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Bidel Z, Nazarzadeh M, Canoy D, Copland E, Gerdts E, Woodward M, Gupta AK, Reid CM, Cushman WC, Wachtell K, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K. Sex-Specific Effects of Blood Pressure Lowering Pharmacotherapy for the Prevention of Cardiovascular Disease: An Individual Participant-Level Data Meta-Analysis. Hypertension 2023; 80:2293-2302. [PMID: 37485657 DOI: 10.1161/hypertensionaha.123.21496] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Whether the relative effects of blood pressure (BP)-lowering treatment on cardiovascular outcomes differ by sex, particularly when BP is not substantially elevated, has been uncertain. METHODS We conducted an individual participant-level data meta-analysis of randomized controlled trials of pharmacological BP lowering. We pooled the data and categorized participants by sex, systolic BP categories in 10-mm Hg increments from <120 to ≥170 mm Hg, and age categories spanning from <55 to ≥85 years. We used fixed-effect one-stage individual participant-level data meta-analyses and applied Cox proportional hazard models, stratified by trial, to analyze the data. RESULTS We included data from 51 randomized controlled trials involving 358 636 (42% women) participants. Over 4.2 years of median follow-up, a 5-mm Hg reduction in systolic BP decreased the risk of major cardiovascular events both in women and men (hazard ratio [95% CI], 0.92 [0.89-0.95] for women and 0.90 [0.88-0.93] for men; P for interaction, 1). There was no evidence for heterogeneity of relative treatment effects by sex for the major cardiovascular disease, its components, or across the different baseline BP categories (all P for interaction, ≥0.57). The effects in women and men were consistent across age categories and the types of antihypertensive medications (all P for interaction, ≥0.14). CONCLUSIONS The effects of BP reduction were similar in women and men across all BP and age categories at randomization and with no evidence to suggest that drug classes had differing effects by sex. This study does not substantiate sex-based differences in BP-lowering treatment.
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Affiliation(s)
- Zeinab Bidel
- Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (Z.B., D.C., E.C., K.R.)
| | - Milad Nazarzadeh
- Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (Z.B., D.C., E.C., K.R.)
| | - Emma Copland
- Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (Z.B., D.C., E.C., K.R.)
| | - Eva Gerdts
- Department of Clinical Science, Centre for Research on Cardiac Disease in Women, University of Bergen, Norway (E.G.)
| | - Mark Woodward
- The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W., J.C.)
| | - Ajay K Gupta
- William Harvey Research Institute, Queen Mary University of London, United Kingdom (A.K.G.)
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (C.M.R.)
| | - William C Cushman
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis (W.C.C.)
| | - Kristian Wachtell
- Department of Cardiology, NewYork-Presbyterian/Weill Cornell Medical Center (K.W.)
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (K.T.)
| | - Barry R Davis
- The University of Texas School of Public Health, Houston (B.R.D.)
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W., J.C.)
| | - Carl J Pepine
- College of Medicine, University of Florida, Gainesville (C.J.P.)
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- Nuffield Department of Women's and Reproductive Health (Z.B., M.N., D.C., E.C., K.R.), University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (Z.B., D.C., E.C., K.R.)
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Ihdayhid AR, Fairbairn TA, Gulsin GS, Tzimas G, Danehy E, Updegrove A, Jensen JM, Taylor CA, Bax JJ, Sellers SL, Leipsic JA, Nørgaard BL. Cardiac computed tomography-derived coronary artery volume to myocardial mass. J Cardiovasc Comput Tomogr 2022; 16:198-206. [PMID: 34740557 DOI: 10.1016/j.jcct.2021.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
In the absence of disease impacting the coronary arteries or myocardium, there exists a linear relationship between vessel volume and myocardial mass to ensure balanced distribution of blood supply. This balance may be disturbed in diseases of either the coronary artery tree, the myocardium, or both. However, in contemporary evaluation the coronary artery anatomy and myocardium are assessed separately. Recently the coronary lumen volume to myocardial mass ratio (V/M), measured noninvasively using coronary computed tomography angiography (CTCA), has emerged as an integrated measure of myocardial blood supply and demand in vivo. This has the potential to yield new insights into diseases where this balance is altered, thus impacting clinical diagnoses and management. In this review, we outline the scientific methodology underpinning CTCA-derived measurement of V/M. We describe recent studies describing alterations in V/M across a range of cardiovascular conditions, including coronary artery disease, cardiomyopathies and coronary microvascular dysfunction. Lastly, we highlight areas of unmet research need and future directions, where V/M may further enhance our understanding of the pathophysiology of cardiovascular disease.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia.
| | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
| | - Gaurav S Gulsin
- University of Leicester and the Leicester NIHR Biomedical Research Centre, Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom; Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Georgios Tzimas
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | | | | | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Jeroen J Bax
- Leiden University, Department of Medicine, Leiden, Netherlands.
| | - Stephanie L Sellers
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Lalnuneng A. Age variation in blood pressure: Rural-urban and sex differences among the Hmar adults of Manipur, Northeast India. Am J Hum Biol 2021; 34:e23656. [PMID: 34387918 DOI: 10.1002/ajhb.23656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Increase in blood pressure (BP) is thought to be an unavoidable consequence of ageing but in secluded communities and in rural areas this is not the case. AIMS The present study aims to examine blood pressure response with age across place of residence and sex; the prevalence of hypertension in relation to place of residence and sex; and to find out the relative importance of biological and behavioural factors as risk factors for hypertension among the Hmar adults (17 to 70 years of age) of Manipur, Northeast India. MATERIALS AND METHODS A cross-sectional sample was collected on 1207 Hmars adults residing in rural and urban settings in Manipur, Northeast India. Demographic data, blood pressure, height, weight and behavioural factors were collected. RESULTS Blood pressure significantly increases with an increasing age and this trend is more pronounced in urban settings compared to rural settings. The overall prevalence of hypertension in the present study is about 21 per cent. Urban Hmar males, rural and urban Hmar females who are ≥ 45 years of age show significantly higher risk of developing hypertension compared to their counterparts who are < 45 years of age, but the same is not observed in Hmar males from rural areas. Males show significantly higher odds of developing hypertension compared to females in both the settings. Obesity is the strongest predictor of hypertension in both the place of residence and sexes. DISCUSSION AND CONCLUSION The present study confirms that population blood pressure does not show a marked increase with increasing age in traditional/rural areas which is clearly perceptible in Hmar men. It also strengthen the case that urban residence, men, increasing age and overweight and/or obese significantly increases the odds of developing hypertension.
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Affiliation(s)
- Abigail Lalnuneng
- Department of Anthropology, North-Eastern Hill University, Umshing Mawkynroh, Shillong, Meghalaya, India
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