1
|
Wang Z, Li W, Jiang C, Wang J, Hua C, Tang Y, Zhang H, Liu X, Wang Y, Gao M, Lv Q, Dong J, Ma C, Du X. Association between blood pressure variability and risk of kidney function decline in hypertensive patients without chronic kidney disease: a post hoc analysis of Systolic Blood Pressure Intervention Trial study. J Hypertens 2024; 42:1203-1211. [PMID: 38690929 DOI: 10.1097/hjh.0000000000003715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Blood pressure variability (BPV) is a risk factor for poor kidney function independent of blood pressure (BP) in chronic kidney disease (CKD). Little is known about the association between kidney function decline and BPV in hypertensive patients without CKD. METHODS A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. BPV was measured as standard deviation (SD) and average real variability (ARV). Cox proportional hazard models were employed to explore the relationship between BPV and incident CKD and albuminuria. RESULTS A total of 5700 patients were included, with a mean age of 66.4 years old. During a median of 3.29 years follow-up, 150 (2.6%) patients developed CKD and 222 (7.2%) patients developed albuminuria. Patients were divided into four groups according to the quartiles of BPV. Compared with SBPV Q1, the incidence of CKD was higher in SBPV Q2-Q4; hazard ratios and 95% confidence interval were 1.81 (1.07-3.04), 1.85 (1.10-3.12) and 1.90 (1.13-3.19), respectively. The association between incident CKD and albuminuria with DBPV was less significant than SBPV. Similar results were found when measuring BPV as ARV and SD. No interaction was detected in BP-lowering strategy and SBPV on incident CKD and albuminuria ( P > 0.05). CONCLUSION This study found that BPV was a risk factor for incident CKD and albuminuria in patients without CKD, especially SBPV. Although intensive BP control increased the risk of CKD, the association between SBPV and kidney function decline did not differ between the two treatment groups. REGISTRATION URL: https://clinicaltrials.gov/ , Unique identifier: NCT01206062.
Collapse
Affiliation(s)
| | - Wenjie Li
- Department of Cardiology, Anzhen Hospital
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital
| | - Jue Wang
- Department of Cardiology, Anzhen Hospital
| | - Chang Hua
- Department of Cardiology, Anzhen Hospital
| | | | - Hao Zhang
- Department of Cardiology, Anzhen Hospital
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital
| | | | | | - Qiang Lv
- Department of Cardiology, Anzhen Hospital
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | | | - Xin Du
- Department of Cardiology, Anzhen Hospital
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health (Australia), The University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Liu Y, Kong Y, Yan Y, Hui P. Explore the value of carotid ultrasound radiomics nomogram in predicting ischemic stroke risk in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1357580. [PMID: 38706699 PMCID: PMC11066235 DOI: 10.3389/fendo.2024.1357580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Background and objective Type 2 Diabetes Mellitus (T2DM) with insulin resistance (IR) is prone to damage the vascular endothelial, leading to the formation of vulnerable carotid plaques and increasing ischemic stroke (IS) risk. The purpose of this study is to develop a nomogram model based on carotid ultrasound radiomics for predicting IS risk in T2DM patients. Methods 198 T2DM patients were enrolled and separated into study and control groups based on IS history. After manually delineating carotid plaque region of interest (ROI) from images, radiomics features were identified and selected using the least absolute shrinkage and selection operator (LASSO) regression to calculate the radiomics score (RS). A combinatorial logistic machine learning model and nomograms were created using RS and clinical features like the triglyceride-glucose index. The three models were assessed using area under curve (AUC) and decision curve analysis (DCA). Results Patients were divided into the training set and the testing set by the ratio of 0.7. 4 radiomics features were selected. RS and clinical variables were all statically significant in the training set and were used to create a combination model and a prediction nomogram. The combination model (radiomics + clinical nomogram) had the largest AUC in both the training set and the testing set (0.898 and 0.857), and DCA analysis showed that it had a higher overall net benefit compared to the other models. Conclusions This study created a carotid ultrasound radiomics machine-learning-based IS risk nomogram for T2DM patients with carotid plaques. Its diagnostic performance and clinical prediction capabilities enable accurate, convenient, and customized medical care.
Collapse
Affiliation(s)
| | | | | | - Pinjing Hui
- Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
3
|
Liu T, Wang Y, Li Y, Zhang K, Fan H, Ren J, Li J, Li Y, Li X, Wu X, Wang J, Xue L, Gao X, Yan Y, Li G, Liu Q, Niu W, Du W, Liu Y, Niu X. Minor stroke patients with mild-moderate diastolic blood pressure derive greater benefit from dual antiplatelet therapy. Hypertens Res 2024; 47:291-301. [PMID: 37670003 PMCID: PMC10838769 DOI: 10.1038/s41440-023-01422-8] [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: 04/04/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/07/2023]
Abstract
Not only systolic blood pressure (SBP) but also diastolic blood pressure (DBP) increases the risk of recurrence in the short- or long-term outcomes of stroke. The interaction between DBP and antiplatelet treatment for China stroke patients is unclear. This multicenter, observational cohort study included 2976 minor ischemic stroke patients. Patients accepted single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) after arrival, and baseline DBP levels were trichotomized into <90 mmHg, 90-110 mmHg and ≥110 mmHg. We explore the interaction effect between antiplatelet therapy and DBP on 90-days composite vascular events. A total of 257 (8.6%) patients reached a composite vascular event during follow-up. The interaction term between DBP levels and treatment group (SAPT vs. DAPT) was significant (P for interaction = 0.013). DAPT's adjusted HR for composite events in patients with DBP between 90 and 110 mmHg was 0.56 (95% confidence interval, 0.36 0.88; P = 0.011) and DBP ≥ 110 mmHg was 4.35 (95% confidence interval, 1.11-19.94; P = 0.046). The association between treatment and DBP was still consistent after propensity score matching of the baseline characteristics. The interaction term of DBP × treatment was not significant for the safety outcomes of severe bleeding (P for interaction = 0.301) or hemorrhage stroke (P for interaction = 0.831). In this cohort study based on the real world, patients with a DBP between 90 and 110 mmHg received a greater benefit from 90 days of DAPT than those with lower and higher baseline DBP. REGISTRATION: ( https://www.chictr.org.cn ; Unique identifier: ChiCTR1900025214).
Collapse
Affiliation(s)
- Tingting Liu
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefang Nan Street, Yingze District, Taiyuan, Shanxi, China
| | - Yongle Wang
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefang Nan Street, Yingze District, Taiyuan, Shanxi, China
- Shanxi Medical University, No. 58, Xinjian Nan Street, Yingze District, Taiyuan, China
| | - Yanan Li
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefang Nan Street, Yingze District, Taiyuan, Shanxi, China
- Shanxi Medical University, No. 58, Xinjian Nan Street, Yingze District, Taiyuan, China
| | - Kaili Zhang
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Haimei Fan
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Jing Ren
- Shanxi Province Cardiovascular Disease Hospital, Taiyuan, Shanxi, China
| | - Juan Li
- Chanzhou Central Hospital, Chanzhou, Hebei, China
| | - Yali Li
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefang Nan Street, Yingze District, Taiyuan, Shanxi, China
- Shanxi Medical University, No. 58, Xinjian Nan Street, Yingze District, Taiyuan, China
| | - Xinyi Li
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Xuemei Wu
- Department of Neurology, Sixth Hospital of Shanxi Medical University (General Hospital of Tisco), Taiyuan, Shanxi, China
| | - Junhui Wang
- Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, Shanxi, China
| | - Lixi Xue
- Yanhu Branch First Hospital of Shanxi Medical University, Yuncheng, Shanxi, China
| | - Xiaolei Gao
- Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, Shanxi, China
| | - Yuping Yan
- Taiyuan Wanbailin District Medical Group Central Hospital, Taiyuan, Shanxi, China
| | - Gaimei Li
- China Railway 17th Bureau Group Company Central Hospital, Taiyuan, Shanxi, China
| | - Qingping Liu
- China Railway 17th Bureau Group Company Central Hospital, Taiyuan, Shanxi, China
| | - Wenhua Niu
- First People's Hospital of JIN ZHONG, Jinzhong, Shanxi, China
| | - Wenxian Du
- First People's Hospital of JIN ZHONG, Jinzhong, Shanxi, China
| | - Yuting Liu
- Shanxi Province Cardiovascular Disease Hospital, Taiyuan, Shanxi, China
| | - Xiaoyuan Niu
- Department of Neurology, First Hospital of Shanxi Medical University, No. 85, Jiefang Nan Street, Yingze District, Taiyuan, Shanxi, China.
| |
Collapse
|
4
|
Abstract
Since 2015, stroke has become the leading cause of death and disability in China, posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program, an estimated 17.8 million [95% confidence interval (CI) 17.6-18.0 million] adults in China had experienced a stroke in 2020, with 3.4 million (95% CI 3.3-3.5 million) experiencing their first-ever stroke and another 2.3 million (95% CI 2.2-2.4 million) dying as a result. Additionally, approximately 12.5% (95% CI 12.4-12.5%) of stroke survivors were left disabled, as defined by a modified Rankin Scale score greater than 1, equating to 2.2 million (95% CI 2.1-2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes, hypertension, and hyperlipidemia continues to rise and remains poorly controlled, the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness, treatment, and control rates in hypertensive patients were: 60.1%, 42.5%, and 25.4%, respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%, suggesting there are 120 million adults with diabetes in China, and the awareness, treatment, and control rates in diabetic patients were: 43.3%, 49.0%, and 49.4%, respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%, an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3,418,432 stroke cases [mean age ± standard error (SE) was (65.700 ± 0.006) years, and 59.1% were male] were admitted during 2020. Of those, over 80% (81.9%) were ischemic stroke (IS), 14.9% were intracerebral hemorrhage (ICH) strokes, and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean ± SE of hospitalization expenditures was Chinese Yuan (CNY) (16,975.6 ± 16.3), ranging from (13,310.1 ± 12.8) in IS to (81,369.8 ± 260.7) in SAH, and out-of-pocket expenses were (5788.9 ± 8.6), ranging from (4449.0 ± 6.6) in IS to (30,778.2 ± 156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion, of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95% CI 9.2-9.2%), ranging from 6.4% (95% CI 6.4-6.5%) for IS to 21.8% for ICH (95% CI 21.8-21.9%). From 2019 to 2020, the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy (IVT), 49,845 patients receiving mechanical thrombectomy (MT), and 14,087 patients receiving bridging (IVT + MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95% CI 3.2-3.3%), 7.7% (95% CI 7.5-8.0%), and 12.9% (95% CI 12.3-13.4%), respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95% CI 8.8-9.0%), 16.5% (95% CI 16.2-16.9%), and 16.8% (95% CI 16.2-17.4%), respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up. Of those, over 86.9% were IS, 10.8% were ICH strokes, and 2.3% were SAH strokes. The disability rate [% (95% CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95% CI 14.6-15.0%) and 14.0% (95% CI 13.8-14.2%), respectively. The mortality rate [% (95% CI)] of stroke at 3-month and 12-month was 4.2% (95% CI 4.1-4.3%) and 8.5% (95% CI 8.4-8.6%), respectively. The recurrence rate [% (95% CI)] of stroke at 3-month and 12-month was 3.6% (95% CI 3.5-3.7%) and 5.6% (95% CI 5.4-5.7%), respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review, and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.
Collapse
Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Long-De Wang
- School of Public Health, Peking University, Beijing, 100191, China.
| |
Collapse
|
5
|
García-Carrizo F, Galmés S, Picó C, Palou A, Rodríguez AM. Supplementation with the Prebiotic High-Esterified Pectin Improves Blood Pressure and Cardiovascular Risk Biomarker Profile, Counteracting Metabolic Malprogramming. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:13200-13211. [PMID: 36214580 PMCID: PMC9585587 DOI: 10.1021/acs.jafc.2c03143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/01/2023]
Abstract
Supplementation with the prebiotic pectin is associated with beneficial health effects. We aimed to characterize the cardioprotective actions of chronic high-esterified pectin (HEP) supplementation (10%) in a model of metabolic malprogramming in rats, prone to obesity and associated disorders: the progeny of mild calorie-restricted dams during the first half of pregnancy. Results show that pectin supplementation reverses metabolic malprogramming associated with gestational undernutrition. In this sense, HEP supplementation improved blood pressure, reduced heart lipid content, and regulated cardiac gene expression of atrial natriuretic peptide and lipid metabolism-related genes. Moreover, it caused an elevation in circulating levels of fibroblast growth factor 21 and a higher expression of its co-receptor β-klotho in the heart. Most effects are correlated with the gut levels of beneficial bacteria promoted by HEP. Therefore, chronic HEP supplementation shows cardioprotective actions, and hence, it is worth considering as a strategy to prevent programmed cardiometabolic alterations.
Collapse
Affiliation(s)
- Francisco García-Carrizo
- Laboratory
of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics,
Biomarkers and Risk Evaluation−NuBE), University of the Balearic Islands, 07122 Palma, Spain
- Department
of Adipocyte Development and Nutrition (ADE), German Institute of Human Nutrition (DIfE), 14558 Potsdam-Rehbrücke, Germany
| | - Sebastià Galmés
- Laboratory
of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics,
Biomarkers and Risk Evaluation−NuBE), University of the Balearic Islands, 07122 Palma, Spain
- Health
Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Centro
de Investigación Biomédica en Red de Fisiopatología
de la Obesidad y Nutrición, Instituto
de Salud Carlos III, 28029 Madrid, Spain
| | - Catalina Picó
- Laboratory
of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics,
Biomarkers and Risk Evaluation−NuBE), University of the Balearic Islands, 07122 Palma, Spain
- Health
Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Centro
de Investigación Biomédica en Red de Fisiopatología
de la Obesidad y Nutrición, Instituto
de Salud Carlos III, 28029 Madrid, Spain
| | - Andreu Palou
- Laboratory
of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics,
Biomarkers and Risk Evaluation−NuBE), University of the Balearic Islands, 07122 Palma, Spain
- Health
Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Centro
de Investigación Biomédica en Red de Fisiopatología
de la Obesidad y Nutrición, Instituto
de Salud Carlos III, 28029 Madrid, Spain
| | - Ana María Rodríguez
- Laboratory
of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics,
Biomarkers and Risk Evaluation−NuBE), University of the Balearic Islands, 07122 Palma, Spain
- Health
Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Centro
de Investigación Biomédica en Red de Fisiopatología
de la Obesidad y Nutrición, Instituto
de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
6
|
Yu XF, Yin WW, Huang CJ, Yuan X, Xia Y, Zhang W, Zhou X, Sun ZW. Risk factors for relapse and nomogram for relapse probability prediction in patients with minor ischemic stroke. World J Clin Cases 2021; 9:9440-9451. [PMID: 34877279 PMCID: PMC8610887 DOI: 10.12998/wjcc.v9.i31.9440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The identification of risk factors for recurrence in patients with minor ischemic stroke (MIS) is a critical medical need.
AIM To develop a nomogram for individualized prediction of in-hospital recurrence in MIS patients.
METHODS Based on retrospective collection, a single-center study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2019. Univariate and multivariate logistic regression analyses were used to determine the risk factors associated with MIS recurrence. The least absolute shrinkage and selection operator regression was performed for preliminary identification of potential risk factors. Uric acid, systolic blood pressure, serum total bilirubin (STBL), and ferritin were integrated for nomogram construction. The predictive accuracy and calibration of the nomogram model were assessed by the area under the receiver operating characteristic curve (AUC-ROC) and Hosmer-Lemeshow test, respectively.
RESULTS A total of 2216 MIS patients were screened. Among them, 155 were excluded for intravascular therapy, 146 for unknown National Institutes of Health Stroke Scale score, 195 for intracranial hemorrhage, and 247 for progressive stroke. Finally, 1244 patients were subjected to further analysis and divided into a training set (n = 796) and a validation set (n = 448). Multivariate logistic regression analysis revealed that uric acid [odds ratio (OR): 0.997, 95% confidence interval (CI): 0.993-0.999], ferritin (OR: 1.004, 95%CI: 1.002-1.006), and STBL (OR: 0.973, 95%CI: 0.956-0.990) were independently associated with in-hospital recurrence in MIS patients. Our model showed good discrimination; the AUC-ROC value was 0.725 (95%CI: 0.646-0.804) in the training set and 0.717 (95%CI: 0.580-0.785) in the validation set. Moreover, the calibration between nomogram prediction and the actual observation showed good consistency. Hosmer-Lemeshow test results confirmed that the nomogram was well-calibrated (P = 0.850).
CONCLUSION Our present findings suggest that the nomogram may provide individualized prediction of recurrence in MIS patients.
Collapse
Affiliation(s)
- Xian-Feng Yu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wen-Wen Yin
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Chao-Juan Huang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xin Yuan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yu Xia
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wei Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xia Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zhong-Wu Sun
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| |
Collapse
|
7
|
Basson MD, Newman WE, Klug MG. Correlations Among Visit-to-Visit Blood Pressure Variability and Treatment With Antihypertensive Medication With Long-Term Adverse Outcomes in a Large Veteran Cohort. Am J Hypertens 2021; 34:1092-1099. [PMID: 34115112 DOI: 10.1093/ajh/hpab087] [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: 03/17/2021] [Revised: 05/13/2021] [Accepted: 06/07/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Blood pressure variability (BPV) is associated with adverse events (AEs) independently of hypertension. It has been suggested that calcium channel blockers (CCBs) may reduce BPV, and thus be particularly valuable in hypertensives with high BPV. We sought to investigate how CCB affect BPV progression and whether long-term adverse effects of BPV differ after CCB treatment than after treatment with other antihypertensives. METHODS We retrospectively analyzed 25,268 US veterans who had been followed for 3 years without hypertensive therapy, started on a single class of antihypertensive agents (thiazides, CCBs, ACE inhibitors, or beta blockers [BBs]), treated for 6 years, and then followed for 3 additional years. BPV was calculated as SD of systolic or diastolic blood pressures from at least 10 measurements over each 3-year period. A combined AE endpoint included hospitalization, coronary artery bypass grafting, carotid endarterectomy, angioplasty, amputation, arteriovenous fistula creation, and mortality was assessed in years 9-12. RESULTS Post-medication high BPV and BB or thiazide use were associated with increased AE risk. Medication type also affected mean post-medication BPV. The effects of medications except for BBs on AE and mortality was independent of the patient BPV. CONCLUSIONS The possible deleterious effects of thiazides should be considered within the context of the study population, who were mostly male and received only a single class of hypertensives. While CCB may ameliorate BPV over time, this study does not support choosing CCB over other agents specifically to lessen BPV-associated risk.
Collapse
Affiliation(s)
- Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
- Department of Research Service, Fargo VA Medical Center, Fargo, North Dakota, USA
| | - William E Newman
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
- Department of Internal Medicine Service, Fargo VA Medical Center, Fargo, North Dakota, USA
| | - Marilyn G Klug
- Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| |
Collapse
|