliation(s)
- José C. E. Serrano
- NUTREN-Nutrigenomics, Department of Experimental Medicine, University of Lleida, 25198 Lleida, Spain;
| | - Eva Castro-Boqué
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida, IRBLleida, 25198 Lleida, Spain; (E.C.-B.); (A.G.-C.); (M.B.-L.); (J.M.V.)
| | - Alicia García-Carrasco
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida, IRBLleida, 25198 Lleida, Spain; (E.C.-B.); (A.G.-C.); (M.B.-L.); (J.M.V.)
| | | | | | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida, IRBLleida, 25198 Lleida, Spain; (E.C.-B.); (A.G.-C.); (M.B.-L.); (J.M.V.)
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida, IRBLleida, 25198 Lleida, Spain; (E.C.-B.); (A.G.-C.); (M.B.-L.); (J.M.V.)
| | - Alberto E. Espinel
- Pharmactive Biotech S.L.U., 28049 Madrid, Spain; (M.I.M.-V.); (D.G.-H.); (A.E.E.)
| | - Manuel Portero-Otín
- NUTREN-Nutrigenomics, Department of Experimental Medicine, University of Lleida, 25198 Lleida, Spain;
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11
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Kurniansyah N, Goodman MO, Khan AT, Wang J, Feofanova E, Bis JC, Wiggins KL, Huffman JE, Kelly T, Elfassy T, Guo X, Palmas W, Lin HJ, Hwang SJ, Gao Y, Young K, Kinney GL, Smith JA, Yu B, Liu S, Wassertheil-Smoller S, Manson JE, Zhu X, Chen YDI, Lee IT, Gu CC, Lloyd-Jones DM, Zöllner S, Fornage M, Kooperberg C, Correa A, Psaty BM, Arnett DK, Isasi CR, Rich SS, Kaplan RC, Redline S, Mitchell BD, Franceschini N, Levy D, Rotter JI, Morrison AC, Sofer T. Evaluating the use of blood pressure polygenic risk scores across race/ethnic background groups. Nat Commun 2023; 14:3202. [PMID: 37268629 PMCID: PMC10238525 DOI: 10.1038/s41467-023-38990-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/24/2023] [Indexed: 06/04/2023] Open
Abstract
We assess performance and limitations of polygenic risk scores (PRSs) for multiple blood pressure (BP) phenotypes in diverse population groups. We compare "clumping-and-thresholding" (PRSice2) and LD-based (LDPred2) methods to construct PRSs from each of multiple GWAS, as well as multi-PRS approaches that sum PRSs with and without weights, including PRS-CSx. We use datasets from the MGB Biobank, TOPMed study, UK biobank, and from All of Us to train, assess, and validate PRSs in groups defined by self-reported race/ethnic background (Asian, Black, Hispanic/Latino, and White). For both SBP and DBP, the PRS-CSx based PRS, constructed as a weighted sum of PRSs developed from multiple independent GWAS, perform best across all race/ethnic backgrounds. Stratified analysis in All of Us shows that PRSs are better predictive of BP in females compared to males, individuals without obesity, and middle-aged (40-60 years) compared to older and younger individuals.
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Affiliation(s)
- Nuzulul Kurniansyah
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew O Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Alyna T Khan
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jiongming Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Elena Feofanova
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kerri L Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer E Huffman
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Tanika Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tali Elfassy
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Xiuqing Guo
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Walter Palmas
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Henry J Lin
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shih-Jen Hwang
- The Population Sciences Branch of the National Heart, Lung and Blood Institute, Bethesda, MD, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Yan Gao
- The Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jennifer A Smith
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
| | - Sylvia Wassertheil-Smoller
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - JoAnn E Manson
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Yii-Der Ida Chen
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - C Charles Gu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sebastian Zöllner
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Adolfo Correa
- Departments of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bruce M Psaty
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
- Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Donna K Arnett
- Office of the Provost, University of South Carolina, Columbia, SC, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Robert C Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Levy
- The Population Sciences Branch of the National Heart, Lung and Blood Institute, Bethesda, MD, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Jerome I Rotter
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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12
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Kaushal S, Nyoni AM. Why do rewards fail to motivate knowledge sharing behavior among employees? VINE JOURNAL OF INFORMATION AND KNOWLEDGE MANAGEMENT SYSTEMS 2022. [DOI: 10.1108/vjikms-06-2022-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to investigate the factors that lead to the failure of some rewards to induce knowledge sharing behavior among employees, with much focus on employees’ attitudes and leadership’s knowledge of employees’ preferences, and presents a model that depicts the linkages.
Design/methodology/approach
To investigate why the provision of some rewards fails to induce knowledge sharing behavior among employees, this study uses the preferred reporting items for systematic reviews and meta-analyses framework to identify and analyze 56 articles published from 2000 to 2021.
Findings
Knowledge sharing is positively linked to organizational performance. Further, employees’ negative attitudes toward a reward system negatively relate to knowledge sharing behavior. Furthermore, management’s lack of knowledge of employees’ preferences regarding rewards leads to the provision of incorrect rewards that do not enhance knowledge sharing behavior. Finally, a conceptual model depicting the linkages among the variables under consideration has been presented.
Research limitations/implications
Through the present study, employees’ attitudes toward rewards and leadership’s knowledge of employees’ preferences have been presented as critical factors that can lead to the failure of some rewards to induce knowledge sharing behavior. Further, the conceptual framework that can guide managers and leaders in strategizing on how best to develop and implement correct reward systems has been presented.
Originality/value
The present study is a significant contribution to the literature by focusing on the negative side of rewards toward knowledge sharing behavior with a focus on employees’ attitudes and leadership’s awareness of employees’ preferences regarding rewards.
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13
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Singh SP, Varghese KJ, Qureshi FM, Anderson MC, Foxworth J, Knuepfer MM. Catheter-based renal sympathetic nerve denervation on hypertension management outcomes. World J Radiol 2022; 14:238-248. [PMID: 36160631 PMCID: PMC9350608 DOI: 10.4329/wjr.v14.i7.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/06/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Renal sympathetic denervation (RSD) provides a minimally invasive interventional treatment modality for patients with resistant hypertension. However, the post-operative outcomes remain a key area of investigation since its earliest clinical trials.
AIM To evaluate patient outcomes after RSD intervention among peer-reviewed patient cases.
METHODS A systematic review of literature on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for RSD case studies to assess post-operative hypertension readings and medical management.
RESULTS Among 51 RSD cases, the post-operative RSD patients report an apparent reduction with a mean number of 3.1 antihypertensive medications. The mean systolic arterial blood pressure 1 year following RSD was 136.0 mmHg (95%CI: 118.7-153.3).
CONCLUSION The apparent improvements in office systolic blood pressure after 12 month post-operative RSD can support the therapeutic potential of this intervention for blood pressure reduction. Additional studies which utilized a uniform methodology for blood pressure measurement can further support the findings of this systematic review.
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Affiliation(s)
- Som P Singh
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64106, United States
| | - Kevin J Varghese
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64106, United States
| | - Fahad M Qureshi
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64106, United States
| | - Macy C Anderson
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64106, United States
| | - John Foxworth
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO 64106, United States
| | - Mark M Knuepfer
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
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14
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Weber T, Wassertheurer S, Mayer CC, Hametner B, Danninger K, Townsend RR, Mahfoud F, Kario K, Fahy M, DeBruin V, Peterson N, Negoita M, Weber MA, Kandzari DE, Schmieder RE, Tsioufis KP, Binder RK, Böhm M. Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial. Hypertension 2022; 79:1506-1514. [PMID: 35582957 PMCID: PMC9172874 DOI: 10.1161/hypertensionaha.121.18641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | | | - Christopher C Mayer
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Bernhard Hametner
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Martin Fahy
- Medtronic PLC, Santa Rosa, CA (M.F., V.D., N.P., M.N.)
| | | | | | | | | | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Germany (R.E.S.)
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.P.T.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
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15
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Friedman SM, Barnett CH, Franki R, Pollock B, Garver B, Barnett TD. Jumpstarting Health With a 15-Day Whole-Food Plant-Based Program. Am J Lifestyle Med 2022; 16:374-381. [PMID: 35706593 PMCID: PMC9189589 DOI: 10.1177/15598276211006349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
The 15-day Jumpstart was developed as an evidence-based, affordable, standardized, replicable, and scalable program, designed to demonstrate quickly to patients that changing what they eat can improve their health. The program was designed using the principles of the self-determination theory of motivation and personality. Patients were instructed to eat an Esselstyn-compliant, whole-food plant-based diet consisting of vegetables, fruits, whole grains, and legumes. Of the 389 participants in the program from September 2018 to February 2020, average weight loss was 5.8 pounds (7.3 for those whose body mass index was >30), average systolic blood pressure drop was 6.8 points (16.8 points for those with systolic blood pressure >140), average drop in cholesterol was 26 points (44 points for those with a cholesterol >200), average drop in low-density lipoprotein was 19 points (33 points for those with a low-density lipoprotein >100), and average drop in fasting blood sugar was 5.1 points (28.4 points for those starting in the diabetic range); P value was <.005 for fasting blood sugar and <.001 for all other comparisons. A 15-day program that helps patients adopt an Esselstyn-style whole-food plant-based diet, through education, individualized medical feedback, social support, and facilitated small group work, rapidly improves health.
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Affiliation(s)
- Susan M. Friedman
- Susan M. Friedman, MD, MPH, University of
Rochester School of Medicine and Dentistry, 1000 South Avenue Box 58, Rochester,
NY 14620; e-mail:
| | | | - Robert Franki
- Rochester Lifestyle Medicine Institute,
Rochester, New York
| | - Bruce Pollock
- Rochester Lifestyle Medicine Institute,
Rochester, New York
| | - Beth Garver
- Rochester Lifestyle Medicine Institute,
Rochester, New York
| | - Ted D. Barnett
- Rochester Lifestyle Medicine Institute,
Rochester, New York
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16
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Spieker AJ, Nelson LA, Rothman RL, Roumie CL, Kripalani S, Coco J, Fabbri D, Levy P, Collins SP, Wang T, Liu D, McNaughton CD. Feasibility and Short-Term Effects of a Multi-Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial. J Am Heart Assoc 2022; 11:e024339. [PMID: 35195015 PMCID: PMC9075095 DOI: 10.1161/jaha.121.024339] [Citation(s) in RCA: 2] [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: 11/30/2022]
Abstract
Background Emergency department (ED) visits can be opportunities to address uncontrolled hypertension. We sought to compare short‐term blood pressure measures between the Vanderbilt Emergency Room Bundle (VERB) intervention and usual care plus education. Methods and Results We conducted a randomized trial of 206 adult patients with hypertension and elevated systolic blood pressure (SBP) presenting to 2 urban emergency departments in Tennessee, USA. The VERB intervention included educational materials, a brief motivational interview, pillbox, primary care engagement letter, pharmacy resources, and 45 days of informational and reminder text messages. The education arm received a hypertension pamphlet. After 78 participants were enrolled, text messages requested confirmation of receipt. The primary clinical outcome was 30‐day SBP. The median 30‐day SBP was 122 and 126 mm Hg in the VERB and education arms, respectively. We estimated the mean 30‐day SBP to be 3.98 mm Hg lower in the VERB arm (95% CI, −2.44 to 10.4; P=0.22). Among participants enrolled after text messages were adapted, the respective median SBPs were 121 and 130 mm Hg, and we estimated the mean 30‐day SBP to be 8.57 mm Hg lower in the VERB arm (95% CI, 0.98‒16.2; P=0.027). In this subgroup, the median response rate to VERB text messages was 56% (interquartile range, [26%‒80%]). Conclusions This pilot study demonstrated feasibility and found an improvement in SBP for the subgroup for whom interactive messages were featured. Future studies should evaluate the role of interactive text messaging as part of a comprehensive emergency department intervention to improve blood pressure control. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02672787.
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Affiliation(s)
- Andrew J Spieker
- Department of Biostatistics Vanderbilt University Medical Center Nashville TN
| | - Lyndsay A Nelson
- Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Russell L Rothman
- Institute for Medicine and Public Health Vanderbilt University Medical Center Nashville TN
| | - Christianne L Roumie
- Department of Medicine Vanderbilt University Medical Center Nashville TN.,Institute for Medicine and Public Health Vanderbilt University Medical Center Nashville TN.,Geriatric Research Education Clinical Center Tennessee Valley Healthcare System VA Medical Center Nashville TN
| | - Sunil Kripalani
- Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Joseph Coco
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Daniel Fabbri
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Phillip Levy
- Department of Emergency Medicine Wayne State University Detroit MI
| | - Sean P Collins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN.,Geriatric Research Education Clinical Center Tennessee Valley Healthcare System VA Medical Center Nashville TN
| | - Tommy Wang
- Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Dandan Liu
- Department of Biostatistics Vanderbilt University Medical Center Nashville TN
| | - Candace D McNaughton
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN.,ICESSunnybrook Health Sciences CentreUniversity of Toronto Toronto ON Canada
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17
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Albaladejo Blanco C, Martínez Capilla L, Martín García J. Olmesartán y enteropatía una década después: una asociación quizá no tan excepcional. HIPERTENSION Y RIESGO VASCULAR 2022; 39:128-134. [DOI: 10.1016/j.hipert.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
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18
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Decaux A, Edwards JJ, Swift HT, Hurst P, Hopkins J, Wiles JD, O’Driscoll JM. Blood pressure and cardiac autonomic adaptations to isometric exercise training: A randomized sham-controlled study. Physiol Rep 2022; 10:e15112. [PMID: 35083878 PMCID: PMC8792514 DOI: 10.14814/phy2.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Isometric exercise training (IET) is increasingly cited for its role in reducing resting blood pressure (BP). Despite this, few studies have investigated a potential sham effect attributing to the success of IET, thus dictating the aim of the present study. Thirty physically inactive males (n = 15) and females (n = 15) were randomly assigned into three groups. The IET group completed a wall squat intervention at 95% peak heart rate (HR) using a prescribed knee joint angle. The sham group performed a parallel intervention, but at an intensity (<75% peak HR) previously identified to be inefficacious over a 4-week training period. No-intervention controls maintained their normal daily activities. Pre- and post-measures were taken for resting and continuous blood pressure and cardiac autonomic modulation. Resting clinic and continuous beat-to-beat systolic (-15.2 ± 9.2 and -7.3 ± 5.6 mmHg), diastolic (-4.6 ± 5 and -4.5 ± 5.1), and mean (-7 ± 4.2 and -7.5 ± 5.3) BP, respectively, all significantly decreased in the IET group compared to sham and no-intervention control. The IET group observed a significant decrease in low-frequency normalized units of heart rate variability concurrent with a significant increase in high-frequency normalized units of heart rate variability compared to both the sham and no-intervention control groups. The findings of the present study reject a nonspecific effect and further support the role of IET as an effective antihypertensive intervention. Clinical Trials ID: NCT05025202.
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Affiliation(s)
- Anthony Decaux
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Jamie J. Edwards
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Harry T. Swift
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Philip Hurst
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Jordan Hopkins
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Jonathan D. Wiles
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Jamie M. O’Driscoll
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
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19
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Edwards J, De Caux A, Donaldson J, Wiles J, O'Driscoll J. Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis. Br J Sports Med 2021; 56:506-514. [PMID: 34911677 DOI: 10.1136/bjsports-2021-104642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy of isometric exercise training (IET) versus high-intensity interval training (HIIT) in the management of resting blood pressure (BP). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed (MEDLINE), the Cochrane library and SPORTDiscus were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1 January 2000 and 1 September 2020. Research trials reporting the effects of IET or HIIT on resting BP following a short-term intervention (2-12 weeks). RESULTS 38 studies were analysed (18 IET and 20 HIIT), including 1583 (672 IET and 911 HIIT) participants, of which 612 (268 IET and 344 HIIT) were controls.IET produced significantly greater reductions in resting BP compared with HIIT with systolic, diastolic and mean BP effect sizes of 8.50 mm Hg vs 2.86 mm Hg (Q=17.10, p<0.001), 4.07 mm Hg vs 2.48 mm Hg (Q=4.71, p=0.03) and 6.46 mm Hg vs 3.15 mm Hg (Q=4.21, p=0.04) respectively. However, HIIT reduced resting heart rate significantly more than IET (3.17bpm vs 1.34bpm, Q=7.63, p=0.006). CONCLUSION While both modes are efficacious, IET appears to be the superior mode of exercise in the management of resting BP. However, HIIT may achieve wider physiological benefits, with greater reductions in resting heart rate.
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Affiliation(s)
- Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Anthony De Caux
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - James Donaldson
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK.,Department of Sport Science, Nottingham Trent University, Nottingham, UK
| | - Jonathan Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
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20
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AlRuthia Y, Alotaibi F, Jamal A, Sales I, Alwhaibi M, Alqahtani N, AlNajrany SM, Almalki K, Alsaigh A, Mansy W. Cost Effectiveness of ACEIs/ARBs versus Amlodipine Monotherapies: A Single-Center Retrospective Chart Review. Healthcare (Basel) 2021; 9:healthcare9070798. [PMID: 34202109 PMCID: PMC8304800 DOI: 10.3390/healthcare9070798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this retrospective chart review study was to examine the cost effectiveness of angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); and dihydropyridine calcium channel blockers (CCBs) such as amlodipine, monotherapies in the management of essential hypertension among adult patients (≥18 years) without cancer, cardiovascular disease, and chronic kidney disease in the primary care clinics of a university-affiliated tertiary care hospital. Patients were followed up for at least 12 months from the initiation of therapy. Propensity score bin bootstrapping with 10,000 replications was conducted to generate the 95% confidence intervals (CI) for both treatment outcome (e.g., reduction of the systolic (SBP) and diastolic blood pressures (DBP) in mmHG) and the cost (e.g., costs of drugs, clinic visits, and labs in Saudi riyals (SAR)). Among the 153 included patients who met the inclusion criteria, 111 patients were on ACEIs/ARBs, while 44 patients were on amlodipine. On the basis of the bootstrap distribution, we found that the use of ACEIs/ARBs was associated with an incremental reduction of SBP of up to 4.46 mmHg but with an incremental cost of up to SAR 116.39 (USD 31.04), which results in an incremental cost effectiveness ratio (ICER) of SAR 26.09 (USD 6.95) per 1 mmHg reduction with 55.26% level of confidence. With regard to DBP, ACEIs/ARBs were associated with an incremental reduction of DBP of up to 5.35 mmHg and an incremental cost of up to SAR 144.96 (USD 38.66), which results in an ICER of SAR 27.09 (USD 7.23) per 1 mmHg reduction with 68.10% level of confidence. However, ACEIs/ARBs were less effective and costlier than amlodipine in reducing SBP and DBP with 44.74% and 31.89% levels of confidence, respectively. The findings of this study indicate that the use of ACEI or ARB as a monotherapy seems to be more effective than amlodipine monotherapy in the management of essential hypertension in primary care settings with minimal incremental cost.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
- Correspondence: (Y.A.); (A.J.); Tel.: +966-114-677-483 (Y.A.); Fax: +966-114-677-480 (Y.A.)
| | - Fahad Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Amr Jamal
- Family and Community Medicine Department, College of Medicine, King Saud University, P.O. Box 3145, Riyadh 12372, Saudi Arabia
- Correspondence: (Y.A.); (A.J.); Tel.: +966-114-677-483 (Y.A.); Fax: +966-114-677-480 (Y.A.)
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Nawaf Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Sina M. AlNajrany
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Khalid Almalki
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Abdulaziz Alsaigh
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
| | - Wael Mansy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (F.A.); (I.S.); (M.A.); (N.A.); (S.M.A.); (K.A.); (A.A.); (W.M.)
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21
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de Courrèges A, Occelli F, Muntaner M, Amouyel P, Meirhaeghe A, Dauchet L. The relationship between neighbourhood walkability and cardiovascular risk factors in northern France. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 772:144877. [PMID: 33770881 DOI: 10.1016/j.scitotenv.2020.144877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/30/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although walkability is known to be associated with obesity and hypertension through increased physical activity; data on cardiovascular risk factors (especially in the Europe) are scarce. We assessed the relationship between neighbourhood walkability and cardiometabolic factors (including obesity, hypertension, the blood lipid profile, and serum glycated haemoglobin (HbA1c) levels) among adults living in northern France. METHODS Data were extracted from the ELISABET study database (2011-2013). The participants (aged between 40 and 65) resided in or around the cities of Lille and Dunkirk. For each residential address, we determined a neighbourhood walkability index (using a geographic information system) and the Walk Score®. Multilevel linear and logistic models were used to assess the relationships between neighbourhood walkability on one hand and body mass index (BMI), obesity, blood pressure, hypertension, serum HDLC, LDL-C, triglyceride and HbA1c levels, and physical activity level on the other. RESULTS 3218 participants were included. After adjusting for individual and neighbourhood variables, we found that a higher neighbourhood walkability index was associated with a lower BMI (-0.23 kg.m-2; 95% confidence interval (CI) [-0.44;-0.01] for a one interquartile range (IQR) increment), a lower systolic blood pressure (-1.66 mmHg; 95% CI [-2.46;-0.85] per IQR), a lower prevalence of hypertension (% of increase: -7.12, 95% CI [-13.56;-0.52] per IQR), and a higher prevalence of moderate or high physical activity (% of increase = 6.9; 95% CI [1.2;12.72] per IQR). The walkability index was not significantly associated with other cardiovascular risk factors. Similar results were observed for the Walk Score®. CONCLUSION Our results showed that residence in a more walkable neighbourhood was associated with a lower prevalence of vascular risk factors. Promoting neighbourhood walkability might help to improve the population's cardiovascular health.
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Affiliation(s)
- Antoine de Courrèges
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France.
| | - Florent Occelli
- Univ. Lille, IMT Lille Douai, Univ. Artois, Yncrea Hauts-de-France, ULR 4515 - LGCgE, Laboratoire de Génie Civil et géo-Environnement, F-5activity000 Lille, France.
| | - Manon Muntaner
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France.
| | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France.
| | - Aline Meirhaeghe
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France.
| | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France.
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22
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Fu W, He W, Li Y, Chen Y, Liang J, Lei H, Fu L, Chen Y, Ren N, Jiang Q, Shen Y, Ma R, Wang T, Wang X, Zhang N, Xiao D, Liu C. Efficacy and safety of novel-targeted drugs in the treatment of pulmonary arterial hypertension: a Bayesian network meta-analysis. Drug Deliv 2021; 28:1007-1019. [PMID: 34060401 PMCID: PMC8172220 DOI: 10.1080/10717544.2021.1927243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) is a severe and fatal clinical syndrome characterized by high blood pressure and vascular remodeling in the pulmonary arterioles, which is also a rapidly progressing disease of the lung vasculature with a poor prognosis. Although PAH medication made great advances in recent years, the efficacy and safety of the medication are unsatisfactory. Therefore, we aimed to update and expand previous studies to explore the efficacy and safety of PAH-targeted medications. Methods: Relevant articles were searched and selected from published or publicly available data in PubMed, Cochrane Library, CNKI, PsycInfo, and MEDLINE (from inception until October 1st, 2020). To assess the efficacy and safety of PAH therapies, five efficacy outcomes [6-minute walking distance (6MWD), mean pulmonary arterial pressure (mPAP), WHO functional class (WHO FC) improvement, clinical worsening, death] and two safety outcomes [adverse events (AEs), serious adverse events (SAEs)] were selected. And 6MWD was regarded as the primary efficacy outcome. Results: 50 trials included with 10 996participants were selected. In terms of efficacy, all targeted drugs were more effective than placebo. For 6MWD, Bosentan + Sildenafil, Sildenafil, Bosentan + Iloprost were better than others. Bosentan + Iloprost and Bosentan + Sildenafil were better for mPAP. Bosentan + Iloprost and Ambrisentan + Tadalafil were more effective in improving WHO FC. Bosentan + Tadalafil and Bosentan + Iloprost had the Ambrisentan probability to reduce the incidence of clinical worsening. It is demonstrated that Ambrisentan had clear benefits in reducing all-cause mortality. In terms of safety, no therapies had been shown to reduce the incidence of SAEs significantly, and Ambrisentan + Tadalafil significantly increased the incidence of AEs. Conclusions: Phosphodiesterase 5 inhibitor (PDE5i) + Endothelin Receptor Antagonists (ERA) seems to be better therapy for PAH. Prostacyclin analogs (ProsA) + ERA appear promising, though additional data is warranted. Registration PROSPERO CRD42020218818.
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Affiliation(s)
- Wenhai Fu
- Department of Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Wenjun He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yuexin Li
- Department of Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yangxiao Chen
- Department of Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Liang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hui Lei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Lin Fu
- Department of Medicine, First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yanghang Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ni Ren
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Qian Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yi Shen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ran Ma
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Tao Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xinni Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Nuofu Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Dakai Xiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chunli Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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23
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Edwards JJ, Taylor KA, Cottam C, Jalaludeen N, Coleman DA, Wiles JD, Sharma R, O'Driscoll JM. Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study. J Hypertens 2021; 39:341-348. [PMID: 33031171 DOI: 10.1097/hjh.0000000000002630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hypertension remains the leading cause of cardiovascular disease and premature mortality globally. Although high-intensity interval training (HIIT) is an effective nonpharmacological intervention for the reduction of clinic blood pressure (BP), very little research exists regarding its effects on ambulatory BP. The aim of this study was to measure alterations in ambulatory and clinic BP following HIIT in physically inactive adults. METHODS Forty-one participants (22.8 ± 2.7 years) were randomly assigned to a 4-week HIIT intervention or control group. The HIIT protocol was performed on a cycle ergometer set against a resistance of 7.5% bodyweight and consisted of 3 × 30-s maximal sprints separated with 2-min active recovery. Clinic and ambulatory BP was recorded pre and post the control period and HIIT intervention. RESULTS Following the HIIT intervention, 24-h ambulatory BP significantly decreased by 5.1 mmHg in sBP and 2.3 mmHg in dBP (P = 0.011 and 0.012, respectively), compared with the control group. In addition, clinic sBP significantly decreased by 6.6 mmHg compared with the control group (P = 0.021), with no significant changes in dBP and mean BP (mBP). Finally, 24-h ambulatory diastolic, daytime sBP, mBP and dBP, and night-time sBP and mBP variability significantly decreased post-HIIT compared with the control group. CONCLUSION HIIT remains an effective intervention for the management of BP. Our findings support enduring BP reduction and improved BP variability, which are important independent risk factors for cardiovascular disease.
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Affiliation(s)
- Jamie J Edwards
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Katrina A Taylor
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Christian Cottam
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Navazh Jalaludeen
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Damian A Coleman
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Jonathan D Wiles
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
| | - Rajan Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - Jamie M O'Driscoll
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
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24
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DeMoss DS, Teigen KJ, Claassen CA, Fisk MJ, Blair SE, Bakre SA, Hurd CL, Rush AJ. Association between depression and hypertension using classic and revised blood pressure thresholds. Fam Pract 2020; 37:616-622. [PMID: 33075127 DOI: 10.1093/fampra/cmaa010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a primary care population, the relationship between treatment of depression and hypertension (HTN) under the recently revised American College of Cardiology and American Heart Association HTN thresholds for diagnosing HTN is unknown. OBJECTIVE To compare the association between changes in severity of co-occurring depression and HTN over time using the newly revised versus previous HTN guidelines. METHODS In this retrospective cohort study, outpatients ≥18 years (n = 3018) with clinically significant depressive symptoms and elevated blood pressure at baseline were divided into a 'revised' guideline group (baseline blood pressure ≥130/80 mmHg), a 'classic' guideline group (≥140/90 mmHg) and a 'revised-minus-classic' group (≥130/80 and <140/90 mmHg). Depressive symptom change was assessed using the Patient Health Questionnaire-9 (PHQ-9). Correlations between changes in PHQ-9 scores and HTN levels by group over a 6- to 18-month observation period were assessed using robust regression analysis. RESULTS There were demographic and clinical differences between groups. A total of 41% of study subjects (1252/3018) had a visit during the follow-up period where additional PHQ-9 and HTN results were available. Depressive symptom change was unrelated to change in blood pressure in the revised and revised-minus-classic groups. The classic HTN group demonstrated a clinically insignificant change in systolic blood pressure for each unit change in PHQ-9 score (β = 0.23, P-value =0.02). CONCLUSIONS Although a statistically significant association between reduced HTN levels and improvement in depressive symptoms was demonstrated under classic HTN guidelines, there was no clinically meaningful association between treatment of depression and improved HTN levels under either guideline.
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Affiliation(s)
- Dustin S DeMoss
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Kari J Teigen
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Cynthia A Claassen
- Behavioral Health Service, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Mandy J Fisk
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Somer E Blair
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, TX, USA
| | | | - Cheryl L Hurd
- Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Augustus J Rush
- Duke-National University of Singapore, Singapore.,Duke Medical School, Durham, NC, USA.,Texas Tech Health Sciences Center, Odessa, TX, USA.,Curbstone Consultant, Santa Fe, NM, USA
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25
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Liao CT, Wu PC, Shih JC, Cheng TJ, Wu WS. Higher hypertension prevalence, lower incidence, and aggressive treatment with decreasing mortality, cardiovascular, and cerebrovascular incidence in Taiwan from 2005 to 2010: A 2 population-based cohorts study. Medicine (Baltimore) 2020; 99:e22437. [PMID: 32991480 PMCID: PMC7523812 DOI: 10.1097/md.0000000000022437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality, and economic impact on society. The aims of this study are to compare the secular changes in age-stratified hypertension prevalence, incidence, co-morbidity, and 3 years of cardiovascular outcome in Taiwan in the years 2005 and 2010.We enrolled hypertensive individuals from the datasets of the Longitudinal Health Insurance Database (LHID) in 2005 and 2010 in Taiwan separately. We analyzed the hypertension prevalence, incidence, medication treatment, and associated morbidities. The risks of cardiovascular and cerebrovascular events and all-causes mortalities among the hypertensive individuals were evaluated in 3 years of follow-up.There was an increased prevalence of hypertension but decreased incidence of hypertension in those over 65 from 2005 to 2010. Dyslipidemia was the highest rate of co-morbidity in 2005 and 2010. The most frequent categories of anti-hypertensive agents prescribed was 1 or 2 for both 2005 and 2010. Calcium channel blockers were the most common anti-hypertensive agents prescribed, followed by Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers. After 3 years of follow-up, the risks of coronary artery disease (CAD), cerebrovascular diseases (CVD) as well as death were less in 2010 than in 2005 in Taiwan.Our study showed that hypertension individuals had an increased prevalence, younger age, decreased incidence, increased medication treatment associated with decreased the CAD, CVD, and mortalities in 2010 compared to 2005 in Taiwan.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Public Health of Medicine, College of Medicine, National Cheng Kung University
| | - Pei-Chih Wu
- Department of Green Energy and Environmental Resources
- Department of Occupational Safety and Health, Chang Jung Christian University
| | - Jung-Chang Shih
- Division of Cardiovascular Medicine, Chiali branch of Chi-Mei Hospital
| | - Tain-Junn Cheng
- Departments of Neurology and Occupational Medicine, Chi-Mei Medical Center
| | - Wen-Shiann Wu
- Division of Cardiovascular Medicine, Chi-Mei Medical Center
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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26
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Demidova TY, Kislyak OA. The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Arterial hypertension (AH) is powerful and modifying factor of developing macrovascular and microvascular complications of diabetes. Patients with AH and diabetes belong to group with high and very high levels risk of developing cardiovascular complications and chronic kidney disease. The combination of type 2 diabetes mellitus and AH dramatically increases the risk of developing terminal stages of microvascular and macrovascular diabetic complications: blindness, end-stage chronic kidney disease, amputation of the lower extremities, myocardial infarction, cerebral stroke, worsens the patients prognosis and quality of life. There is ample evidence that blood pressure control in diabetic patients may be critical for improving long-term prognosis. This observation does not lose its relevance even with the emergence of new antidiabetic drugs with proven cardio- and nephroprotective effects. Modern clinical researchers and meta-analysis show the priority of combined antihypertensive therapy, which increases the efficacy of blood pressure correction and prophylaxis of long-term complications in patients with type 2 diabetes. In this article we want to pay attention to features of AH in patients with diabetes, to bi-directional pathogenic mechanisms, to discuss the new algorithms of the treatment and therapeutic needs of these patients. It is important to accent the understanding of the integrity and unity of pathogenic mechanisms which are needed in correction. Innovative antihyperglycemic therapy demonstrates the ability of blood pressure decrease. The synergy of effects let us successfully realize the strategy of multi-factor control and reduce a risk of micro- and macrovascular complications.
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Affiliation(s)
| | - O. A. Kislyak
- Pirogov Russian National Research Medical University
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27
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Derington CG, Cohen JB, Bress AP. Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations. J Hum Hypertens 2020; 34:617-623. [PMID: 32332921 DOI: 10.1038/s41371-020-0340-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Catherine G Derington
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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van Helmond N, Jongejan WJ, Hirsh RA. Comment on "Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study". J Med Internet Res 2020; 22:e15952. [PMID: 32319964 PMCID: PMC7203612 DOI: 10.2196/15952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/28/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, United States
| | | | - Robert A Hirsh
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, United States
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Salvador MR, Cunha Gonçalves S, Quinaz Romana G, Nunes B, Kislaya I, Matias Dias C, Rodrigues AP. Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination Survey. Rev Port Cardiol 2020; 38:697-705. [PMID: 31955972 DOI: 10.1016/j.repc.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is one of the main risk factors for disability and death from cardiovascular disease. Current guidelines include initiatives to control blood pressure in hypertensive patients that focus on lifestyle changes. The main objective of this study was to analyze the association between lifestyle and blood pressure in patients under antihypertensive medication. METHODS Data collected in the Portuguese National Health Examination Survey (INSEF) were analyzed. Individuals who met INSEF inclusion criteria and reported being under antihypertensive medication in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, added salt intake, fruit and vegetable consumption, and physical activity) were assessed by questionnaire, and systolic and diastolic blood pressure were measured by physical examination. Associations between lifestyle factors and blood pressure, stratified by gender and adjusted for sociodemographic variables and obesity, were estimated through a multiple linear regression model. RESULTS Alcohol consumption (beta=6.31, p=0.007) and smoking (beta=4.72, p=0.018) were positively associated with systolic blood pressure in men. Added salt intake, fruit and vegetable consumption, and physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioral variable. CONCLUSIONS These conclusions highlight the need in the population under antihypertensive medication, particularly in men, to focus on the fight against high systolic blood pressure in the two modifiable and preventable behaviors of smoking and alcohol consumption.
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Affiliation(s)
- Mário Rui Salvador
- Unidade de Saúde Pública, ACES Dão Lafões, Viseu, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
| | - Susana Cunha Gonçalves
- Unidade de Saúde Pública, ACES Médio Tejo, Alcanena, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Guilherme Quinaz Romana
- Unidade de Saúde Pública, ACES Lisboa Norte, Lisboa, Portugal; Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Ana Paula Rodrigues
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
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Salvador MR, Cunha Gonçalves S, Quinaz Romana G, Nunes B, Kislaya I, Matias Dias C, Rodrigues AP. Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination Survey. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Modernizing the World Health Organization List of Essential Medicines for Preventing and Controlling Cardiovascular Diseases. J Am Coll Cardiol 2019; 71:564-574. [PMID: 29406862 DOI: 10.1016/j.jacc.2017.11.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 11/22/2022]
Abstract
The World Health Organization (WHO) Model List of Essential Medicines (EML) is a key tool for improving global access to medicines for all conditions, including cardiovascular diseases (CVDs). The WHO EML is used by member states to determine their national essential medicine lists and policies and to guide procurement of medicines in the public sector. Here, we describe our efforts to modernize the EML for global CVD prevention and control. We review the recent history of applications to add, delete, and change indications for CVD medicines, with the aim of aligning the list with contemporary clinical practice guidelines. We have identified 4 issues that affect decisions for the EML and may strengthen future applications: 1) cost and cost-effectiveness; 2) presence in clinical practice guidelines; 3) feedback loops; and 4) community engagement. We share our lessons to stimulate others in the global CVD community to embark on similar efforts.
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Antihypertensive drug use in resistant and nonresistant hypertension and in controlled and uncontrolled resistant hypertension. J Hypertens 2019; 36:1563-1570. [PMID: 29601411 DOI: 10.1097/hjh.0000000000001729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH. METHODS Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event. RESULTS In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17). CONCLUSION The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.
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Paz MA, Farrerons M, Saez M, Saurina C, Pinto MG, Castro S, Sobrino J, de Tuero GC. Practical application of the ATOM study: Treatment efficacy of antihypertensive drugs in monotherapy or combination (ATOM metaanalysis according to PRISMA statement); tables for the use of antihypertensive drugs in monotherapy or combination. Medicine (Baltimore) 2019; 98:e15010. [PMID: 30985647 PMCID: PMC6485836 DOI: 10.1097/md.0000000000015010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The response to antihypertensive drugs is predictable. The absence of precise prescription recommendations to treat arterial hypertension (HT) lead to use drugs unable to reduce blood pressure (BP) to target values.We published ATOM study, in which we found significant differences in the ability to reduce BP between the different drugs.The objective of the study was to determine the expected decrease in blood pressure with the use of commercialized doses of the drugs commonly used in the treatment of HT in clinical practice, to avoid the use of drugs or combinations that even with the best response, are unable to obtain the necessary BP decrease to reach the goal. METHODS The analysis was based on the results of the ATOM study. To convert the mean doses of the different drugs and combinations in commercialized doses, the conclusions of the study by Law et al have been applied. RESULTS Based on the results, two tables were drawn, one for systolic BP and the other for diastolic BP, where the doses of the different drugs and combinations are classified according to the BP decrease that can be expected from them. In order to favor the use of the tables in clinical practice, the different drugs have been grouped in intervals of 10 millimeters of mercury (mmHg) for the decrease of the systolic BP and of 5 mmHg for the diastolic BP. CONCLUSIONS Recommendations for the use of antihypertensive treatments should not be limited to pharmacological families. They should also consider differences between drugs or specific combinations. From the data of the ATOM study we have implemented tables that express the effect of the drugs commonly used in clinical practice and that should allow the clinicians to choose with care the treatment to use.
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Affiliation(s)
- Marco A Paz
- Hospital de Santa Caterina, Girona
- Department of Medical Sciences, University of Girona, Girona
| | - Monica Farrerons
- Research Group of Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- Medical Student, University of Girona, Girona
| | - Marc Saez
- Research Group of Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid
| | - Carme Saurina
- Research Group of Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid
| | - Marc Garcia Pinto
- Research Group of Statistics, Econometrics and Health (GRECS), University of Girona, Girona
| | | | - Javier Sobrino
- Fundació Hospital de l'Esperit Sant, Universitat de Barcelon, Santa Coloma de Gramanet, Barcelona
| | - Gabriel Coll de Tuero
- Department of Medical Sciences, University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid
- Research Support Unit, University Institute of Research in Primary Care Jordi Gol (IdIAPGol), Girona, Spain
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Braschi A. Potential Protective Role of Blood Pressure-Lowering Drugs on the Balance between Hemostasis and Fibrinolysis in Hypertensive Patients at Rest and During Exercise. Am J Cardiovasc Drugs 2019; 19:133-171. [PMID: 30714087 DOI: 10.1007/s40256-018-00316-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In patients with hypertension, the triad represented by endothelial dysfunction, platelet hyperactivity, and altered fibrinolytic function disturbs the equilibrium between hemostasis and fibrinolysis and translates into a hypercoagulable state, which underlies the risk of thrombotic complications. This article reviews the scientific evidence regarding some biological effects of antihypertensive drugs, which can protect patients from the adverse consequences of hypertensive disease, improving endothelial function, enhancing antioxidant activity, and restoring equilibrium between hemostatic and fibrinolytic factors. These protective effects appear not to be mediated through blood pressure reduction and are not shared by all molecules of the same pharmacological class.
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Affiliation(s)
- Annabella Braschi
- Ambulatory of Cardiovascular Diseases, Via col. Romey n.10, 91100, Trapani, Italy.
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Dong OM. Excessive dietary sodium intake and elevated blood pressure: a review of current prevention and management strategies and the emerging role of pharmaconutrigenetics. BMJ Nutr Prev Health 2018; 1:7-16. [PMID: 33235949 PMCID: PMC7678480 DOI: 10.1136/bmjnph-2018-000004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Olivia M Dong
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Manzur F, Rico A, Romero JD, Rodriguez-Martinez CE. Efficacy and Safety of Valsartan or Chlorthalidone vs. Combined Valsartan and Chlorthalidone in Patients With Mild to Moderate Hypertension: The VACLOR Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818796482. [PMID: 30202211 PMCID: PMC6122245 DOI: 10.1177/1179546818796482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/02/2018] [Indexed: 01/19/2023]
Abstract
Objective: To evaluate the efficacy and safety of valsartan (V) or chlorthalidone (C)
monotherapy in comparison with a fixed combination of valsartan and
chlorthalidone (V + C). Methods: This 12-week multicenter randomized three-arm open-label study randomly
allocated 72 patients to V or C as monotherapy or a combination of V + C.
The aim was to measure changes in office systolic blood pressure (SBP) and
diastolic blood pressure (DBP) and in 24-hour ambulatory blood pressure
monitoring (ABPM) from baseline to week 12, in addition to medication
tolerability. Results: The proportion of patients achieving target BP in office at week 12 was not
statistically different for the three groups. However, comparisons of
daytime and nighttime 24-hour ABPM values from baseline to week 12 revealed
significant differences in nighttime mean SBP for the three groups, due to a
significantly greater reduction in the values in patients assigned to the V
+ C group (−14.7 vs. −8.7 vs. −10.7, P = .042, V+C; V; C,
respectively). Although patients assigned to the V + C group also had
greater nighttime reduction in mean DBP values compared with those in the
other groups, this difference was not statistically significant. The
incidence of adverse events did not differ significantly. Conclusion: In patients with hypertension treated with V, C, and both medications
combined, the fixed combination of V + C provided a significantly greater
reduction of late night to early morning BP values when interventions were
assessed with 24-hour ABPM. Trial registration: clinicaltrials.gov Identifier: NCT.01850160, https://clinicaltrials.gov/ct2/show/NCT01850160
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Affiliation(s)
- Fernando Manzur
- School of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Andrés Rico
- Internal Medicine Department, MedPlus Medicina Prepagada, Bogotá, Colombia
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Basile J, Egan B, Punzi H, Ali S, Li Q, Patel M, Neutel J. Risk of Hospitalization for Cardiovascular Events with β-Blockers in Hypertensive Patients: A Retrospective Cohort Study. Cardiol Ther 2018; 7:173-183. [PMID: 30191469 PMCID: PMC6251822 DOI: 10.1007/s40119-018-0117-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION β-Blockers are a heterogenous class of drugs that are no longer recommended for initial antihypertension monotherapy due to unfavorable long-term cardiovascular events observed with non-vasodilatory β-blockers. However, the comparative cardiovascular event risk between the vasodilatory β1-selective antagonist/β3 agonist nebivolol and non-vasodilatory β1-blockers, atenolol and metoprolol, is unknown. METHODS Incident nebivolol, atenolol, or metoprolol monotherapy users with hypertension were identified using US claims data (2007-2014). The first β-blocker claim on/after 1/1/2008 defined the index drug/date. Hypertensive patients without pre-index cardiovascular history were followed until index drug discontinuation (> 90 day supply gap), use of other β-blockers, or end of continuous plan enrollment. Patients were pair-wise propensity score-matched using logistic regression, adjusted for baseline demographics, Charlson Comorbidity Index score, comorbid chronic pulmonary disease, rheumatic disease, renal disease, and diabetes, and use of other antihypertensive drugs during baseline. Time to first hospital claim for a cardiovascular event was assessed via Cox proportional hazards regression, adjusted for the variables above. RESULTS Inclusion criteria were met by 81,402 patients (n = 27,134 in each matched treatment cohort), with no between-cohort differences in baseline characteristics, comorbid conditions, or average follow-up duration. Atenolol and metoprolol cohorts had greater risk of hospitalization for a composite event (myocardial infarction, angina, congestive heart failure, stroke) than nebivolol users (adjusted hazard ratios [95% confidence interval] atenolol: 1.68 [1.29, 2.17]; metoprolol: 2.05 [1.59, 2.63]; P < 0.001, both). Risks of most individual cardiovascular events were also lower with nebivolol, including myocardial infarction and angina versus atenolol, and myocardial infarction, congestive heart failure, and angina versus metoprolol (P < 0.05, all). CONCLUSIONS Nebivolol was associated with significantly lower risk of hospitalization due to composite cardiovascular events than atenolol or metoprolol in this large retrospective cohort study of monotherapy with three different β1-selective blockers in hypertensive patients. FUNDING Allergan plc, Madison, NJ, USA.
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Affiliation(s)
- Jan Basile
- Medical University of South Carolina, Charleston, SC, USA.
| | - Brent Egan
- The Care Coordination Institute, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Henry Punzi
- UT Southwestern Medical Center, Carrollton, TX, USA
| | | | | | | | - Joel Neutel
- Orange County Research Center, Tustin, CA, USA
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Abstract
BACKGROUND Extensive clinical experience on metoprolol has been gained in different cardiovascular conditions. REVIEW This paper discusses the use of metoprolol, with a focus on the extended-release formulation, in clinical practice in the light of existing evidence and current recommendations. This is a narrative review based on existing evidence and clinical experience of the author. Evidence on the use of metoprolol in heart failure, ischemic artery disease, arterial hypertension, and atrial fibrillation is well-established. CONCLUSIONS Metoprolol still appears to be a suitable pharmacological option in different cardiovascular conditions. Research on this molecule is still active and new, promising settings of use are being explored and may provide relevant results in the years to come.
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Affiliation(s)
- Guido Grassi
- a Clinica Medica , Department of Health Science , University Milano-Bicocca , Milano , Italy
- b IRCCS Multimedica , Sesto San Giovanni , Milano , Italy
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Naydenov Naydenov S, Margaritov Runev N, Ivanov Manov E, Georgieva Torbova-Gigova S. EFFICACY AND SAFETY OF A SINGLE-PILL COMBINATION OF ATORVASTATIN/AMLODIPINE IN PATIENTS WITH ARTERIAL HYPERTENSION AND DYSLIPIDEMIA. Acta Clin Croat 2018; 57:464-472. [PMID: 31168179 PMCID: PMC6536285 DOI: 10.20471/acc.2018.57.03.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk.
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Affiliation(s)
| | - Nikolay Margaritov Runev
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
| | - Emil Ivanov Manov
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
| | - Svetla Georgieva Torbova-Gigova
- 1Prof. St. Kirkovich Department of Internal Diseases, Medical University of Sofia, Sofia, Bulgaria; 2Tokuda Hospital, Sofia, Bulgaria
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Batty JA, Tang M, Hall M, Ferrari R, Strauss MH, Hall AS. Blood pressure reduction and clinical outcomes with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers: protocol for a systematic review and meta-regression analysis. Syst Rev 2018; 7:131. [PMID: 30144828 PMCID: PMC6109343 DOI: 10.1186/s13643-018-0779-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 07/17/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) efficaciously reduce systolic blood pressure (BP), a well-established risk factor for myocardial infarction (MI). Both inhibit the renin-angiotensin system, albeit through different mechanisms, and produce similar reductions in BP. However, in parallel meta-analyses of ACEi and ARB trials, ACEis reduce risk of MI whereas ARBs do not-a phenomenon described as the 'ARB-MI paradox'. In addition, ACEis reduce all-cause mortality, whereas ARBs do not, which appears to be independent of BP lowering. The divergent cardiovascular effects of ACE inhibitors and ARBs, despite similar BP reductions, are counter-intuitive. This systematic review aims to ascertain the extent to which clinical outcomes in randomised trials of ACEi and ARBs are attributable to reductions in systolic BP. METHODS A comprehensive search of bibliographic databases will be performed to identify all randomised studies of agents of the ACEi and ARB class. Placebo and active comparator-controlled studies that report clinical outcomes, with greater than 500 person-years of follow-up in each study arm, will be included. Two independent reviewers will screen study records against a priori-defined eligibility criteria and perform data extraction. The Cochrane Risk of Bias Tool will be applied to all included studies. Studies retracted subsequent to initial publication will be excluded. Primary outcomes of interest include MI and all-cause mortality; secondary outcomes include stroke, heart failure, revascularisation and cardiovascular mortality. Meta-regression will be performed, evaluating the relationship between attained reduction in systolic BP and relative risk of each outcome, stratified by drug class. Where a BP-dependent effect exists (two-tailed p value < 0.05), relative risks, standardised per 10 mmHg difference in BP, will be reported for each study outcome. Publication bias will be examined using Funnel plots, and calculation of Egger's statistic. DISCUSSION This systematic review will provide a detailed synthesis of evidence regarding the relationship between BP reduction and clinical outcomes with ACEi and ARBs. Greater understanding of the dependency of the effect of each class on BP reduction will advance insight into the nature of the ARB-MI paradox and guide the future usage of these agents. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072988.
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Affiliation(s)
- Jonathan A Batty
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, UK
| | - Mengyao Tang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marlous Hall
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Roberto Ferrari
- Centro Cardiologico Universitario e and LTTA Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care and Research, ES Health Science Foundation, Cotignola, RA, Italy
| | | | - Alistair S Hall
- Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
- Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, UK.
- Leeds General Infirmary Old Site, Great George Street, Leeds, LS1 3EX, UK.
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Gorostidi M, de la Sierra A. Combination therapies for hypertension – why we need to look beyond RAS blockers. Expert Rev Clin Pharmacol 2018; 11:841-853. [DOI: 10.1080/17512433.2018.1509705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain
| | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
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Yimer H, Yaregal D, Getinet H, Hailekirose A. Evidence based guideline on perioperative optimization of hypertensive patients booked for elective surgery at a low-income country. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rietz H, Franklin KA, Carlberg B, Sahlin C, Marklund M. Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial. J Am Heart Assoc 2018; 7:e008642. [PMID: 29929990 PMCID: PMC6064893 DOI: 10.1161/jaha.118.008642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea-hypopnea index, <30). METHODS AND RESULTS In this 4-month, double-blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24-hour blood pressure measurements were performed at baseline and at follow-up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0-17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea-hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7-10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups. CONCLUSIONS A mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.
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Affiliation(s)
- Helene Rietz
- Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden
| | - Carin Sahlin
- Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden
| | - Marie Marklund
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A. The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis. Adv Nutr 2017; 8:830-838. [PMID: 29141968 PMCID: PMC5683004 DOI: 10.3945/an.117.016717] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Beetroot is considered a complementary treatment for hypertension because of its high content of inorganic NO3 This systematic review and meta-analysis aimed to clarify several aspects of beetroot juice supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP). We searched PubMed, Scopus, and Embase databases, and the reference lists of previous reviews. Randomized clinical trials that investigated the effects of beetroot juice on resting blood pressure in humans were recruited for quality assessment, meta-analyses, subgroup analyses, and meta-regressions; of these, 22 were conducted between 2009 and 2017 and included a total of 47 intervention (n = 650) and 43 control (n = 598) groups. Overall, SBP (-3.55 mm Hg; 95% CI: -4.55, -2.54 mm Hg) and DBP (-1.32 mm Hg; 95% CI: -1.97, -0.68 mm Hg) were significantly lower in the beetroot juice-supplemented groups than in the control groups. The mean difference of SBP was larger between beetroot juice-supplemented and control groups in the longer than in the shorter (≥14 compared with <14 d) study durations (-5.11 compared with -2.67 mm Hg) and the highest compared with the lowest (500 compared with 70 and 140 mL/d) doses of beetroot juice (-4.78 compared with -2.37 mm Hg). A positive correlation was observed between beetroot juice doses and the mean differences of blood pressures. In contrast, a smaller effect size of blood pressures was observed after supplementation with higher NO3 (milligrams per 100 mL beetroot juice). A weak effect size was observed in a meta-analysis of trials that used NO3-depleted beetroot juice as a placebo compared with other interventions (-3.09 compared with -4.51 mm Hg for SBP and -0.81 compared with -2.01 mm Hg for DBP). Our results demonstrate the blood pressure-lowering effects of beetroot juice and highlight its potential NO3-independent effects.
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Affiliation(s)
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Asghar Ghasemi
- Endocrine Physiology Center, Research Institute for Endocrine Sciences
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Kaneko R, Sano K, Ono S. Heterogeneity of Clinical Trials for Antihypertensive Drugs in Japan: Exploratory Analysis of Confirmatory Phase III Trials Used for Marketing Approval. Clin Pharmacol Ther 2017; 104:120-129. [PMID: 29071718 DOI: 10.1002/cpt.922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/28/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022]
Abstract
The results of pivotal trials, which provide a rationale for marketing approval decisions for new drugs, are considered for various comparative purposes in postmarketing analyses. Using meta-regression analysis of 91 randomized controlled trials of 61 approved antihypertensive drugs in Japan, we show that mean baseline blood pressure (BP) of each arm was associated with predetermined entry criteria (EC), age, and trial start year (TSY). BP changes following treatment were associated with EC, subject characteristics (e.g., age, complications, baseline BP), study design (e.g., concomitant drug use), and TSY. Effect sizes were generally larger in trials for the first and second drugs in the same class than in trials for follow-on drugs. Results of pivotal trials may vary depending on many factors, suggesting possible challenges associated with the comparison of these results indirectly. Due to the heterogeneity in pivotal trials, caution should be exercised when comparing approved drugs and conducting meta-analyses retrospectively.
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Affiliation(s)
- Reina Kaneko
- Laboratory of Pharmaceutical Regulatory Science, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Kota Sano
- Laboratory of Pharmaceutical Regulatory Science, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulatory Science, Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
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Abstract
Studies involving adoptive families and twins have demonstrated the genetic basis of hypertension and shown that genetic factors account for about 40% of the variance in blood pressure among individuals. Arterial hypertension is genetically complex: multiple genes influence the blood pressure phenotype through allelic effects from single genes and gene-gene interactions. Moreover, environmental factors also modify the blood pressure phenotype. This complexity explains why the identification of the underlying genes has not been as successful in hypertension as in other diseases (such as type 1 and type 2 diabetes mellitus). The identification of the genetic determinants of hypertension has been most successful in endocrine forms of hypertension, which have well-defined phenotypes that permit a precise patient stratification into homogeneous cohorts. A promising area for the application of genetic testing to personalized medicine is the prediction of responses and adverse reactions to antihypertensive drugs. The identification of genetic markers of drug response will enable the design of randomized controlled trials in much smaller series of patients than is currently possible, decreasing the costs and times from drug design to clinical use and ultimately providing patients and doctors with a larger number of tools to combat hypertension, the most important risk factor for cardiovascular disease. This Review focuses on the rapidly developing field of genetic testing in patients with arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Giulio Ceolotto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Brasilina Caroccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Livia Lenzini
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
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