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Dong Y, Gong Y, Han Y, Yu H, Zeng X, Chen Z, An R, Sun N, Chen Z, Yin X. Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study. Int J Obes (Lond) 2023; 47:848-854. [PMID: 37414876 DOI: 10.1038/s41366-023-01335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension are not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension. SUBJECTS/METHODS Our Data were drawn from the medical records of primary-care institutions in China. A total of 24,750 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight ( < 18.5 kg/m2), healthy weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2) and obesity ( ≥ 25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1-4%, stable (-1 to 1%), loss 1-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD. RESULTS After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR = 1.48, 95% CI: 1.19-1.85). Higher risks were seen in participants with loss ≥4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR = 1.33, 95% CI: 1.04-1.70; gain >4%: HR = 1.36, 95% CI: 1.04-1.77). CONCLUSION Obesity and weight change of loss ≥4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse cardiovascular outcomes for patients with hypertension.
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Affiliation(s)
- Yue Dong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yanping Han
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Hanbing Yu
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Xiaozhou Zeng
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Zimei Chen
- Department of Community Health Management, Baoan Central Hospital of Shenzhen, Shenzhen, 518000, PR China
| | - Rongrong An
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Na Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Zhenyuan Chen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
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Hu J, Xu H, Zhu J, Zhang J, Li J, Chen L, Liu X, Qin G. Association between body mass index and risk of cardiovascular disease-specific mortality among adults with hypertension in Shanghai, China. Aging (Albany NY) 2021; 13:6866-6877. [PMID: 33621195 PMCID: PMC7993713 DOI: 10.18632/aging.202543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/25/2020] [Indexed: 06/12/2023]
Abstract
The aim of our study was to examine the association between body mass index (BMI) and the risk of cardiovascular disease (CVD)-specific mortality among Chinese adults with hypertension by sex. This study included 212,394 adult hypertensive patients aged 20-85 years registered in the records of Minhang District during 2007-2018. Cox proportional hazards regression was performed to evaluate the association between BMI and CVD-specific mortality among Chinese adults with hypertension. There were 14,029 deaths over an average of 8.24 years (range, 0.19-11.96 years). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across BMI categories (< 18.5 kg/m2, 18.5-24.9 kg/m2 [reference group], 25.0-29.9 kg/m2, and ≥ 30 kg/m2) for CVD-specific mortality were 1.37 (1.22-1.53), 1.00 (reference), 0.95 (0.90-1.01), and 1.21 (1.04-1.40) in males, and 1.44 (1.31-1.59), 1.00 (reference), 0.96 (0.91-1.01), and 1.04 (0.92-1.17) in females. A U-shaped relationship was observed between BMI and CVD-specific mortality (overall association P< 0.001; non-linearity P< 0.001). This association was attenuated in old age. This study revealed a U-shaped relationship between BMI and CVD-specific mortality among hypertensive men and women. In older people, overweight and obesity are potential factors that reduce the risk of CVD death.
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Affiliation(s)
- Jing Hu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Huilin Xu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jingjing Zhu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Jinling Zhang
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Jun Li
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Linli Chen
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
| | - Xiaohua Liu
- Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- Minhang District Branch of School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Key Lab of Health Technology Assessment, National Health Commission of the People’s Republic of China, Fudan University, Shanghai, People’s Republic of China
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Francischetti EA, de Abreu VG, da Silva Figueiredo LF, Dezonne RS, Coutinho ESF. Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs 2020; 20:447-470. [PMID: 31898196 DOI: 10.1007/s40256-019-00393-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obesity hypertension is an ongoing pandemic. The first-line medications to treat this condition are still subject to debate. We compared diuretics, calcium-channel blockers (CCB), beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) as an initial antihypertensive therapy for prevention of cardiovascular morbimortality of hypertensive individuals who are overweight or obese. METHODS We conducted a search of the literature for randomized clinical trials in which at least 50% of the participants were overweight or obese. The primary outcomes were all-cause mortality, cardiovascular mortality, acute myocardial infarction (MI), heart failure (HF), stroke, or end-stage renal disease. RESULTS Our search yielded 16 randomized studies. Comparisons of two classes of drugs with at least two studies indicated that (1) CCB and ACEI increased the risk of HF [relative risk (RR) = 2.26; 95% confidence interval (CI) 1.16-4.40] and stroke [hazard ratio (HR) = 1.13; 1.00-1.26]), respectively, compared to diuretics; and (2) CCB showed a reduction in stroke (HR = 0.77; 0.66-0.89) and total mortality (HR = 0.94; 0.87-1.01) compared to the BB atenolol. Comparisons of two classes of antihypertensive medications with only one study showed that the risk of MI was higher with ARB valsartan versus CCB (HR = 1.19; 95% CI 1.02-1.38, p = 0.02). In contrast, losartan lowered the risk of a composite cardiovascular outcome compared to atenolol (HR = 0.87; 95% CI 0.77-0.98, p = 0.02). CONCLUSIONS In hypertensive subjects with excess weight, diuretics are more effective for preventing HF and stroke than CCB and ACEI, respectively. CCB are a good first-line choice for prevention of cardiovascular disease, except HF.
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Fugar S, Okoh AK, Dodoo C, Kolkailah AA, Okyne E, Özturk E, Solomon A, Yeboah NAA, Campagnoli T, Volgman A, Williams K. Effect of intensive and standard blood pressure control on cardiovascular outcomes based on body mass index: sub-analysis of the sprint trial. J Hum Hypertens 2020; 34:778-786. [PMID: 31911613 DOI: 10.1038/s41371-019-0296-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022]
Abstract
The present study is a sub-analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) that aimed to evaluate the role of intensive vs. standard hypertensive treatment on cardiovascular outcomes according to the body mass indices of trial participants. SPRINT participants were categorized according to their baseline BMI values into normal (BMI ≥ 18.5 to <25), overweight (BMI ≥ 25 to <30), and obese (BMI ≥ 30) groups. The primary cardiovascular outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular cause. Cox regression analysis was used to calculate hazard ratios for the study outcome in intensive and standard BP treatment among those with varying BMI. Among 9237 participants with, 1682, 3599, and 3956 were normal, overweight and obese, respectively. After a median follow-up of 3.26 years, the hazard ratios for the primary endpoint were 0.82 (95% CI 0.58, 1.16), 0.71 (95% CI 0.54, 0.94), and 0.76 (95% CI 0.59, 0.98) for the normal, overweight, and obese participants, respectively (P value for interaction 0.79). The effect of intensive versus standard SBP treatment for the other secondary endpoints and serious adverse events were all similar in participants of different BMI (all P-interaction > 0.05). In this sub-analysis of the SPRINT trial, intensive blood pressure control had a beneficial effect in reducing the primary endpoint and all-cause mortality irrespective of the participants' BMI.
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Affiliation(s)
- Setri Fugar
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA. .,Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA.
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Heart Health Center, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Christopher Dodoo
- Department of Biostatistics, Texas Health University Health Sciences Center, El Paso, TX, USA
| | - Ahmed A Kolkailah
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Edwin Okyne
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ebru Özturk
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alfred Solomon
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Tania Campagnoli
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Annabelle Volgman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kim Williams
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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Jayedi A, Shab-Bidar S. Nonlinear dose–response association between body mass index and risk of all-cause and cardiovascular mortality in patients with hypertension: A meta-analysis. Obes Res Clin Pract 2018; 12:16-28. [DOI: 10.1016/j.orcp.2018.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/07/2017] [Accepted: 01/08/2018] [Indexed: 01/15/2023]
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Mancusi C, Gerdts E, Losi MA, D'Amato A, Manzi MV, Canciello G, Trimarco V, De Luca N, de Simone G, Izzo R. Differential effect of obesity on prevalence of cardiac and carotid target organ damage in hypertension (the Campania Salute Network). Int J Cardiol 2017. [PMID: 28629621 DOI: 10.1016/j.ijcard.2017.06.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Whether increasing body mass index (BMI) is independently associated with parallel increased prevalence of hypertensive vascular and cardiac target organ damage (TOD) needs further clarification. METHODS We analyzed 8815 hypertensive patients without prevalent cardiovascular disease, participating in the Campania Salute Network, grouped into BMI classes (normal 20-24.9kg/m2, overweight 25-29.9kg/m2 and obese ≥30kg/m2). Vascular and cardiac TOD was defined as ultrasound plaque (intima-media thickness>1.5mm) in >1 of the common or internal carotid arteries and echocardiographic left ventricular (LV) hypertrophy (LVH) (LV mass/height2.7>47g/m2.7 in women and >50g/m2.7 in men), respectively. RESULTS A majority of patients were either overweight (49%) or obese (27%). In spite of more use of combination therapy, the obese group had higher blood pressure (BP) and prevalence of TOD. In multivariate logistic analyses, obesity was associated with a 6.9 times higher prevalence of LVH (95% confidence interval [CI] 5.84-8.17, p=0.0001), independent of significant associations with female sex, age, diabetes mellitus, office systolic BP, antihypertensive and antiplatelet treatment. In contrast, only a 17% increased prevalence of carotid plaques (OR=1.17; 95% CI 1.02-1.33, p=0.02) was found in obese patients independent of significant effect of male sex, older age and higher clinic systolic BP, an association that disappeared once effect of metabolic risk factors and related therapy was also considered. CONCLUSIONS In hypertensive patients participating in the Campania Salute Project, concomitant obesity was associated with a modestly increased prevalence of carotid plaques and a pronounced increase in prevalent LVH.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department for Clinical Science, University of Bergen, Bergen, Norway; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Eva Gerdts
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department for Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Andrea D'Amato
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Valentina Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Neurosciences, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
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Ying A, Arima H, Czernichow S, Woodward M, Huxley R, Turnbull F, Perkovic V, Neal B. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials. Lancet 2015; 385:867-74. [PMID: 25468168 DOI: 10.1016/s0140-6736(14)61171-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI). METHODS We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m(2), 25 to <30 kg/m(2), and ≥30 kg/m(2)) or a continuous variable. FINDINGS Analyses were based on 135,715 individuals from 22 trials who had 14,353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m(2) higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics. INTERPRETATION We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. FUNDING None.
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Weber MA, Jamerson K, Bakris GL, Weir MR, Zappe D, Zhang Y, Dahlof B, Velazquez EJ, Pitt B. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2013; 381:537-45. [PMID: 23219284 DOI: 10.1016/s0140-6736(12)61343-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In previous clinical trials in high-risk hypertensive patients, paradoxically higher cardiovascular event rates have been reported in patients of normal weight compared with obese individuals. As a prespecified analysis of the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, we aimed to investigate whether the type of hypertension treatment affects patients' cardiovascular outcomes according to their body size. METHODS On the basis of body-mass index (BMI), we divided the full ACCOMPLISH cohort into obese (BMI ≥30, n=5709), overweight (≥25 to <30, n=4157), or normal weight (<25, n=1616) categories. The ACCOMPLISH cohort had already been randomised to treatment with single-pill combinations of either benazepril and hydrochlorothiazide or benazepril and amlodipine. We compared event rates (adjusted for age, sex, diabetes, previous cardiovascular events, stroke, or chronic kidney disease) for the primary endpoint of cardiovascular death or non-fatal myocardial infarction or stroke. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170950. FINDINGS In patients allocated benazepril and hydrochlorothiazide, the primary endpoint (per 1000 patient-years) was 30·7 in normal weight, 21·9 in overweight, and 18·2 in obese patients (overall p=0·0034). However, in those allocated benazepril and amlodipine, the primary endpoint did not differ between the three BMI groups (18·2, 16·9, and 16·5, respectively; overall p=0·9721). In obese individuals, primary event rates were similar with both benazepril and hydrochlorothiazide and benazepril and amlodipine, but rates were significantly lower with benazepril and amlodipine in overweight patients (hazard ratio 0·76, 95% CI 0·59-0·94; p=0·0369) and those of normal weight (0·57, 0·39-0·84; p=0·0037). INTERPRETATION Hypertension in normal weight and obese patients might be mediated by different mechanisms. Thiazide-based treatment gives less cardiovascular protection in normal weight than obese patients, but amlodipine-based therapy is equally effective across BMI subgroups and thus offers superior cardiovascular protection in non-obese hypertension. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- Michael A Weber
- State University of New York, Downstate College of Medicine, Brooklyn, NY 11203, USA.
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Gerdts E, de Simone G, Lund BP, Okin PM, Wachtell K, Boman K, Nieminen MS, Dahlöf B, Devereux RB. Impact of overweight and obesity on cardiac benefit of antihypertensive treatment. Nutr Metab Cardiovasc Dis 2013; 23:122-129. [PMID: 21775111 DOI: 10.1016/j.numecd.2011.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 02/06/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Increased body mass index (BMI) has been associated with increased cardiovascular morbidity and mortality in hypertension. Less is known about the impact of BMI on improvement in left ventricular (LV) structure and function during antihypertensive treatment. METHODS AND RESULTS Annual BMI, echocardiograms and cardiovascular events were recorded in 875 hypertensive patients with LV hypertrophy during 4.8 years randomized treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy. Patients were grouped by baseline BMI into normal (n = 282), overweight (n = 405), obese (n = 150) and severely obese groups (n = 38) (BMI ≤24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2), respectively). At study end, residual LV hypertrophy was present in 54% of obese and 79% of severely obese patients compared to 31% of normal weight patients (both p < 0.01). In regression analyses, adjusting for initial LV mass/height(2.7), higher BMI predicted less LV hypertrophy reduction and more reduction in LV ejection fraction (both p < 0.05), independent of blood pressure reduction, diabetes and in-study weight change. During follow-up, 91 patients suffered cardiovascular death, myocardial infarction or stroke. In Cox regression analysis 1 kg/m(2) higher baseline BMI predicted a 5% higher rate of cardiovascular events and 10% higher cardiovascular mortality over 4.8 years (both p < 0.05). CONCLUSIONS In hypertensive patients in the LIFE study, increased BMI was associated with less reduction of LV hypertrophy and less improvement in LV systolic function which may contribute to the observed higher cardiovascular event rate of treated hypertensive patients.
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Affiliation(s)
- E Gerdts
- Institute of Medicine, University of Bergen, N-5021, Bergen, Norway.
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Affiliation(s)
- Gerard P. Aurigemma
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Giovanni de Simone
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Timothy P. Fitzgibbons
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
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Abstract
Increased blood pressure is considered an important component of metabolic syndrome. More than 85% of those with metabolic syndrome, even in the absence of diabetes, have elevated blood pressure (BP) or hypertension. The association of elevated BP with the metabolic syndrome is strongly linked through the causative pathway of obesity. Hypertension is the leading metabolic syndrome risk factor that predisposes to increased cardiovascular morbidity and mortality, and is additionally an important risk factor for development of chronic kidney disease in the presence of obesity, the metabolic syndrome, and microalbuminuria. Control of blood pressure in persons with the metabolic syndrome may prevent a significant number of coronary heart disease events. The primary modality of treatment is lifestyle intervention with reduced caloric intake and increased physical activity. Pharmacologic intervention is indicated on the basis of the severity of BP elevation, associated cardiovascular risk factors, and the presence of target organ damage.
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Affiliation(s)
- Stanley S Franklin
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, California
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Negri F, Sala C, Re A, Mancia G, Cuspidi C. Left ventricular geometry and diastolic function in the hypertensive heart: impact of age. Blood Press 2012; 22:1-8. [PMID: 22853636 DOI: 10.3109/08037051.2012.707307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIM The impact of aging on the relationship between left ventricular (LV) mass/geometry and diastolic function as assessed by updated echocardiographic methods, such as tissue Doppler, is poorly defined. We investigated this issue in a cohort of hypertensive patients. METHODS A total of 660 hypertensives (mean age 65 ± 13 years, 48% men) with preserved LV systolic function underwent a comprehensive echo-Doppler examination for routine clinical indications. For the present analysis, the subjects have been divided in two age groups (<65 or ≥65 years). RESULTS Overall, 61% of subjects fulfilled the criteria for LVH, 18% for left atrial (LA) enlargement and 11% for altered LV filling index. Concentric LV geometry was 1.4-fold higher in older hypertensives than in younger counterparts; also the prevalence of LA enlargement and altered LV filling was 2.0- and 1.9-fold higher in the former group, respectively. In older hypertensives, at variance from younger ones, neither LV mass nor relative wall thickness (RWT), a continuous index of LV geometry, were independently correlated to conventional as well as tissue Doppler LV diastolic indexes. CONCLUSIONS Our findings suggest the relationship between cardiac hypertrophy and diastolic function in hypertensive subjects is affected by aging-associated factors unrelated to the amount of LV mass as assessed by standard echocardiography.
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Affiliation(s)
- Francesca Negri
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy
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Salvetti G, Pucci A, Fierabracci P, Ceccarini G, Palagi C, Delle Donne MG, Di Bello V, Piaggi P, Vitti P, Salvetti A, Pinchera A, Santini F. Prevalence of Left Ventricular Hypertrophy and Determinants of Left Ventricular Mass in Obese Women. High Blood Press Cardiovasc Prev 2012; 19:33-9. [DOI: 10.2165/11593700-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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15
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Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications. Hypertens Res 2011; 35:4-16. [PMID: 22048570 DOI: 10.1038/hr.2011.173] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obesity markedly increases the risk of hypertension and cardiovascular disease, which may be related to activation of the sympathetic nervous system (SNS). Sympathetic overactivity directly and indirectly contributes to blood pressure (BP) elevation in obesity, including stimulation of the renin-angiotensin-aldosterone system (RAAS). The adipocyte-derived peptide leptin suppresses appetite, increases thermogenesis, but also raises SNS activity and BP. Obese individuals exhibit hyperleptinemia but are resistant to its appetite-suppressing actions. Interestingly, animal models of obesity exhibit preserved sympathoexcitatory and pressor actions of leptin, despite resistance to its anorexic and metabolic actions, suggesting selective leptin resistance. Disturbance of intracellular signaling at specific hypothalamic neural networks appears to underlie selective leptin resistance. Delineation of these pathways should lead to novel approaches to treatment. In the meantime, treatment of obesity-hypertension has relied on antihypertensive drugs. Although sympathetic blockade is mechanistically attractive in obesity-hypertension, in practice its effects are disappointing because of adverse metabolic effects and inferior outcomes. On the basis of subgroup analyses of obese patients in large randomized clinical trials, drugs such as diuretics and RAAS blockers appear superior in preventing cardiovascular events in obesity--hypertension. An underused alternative approach to obesity-hypertension is induction of weight loss, which reduces circulating leptin and insulin, partially reverses resistance to these hormones, decreases sympathetic activation and improves BP and other risk factors. Though weight loss induced by lifestyle is often modest and transient, carefully selected pharmacological weight loss therapies can produce substantial and sustained antihypertensive effects additive to lifestyle interventions.
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Cuspidi C, Giudici V, Lonati L, Sala C, Valerio C, Mancia G. Left ventricular hypertrophy detection and body mass index in essential hypertension. Blood Press 2010; 19:337-43. [DOI: 10.3109/08037051.2010.506029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kjeldsen SE, Devereux RB, Hille DA, Lyle PA, Dahlöf B, Julius S, Edelman JM, Snapinn SM, de Faire U, Fyhrquist F, Ibsen H, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H. Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention for Endpoint reduction in hypertension study. Blood Press 2010; 18:348-61. [PMID: 20001655 DOI: 10.3109/08037050903460590] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We assessed readily available patient characteristics, including albuminuria (not included in traditional cardiovascular risk scores), as predictors of cardiovascular events in hypertension with left ventricular hypertrophy (LVH) and developed risk algorithms/scores for outcomes. METHODS The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study compared effects of losartan-based versus atenolol-based therapy on cardiovascular events in 9193 patients with hypertension and LVH. Univariate and multivariate analyses identified baseline variables with significant impact on development of the primary composite endpoint (cardiovascular death, stroke and myocardial infarction) and its components. Multivariate analysis used a Cox regression model with stepwise selection process. Risk scores were developed from coefficients of risk factors from the multivariate analysis, validated internally using naïve and jack-knife procedures, checked for discrimination and calibration, and compared with Framingham coronary heart disease and other risk scores. RESULTS LIFE risk scores showed increasing endpoint rates with increasing quintile (first to fifth quintile, composite endpoint 2.8-26.7%, cardiovascular death 0.5-14.4%, stroke 1.2-11.3%, myocardial infarction 1.4-8.1%) and were confirmed with a jack-knife approach that adjusts for potentially optimistic bias. The Framingham coronary heart disease and other risk scores overestimated risk in lower risk patients and underestimated risk in higher risk patients, except for myocardial infarction. CONCLUSION A number of patient characteristics predicted cardiovascular events in patients with hypertension and LVH. Risk scores developed from these patient characteristics, including albuminuria, strongly predicted outcomes and may improve risk assessment of patients with hypertension and LVH and planning of clinical trials.
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Abächerli R, Zhou L, Schmid JJ, Kobza R, Niggli B, Frey F, Erne P. Correlation relationship assessment between left ventricular hypertrophy voltage criteria and body mass index in 41,806 Swiss conscripts. Ann Noninvasive Electrocardiol 2010; 14:381-8. [PMID: 19804516 DOI: 10.1111/j.1542-474x.2009.00330.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Electrocardiographic criteria for left ventricular hypertrophy (LVH) have been limited by low sensitivity at acceptable levels of specificity. A number of studies have demonstrated that body mass index (BMI) is associated with decreased sensitivity of ECG LVH classification in hypertensive patients. The objective of this study is to investigate the correlation relationship between LVH voltage criteria and BMI in Swiss conscripts. METHODS A database of 41,806 young Swiss people, who underwent compulsory conscription for the Swiss Army, was compiled. Along with other medical data, an ECG was taken. Statistical analyses, such as linear regression and calculation of correlation coefficient, were carried out between LVH voltage criteria and BMI. RESULTS The mean age in the studied population was 19.2 +/- 1.1 years with a median age of 19 years (range from 17 to 38 years). We found an overweight prevalence of 25.1%. The results showed that body habitus had significant association with Sokolow-Lyon voltages. A mean decrease of 13%, 5%, 19%, 14%, and 12% for the five studied Sokolow-Lyon indexes were found between normal range subjects (18.5 < or = BMI < 25) and obese subjects (25< or = BMI). CONCLUSIONS Our study confirms the hypothesis that people with higher BMI, a growing section of the population, have lower ECG amplitudes. Therefore, the Sokolow-Lyon voltage criteria may underestimate the presence of LVH for subjects with higher BMI, which is not the case for the Cornell voltage. Our analysis suggests that computerized electrocardiography for the diagnosis of left ventricular hypertrophy based on Sokolow-Lyon voltages should incorporate the BMI factor.
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de Simone G, Okin PM, Gerdts E, Olsen MH, Wachtell K, Hille DA, Dahlöf B, Kjeldsen SE, Devereux RB. Clustered metabolic abnormalities blunt regression of hypertensive left ventricular hypertrophy: the LIFE study. Nutr Metab Cardiovasc Dis 2009; 19:634-640. [PMID: 19361968 DOI: 10.1016/j.numecd.2008.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/30/2008] [Accepted: 12/18/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome predicted outcome in the LIFE study, independently of single risk markers, including obesity, diabetes and baseline ECG left ventricular hypertrophy (LVH). We examined whether clusters of two or more metabolic abnormalities (MetAb, including obesity, high plasma glucose without diabetes, low HDL-cholesterol) in addition to hypertension were associated to levels of ECG LVH reduction comparable to that obtained in hypertensive subjects without or with only one additional metabolic abnormality (no-MetAb). METHODS AND RESULTS We studied 5558 non-diabetic participants without MetAb (2920 women) and 1235 with MetAb (751 women) from the LIFE-study cohort. MetAb was defined by reported LIFE criteria, using partition values from the ATPIII recommendations. Time-trends of Cornell voltage-duration product (CP) over 5 years was assessed using a quadratic polynomial contrast, adjusting for age, sex, prevalent cardiovascular disease and treatment arm (losartan or atenolol). At baseline, despite similar blood pressures, CP was greater in the presence than in the absence of MetAb (p<0.0001). During follow-up, despite similar reduction of blood pressure, CP decreased less in patients with than in those without MetAb, even after adjustment for the respective baseline values (both p<0.002). Losartan was more effective than atenolol in reducing CP independently of MetAb. CONCLUSIONS Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome are related to greater initial ECG LVH in hypertensive patients with value of blood pressure similar to individuals without metabolic abnormalities, and are associated with less reduction of ECG LVH during antihypertensive therapy, potentially contributing to the reported adverse prognosis of metabolic syndrome.
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Affiliation(s)
- G de Simone
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy.
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Abstract
A prediabétesz a diabéteszt megelőző állapot megnevezése, használata abban az esetben ajánlott, ha a vércukorérték eltér az élettani értéktől, de nem éri el a cukorbetegségre jellemző mértéket. A prediabéteszt gyakran visceralis obesitas, a glükóz- és lipidmetabolizmus, valamint a vérnyomás változásának különböző kombinációjával lehet jellemezni. A prediabéteszhez társuló hypertonia kezelése során az életmódváltás még nagyobb jelentőségű, mint az egyéb hypertoniák esetén. A gyógyszeres kezelés kiválasztása során a metabolikusan neutrális antihipertenzív kezelés alapvető jelentőségű. A prediabéteszhez társuló hypertonia népegészségügyi jelentőségét az elhízás járványszerű terjedése jelenti. A felnőtt lakosság több mint 25%-át érintő prediabéteszes hypertonia társulása esetén mind a betegek és az orvosok, mind a finanszírozók számára együttesen kell megtalálni az optimális megoldást.
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Affiliation(s)
- István Barna
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest Korányi S. u. 2/A 1083
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de Simone G, D'Addeo G. Sibutramine: balancing weight loss benefit and possible cardiovascular risk. Nutr Metab Cardiovasc Dis 2008; 18:337-341. [PMID: 18502626 DOI: 10.1016/j.numecd.2008.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 03/19/2008] [Accepted: 03/21/2008] [Indexed: 11/28/2022]
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Genovesi S, Pieruzzi F, Giussani M, Tono V, Stella A, Porta A, Pagani M, Lucini D. Analysis of Heart Period and Arterial Pressure Variability in Childhood Hypertension. Hypertension 2008; 51:1289-94. [DOI: 10.1161/hypertensionaha.107.109389] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simonetta Genovesi
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Federico Pieruzzi
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Marco Giussani
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Valentina Tono
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Andrea Stella
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Alberto Porta
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Massimo Pagani
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
| | - Daniela Lucini
- From the Clinica Nefrologica, S. Gerardo Hospital (S.G., F.P., V.T., A.S.), and Dipartimento di Medicina Clinica e Prevenzione (S.G., F.P., A.S.), University of Milano Bicocca, Milan, Italy; Federazione Italiana Medici Pediatri (M.G.), Milan, Italy; Department of Technologies for Health, Galeazzi Orthopaedic Institute (A.P.), and Department of Clinical Sciences “L. Sacco” (M.P., D.L.), University of Milano, Milan, Italy
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Biaggioni I. Should We Target the Sympathetic Nervous System in the Treatment of Obesity-Associated Hypertension? Hypertension 2008; 51:168-71. [DOI: 10.1161/hypertensionaha.107.090514] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Italo Biaggioni
- From the Department of Medicine and Pharmacology, Division of Clinical Pharmacology, and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, Tenn
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Schindler C, Bramlage P, Thoenes M, Bramlage C, Kirch W. Cardiovascular risk in obese hypertensive patients taking various antihypertensive drugs. Clin Drug Investig 2007; 27:707-17. [PMID: 17803346 DOI: 10.2165/00044011-200727100-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Obese patients often present with multiple co-morbid conditions, including hypertension, which are associated with an increased cardiovascular (CV) risk. We aimed to assess the risk factor profiles of primary-care patients with obesity and hypertension in order to estimate their fatal CV risk in total and according to use of various antihypertensive drugs. METHODS This was a post-hoc analysis of data from a recent observational study involving 72 479 hypertensive patients in 6989 general practices across Germany. Almost all patients (92.3%) were overweight or obese. The 10-year risk for fatal CV events was determined using the SCORE algorithm as published by the European Society of Cardiology. RESULTS Overall, 68% of patients had one or more diseases or conditions in addition to obesity and hypertension. The 10-year fatal CV risk was lowest in the youngest normal weight group (1.7%), and highest in the oldest obese group (26%). Men had a higher risk than women, and risk rose with increasing age. The risk factor profile appeared to differ between patients treated with various antihypertensive classes, e.g. angiotensin II type 1 receptor antagonists were associated with lower risk, diuretics with higher risk. There were moderate differences within drug classes. CONCLUSIONS According to this cross-sectional data, fatal CV risk is strongly increased in obese patients, especially in men and in older age groups. While there were strong associations between use of certain drugs and metabolic risk markers and overall fatal CV risk, the causality of these associations remains to be determined.
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Palmieri V, Roman MJ, Bella JN, Liu JE, Best LG, Lee ET, Howard BV, Devereux RB. Prognostic implications of relations of left ventricular systolic dysfunction with body composition and myocardial energy expenditure: the Strong Heart Study. J Am Soc Echocardiogr 2007; 21:66-71. [PMID: 17628407 PMCID: PMC4294423 DOI: 10.1016/j.echo.2007.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We sought to investigate prognostic implications of the relationships of estimated left ventricular (LV) myocardial energy expenditure (MEE) with LV systolic dysfunction, body composition, and inflammation in a population-based sample of adults without overt congestive heart failure. METHODS Echocardiography was used to assess LV ejection fraction (EF) and MEE. Body composition was evaluated by bioelectric impedance. Dietary recall was used to assess 24-hour calorie intake. Participants in the Strong Heart Study without prior congestive heart failure and with all needed data available (n = 3087) were divided based on LV EF (>55%, 54%-45%, or <45%). RESULTS Participants with EF less than 45% were older and they had lower body mass index, adipose mass, fat-free mass, and 24-hour calorie intake than participants with normal EF (>/=55%), and had greatest reductions of body mass index and physical activity in a time interval of 3.5 years, on average, elapsed between an initial clinical assessment and the evaluation at the time of the echocardiographic examination (P < .01). Lower EF was associated with male sex, hypertension, diabetes, coronary heart disease, and higher fibrinogen, C-reactive protein, and plasma creatinine levels (all P < .01). MEE was higher with lower EF (all P < .001). In Cox regression models, during approximately 8 years of observation, MEE comprised between 97 and 123 cal/min and MEE greater than 123 cal/min were associated with 2.5-fold and additional 3.3-fold higher rates of cardiac death, respectively, compared with MEE less than 97 cal/min, independently of EF, body composition, and other covariates. However, lower adipose mass predicted increased risk of cardiac death independent of MEE and EF. CONCLUSION In a population-based sample of adults including ambulatory individuals with depressed LV systolic function but without overt congestive heart failure, depressed EF was associated independently with higher MEE, lower adipose mass, and higher fibrinogen. However, increased MEE and lower adipose mass predicted cardiac death independently of EF and other covariates.
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Affiliation(s)
- Vittorio Palmieri
- Weill Medical College of Cornell University, New York, New York 10021, USA
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de Simone G, Olsen MH, Wachtell K, Hille DA, Dahlöf B, Ibsen H, Kjeldsen SE, Lyle PA, Devereux RB. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens 2007; 21:625-32. [PMID: 17476291 DOI: 10.1038/sj.jhh.1002203] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The relation of metabolic syndrome (MetS) with cardiovascular outcome may be less evident when preclinical cardiovascular disease is present. We explored, in a post hoc analysis, whether MetS predicts cardiovascular events in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. MetS was defined by >or=2 risk factors plus hypertension: body mass index >or=30 kg/m(2), high-density lipoprotein (HDL)-cholesterol <1.0/1.3 mmol/l (<40/50 mg/dl) (men/women), glucose >or=6.1 mmol/l (>or=110 mg/dl) fasting or >or=7.8 mmol/l (>or=140 mg/dl) nonfasting or diabetes. Cardiovascular death and the primary composite end point (CEP) of cardiovascular death, stroke and myocardial infarction were examined. In MetS (1,591 (19.3%) of 8,243 eligible patients), low HDL-cholesterol (72%), obesity (77%) and impaired glucose (73%) were similarly prevalent, with higher blood pressure, serum creatinine and Cornell product, but lower Sokolow-Lyon voltage (all P<0.001). After adjusting for baseline covariates, hazard ratios for CEPs and cardiovascular death (4.8+/-1.1 years follow-up) were 1.47 (95% confidence interval (CI), 1.27-1.71)- and 1.73 (95% CI, 1.38-2.17)-fold higher with MetS (both P<0.0001), and were only marginally reduced when further adjusted for diabetes, obesity, low HDL-cholesterol, non-HDL-cholesterol, pulse pressure and in-treatment systolic blood pressure and heart rate. Thus, MetS is associated with increased cardiovascular events in hypertensive patients with ECG-LVH, independently of single cardiovascular risk factors.
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Affiliation(s)
- G de Simone
- The Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
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Uretsky S, Bangalore S, Messerli FH. Obesity and mortality: a poorly understood relationship. Am J Cardiol 2007; 99:876-7. [PMID: 17350387 DOI: 10.1016/j.amjcard.2006.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 10/30/2006] [Accepted: 10/30/2006] [Indexed: 11/20/2022]
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Poirier P, Eckel RH. Cardiovascular Complications of Obesity and the Metabolic Syndrome. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chrostowska M, Szczech R, Narkiewicz K. Antihypertensive therapy in the obese hypertensive patient. Curr Opin Nephrol Hypertens 2006; 15:487-92. [PMID: 16914960 DOI: 10.1097/01.mnh.0000242173.14082.dc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Obesity is becoming recognized as one of the most important risk factors for the development of hypertension. The purpose of the review is to examine the latest evidence linking hypertension to obesity, summarize the benefits of weight reduction and present results of recent clinical trials evaluating antihypertensive treatment in obese patients. RECENT FINDINGS Adipose tissue has been directly implicated in the pathogenesis of hypertension. Obesity has been associated with unequivocal changes in cardiovascular structure and function. In contrast to earlier studies, several recent trials included overweight and obese patients. Evidence of potential benefits of angiotensin blockade in the management of obesity hypertension is growing. Hypertension management in obese individuals is complicated by poorer response to treatment, and the increased need for multiple medications. It is important to consider obstructive sleep apnea in obese patients with resistant hypertension. SUMMARY Several new lines of evidence suggest that drugs blocking the renin-angiotensin system might be considered as first-line therapy of obesity-related hypertension. Recent progress in understanding the mechanisms of obesity and associated disease processes might lead to development of novel therapeutic strategies. Further research in this area holds great promise for prevention of obesity-related cardiovascular disease.
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Affiliation(s)
- Marzena Chrostowska
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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Abstract
Cardiovascular risk in a patient with obesity hypertension increases with the extent of risk factor clustering. It is therefore important to determine the global risk of a patient with hypertension rather than to focus solely on blood pressure. Every hypertensive should be screened for other than blood pressure risk factors, target organ damage and concomitant diseases or accompanying clinical conditions. Assessment of blood pressure and target organ damage might be more difficult in obese hypertensives than in normal-weight patients. Intensive lifestyle interventions can reduce weight, and decrease blood pressure and cardiovascular risk in obese hypertensive patients. Current guidelines do not provide specific recommendation for pharmacological management of the hypertensive patients with obesity. Recent trials have consistently shown that therapy involving beta-blockers and diuretics may induce more new-onset diabetes compared with other combination therapies. Several lines of evidence suggest that anti-hypertensive agents that block the renin-angiotensin system may be especially beneficial in treating obese hypertensive patients. Hypertension management in obese individuals is complicated by poorer response to treatment, and the increased need for multiple medications. It is important to consider obstructive sleep apnoea in the differential diagnosis of hypertensive patients who respond poorly to combination therapy with anti-hypertensive medications.
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Affiliation(s)
- K Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdañsk, Debinki 7c, 80-952 Gdañsk, Poland.
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Sharma AM. Clinical trials report. Curr Hypertens Rep 2006. [DOI: 10.1007/s11906-006-0034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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