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Kao TW, Huang CC, Chen JW. Optimal blood pressure for the prevention of hypertensive nephropathy in nondiabetic hypertensive patients in Taiwan. J Clin Hypertens (Greenwich) 2020; 22:1425-1433. [PMID: 32762119 DOI: 10.1111/jch.13956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022]
Abstract
Hypertension is a global health burden. However, clinical reference for the adequate management of blood pressure (BP) to prevent renal injury has yet to be established. Thus, this study aimed to investigate whether optimal control and maintenance of BP at < 140/90, < 130/80, or < 120/70 mmHg could prevent hypertensive nephropathy in nondiabetic hypertensive patients. A single-center observational study of 351 nondiabetic hypertensive patients was conducted in Taiwan. The average age of the participants was 64.0 years, and approximately 57.8% of the participants were men. Kidney function was assessed using estimated glomerular filtration rate (eGFR). The baseline eGFR was 83.8 ± 19.8 mL/min/1.73 m2 . All patients were followed up every 3 months and underwent office BP measurement and blood sampling. Renal events were defined as> 25% and> 50% decline in eGFR. During an average follow-up period of 4.2 ± 2.3 years, a> 25% and> 50% decline in eGFR was noted in 49 and 11 patients, respectively. The Cox regression analysis revealed that a baseline BP ≥ 140/90 mmHg (hazard ratio [HR]: 1.965; 95% confidence interval [CI]: 1.099-3.514, P = 0.023) and ≥ 130/80 mmHg (HR: 2.799; 95% CI: 1.286-6.004, P = 0.009) increased the risk of> 25% decline in eGFR. Moreover, a baseline BP ≥ 140/90 mmHg (HR: 8.120; 95% CI: 1.650-39.956, P = 0.010) and follow-up BP ≥ 140/90 mmHg (HR: 6.402; 95% CI: 1.338-30.637, P = 0.020) increased the risk of> 50% decline in eGFR. In conclusion, a stringent baseline BP < 130/80 mmHg and a follow-up BP < 140/90 mmHg can be considered optimal cutoff values for clinical practice to prevent hypertensive nephropathy.
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Affiliation(s)
- Ting-Wei Kao
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chou Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.,Healthcare and Service Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Rhodehouse BC, Fan J, Chen W, McNeal MJ, Durham CG, Erwin JP. Effect of repeat manual blood pressure measurement on blood pressure and stage of hypertension. Proc (Bayl Univ Med Cent) 2019; 32:498-501. [DOI: 10.1080/08998280.2019.1626657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Bryce C. Rhodehouse
- Department of Medicine, Baylor Scott & White Health, Temple, Texas
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Jerry Fan
- Department of Medicine, Baylor Scott & White Health, Temple, Texas
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Wencong Chen
- Department of Biostatistics, Baylor Scott & White Health, Temple, Texas
| | - Michael J. McNeal
- Department of Medicine, Baylor Scott & White Health, Temple, Texas
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Charis G. Durham
- Department of Medicine, Baylor Scott & White Health, Temple, Texas
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - John P. Erwin
- Department of Medicine, Baylor Scott & White Health, Temple, Texas
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
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Einstadter D, Bolen SD, Misak JE, Bar-Shain DS, Cebul RD. Association of Repeated Measurements With Blood Pressure Control in Primary Care. JAMA Intern Med 2018; 178:858-860. [PMID: 29710186 PMCID: PMC6061958 DOI: 10.1001/jamainternmed.2018.0315] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This observational cohort study evaluated the effect of a second blood pressure (BP) measurement on the rate of BP control among more than 38 000 patients with diagnosed hypertension and who were followed in primary care.
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Affiliation(s)
- Douglas Einstadter
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.,Division of General Internal Medicine, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio.,Better Health Partnership, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Shari D Bolen
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.,Division of General Internal Medicine, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio.,Better Health Partnership, Cleveland, Ohio
| | - James E Misak
- Department of Family Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio.,Population Health Institute, MetroHealth Medical Center, Cleveland, Ohio
| | - David S Bar-Shain
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.,Department of Pediatrics, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Randall D Cebul
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.,Division of General Internal Medicine, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio.,Better Health Partnership, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
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