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Desbiens LC, Nadeau-Fredette AC, Madore F, Agharazii M, Goupil R. Impact of Successive Office Blood Pressure Measurements During a Single Visit on Cardiovascular Risk Prediction: Analysis of CARTaGENE. Hypertension 2023; 80:2209-2217. [PMID: 37615094 DOI: 10.1161/hypertensionaha.123.21510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Multiple office blood pressure (BP) readings correlate more closely with ambulatory BP than single readings. Whether they are associated with long-term outcomes and improve cardiovascular risk prediction is unknown. Our objective was to assess the long-term impact of multiple office BP readings. METHODS We used data from CARTaGENE, a population-based survey comprising individuals aged 40 to 70 years. Three BP readings (BP1, BP2, and BP3) at 2-minute intervals were obtained using a semiautomated device. They were averaged to generate BP1-2, BP2-3, and BP1-2-3 for systolic BP (SBP) and diastolic BP. Cardiovascular events (major adverse cardiovascular event [MACE]: cardiovascular death, stroke, and myocardial infarction) during a 10-year follow-up were recorded. Associations with MACE were obtained using adjusted Cox models. Predictive performance was assessed with 10-year atherosclerotic cardiovascular disease scores and their associated C statistics. RESULTS In the 17 966 eligible individuals, 2378 experienced a MACE during follow-up. Crude SBP values ranged from 122.5 to 126.5 mm Hg. SBP3 had the strongest association with MACE incidence (hazard ratio, 1.10 [1.05-1.15] per SD) and SBP1 the weakest (hazard ratio, 1.06 [1.01-1.10]). All models including SBP1 (SBP1, SBP1-2, and SBP1-2-3) were underperformed. At a given SBP value, the excess MACE risk conferred by SBP3 was 2× greater than SBP1. In atherosclerotic cardiovascular disease scores, SBP3 yielded the highest C statistic, significantly higher than most other SBP measures. In contrast to SBP, all diastolic BP readings yielded similar results. CONCLUSIONS Cardiovascular risk prediction is improved by successive office SBP values, especially when the first reading is discarded. These findings reinforce the necessity of using multiple office BP readings.
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Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital Maisonneuve-Rosemont, Montreal, Canada (L.-C.D., A.-C.N.-F.)
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital Maisonneuve-Rosemont, Montreal, Canada (L.-C.D., A.-C.N.-F.)
| | - François Madore
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital du Sacré-Coeur de Montréal Research Center, Canada (F.M., R.G.)
| | - Mohsen Agharazii
- Department of Medicine, Université Laval, Quebec City, Canada (M.A.)
- CHU de Quebec - Université Laval, Quebec City, Canada (M.A.)
| | - Rémi Goupil
- Department of Medicine, Université de Montréal, Canada (L.-C.D., A.-C.N.-F., F.M., R.G.)
- Hopital du Sacré-Coeur de Montréal Research Center, Canada (F.M., R.G.)
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Kwon CH, Lee HY, Lee JH, Kim M, Sung KC. Optimal office blood pressure levels in younger (<50 years old) Korean hypertensive patients: a nationwide cohort study in South Korea. J Hypertens 2022; 40:2449-2458. [PMID: 35983871 DOI: 10.1097/hjh.0000000000003277] [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: 11/27/2022]
Abstract
BACKGROUND It is unclear what thresholds and targets of office blood pressure (BP) for treatment are appropriate in younger (<50 years old) hypertensive patients. Thus, the aim of this study was to evaluate associations of office BP levels with major cardiovascular events (MACEs) in these patients. METHODS Using the Korean National Health Insurance Service database, data of 98 192 younger (<50 years old) hypertensive patients having BP measurements available without any history of cardiovascular events from 2002 to 2011 were extracted. This cohort study evaluated associations of BP levels (<120/<70, 120-129/70-79, 130-139/80-89, 140-149/90-99, and ≥150/≥100 mmHg) with MACEs. The study outcome was MACE, a composite of cardiovascular death, myocardial infarction, stroke, and heart failure. RESULTS In all patients, those treated with antihypertensive medication accounted for 34.7% and those who achieved BP less than 130/80 mmHg accounted for 35.5%. During a mean follow-up of 9.5 ± 2.8 years, 4918 (5%) MACEs were documented in our cohort. The risk of MACE was the lowest [adjusted hazard ratio: 0.77, 95% confidence interval (CI) 0.66-0.89] for those with BP level of less than 120/less than 70 mmHg. It was the highest (hazard ratio 2.0, 95% CI 1.83-2.19) for those with BP level of at least 150/at least 100 mmHg in comparison with those with BP level of 130-139/80-89 mmHg. These results were consistent for all age groups (20-29, 30-39, and 40-49 years) and both sexes. CONCLUSION Elevated BP level from less than 120 mmHg/less than 70 mmHg is significantly correlated with an increased risk of MACE in younger (<50 years old) Korean hypertensive patients. Lowering BP to less than 120 mmHg/less than 70 mmHg is needed for these patients.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals? J Geriatr Cardiol 2022; 19:254-264. [PMID: 35572223 PMCID: PMC9068589 DOI: 10.11909/j.issn.1671-5411.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047-3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161-1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.
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Kleipool EEF, Rozendaal ES, Mahadew SKN, Kramer MHH, van den Born BJH, Serné EH, Peters MJL, Muller M. The value of ambulatory blood pressure measurement to detect masked diastolic hypotension in older patients treated for hypertension. Age Ageing 2021; 50:1229-1235. [PMID: 33454734 DOI: 10.1093/ageing/afaa287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have 'masked diastolic hypotension'. DESIGN cross-sectional, retrospective cohort study. SETTING academic hospital. SUBJECTS 848 patients treated for hypertension who received ambulatory blood pressure monitoring (ABPM). METHODS cut-off value between on- and off-target systolic blood pressure (SBP): 140 mmHg. Cut-off for low office and/or ambulatory DBP: DBP ≤ 70 mmHg. 'Masked diastolic hypotension' was defined as office DBP > 70 mmHg and mean ambulatory DBP ≤ 70 mmHg. RESULTS mean age of the sample was 60 ± 13 years, 50% was female, 37% had diabetes, 42% preexisting cardiovascular disease (CVD), mean office blood pressure (BP) was 134/79 mmHg. In all patients (n = 848), low office DBP was present in n = 84(10%), while n = 183(22%) had low ambulatory DBP. In all patients with normal-to-high office DBP (n = 764), n = 122(16%) had 'masked diastolic hypotension'. In this group, ambulatory DBP was 14-19 mmHg lower than office DBP. Patients with low ambulatory DBP were older, had more (cardiovascular) comorbidities, and used more (antihypertensive) drugs. Antihypertensive drugs were lowered or discontinued in 30% of all patients with 'masked diastolic hypotension' due to side effects. CONCLUSIONS 'masked diastolic hypotension' is common among patients treated for hypertension, particularly in older patients with CVD (e.g. coronary artery disease, diabetes), patient groups in which the European Society of Cardiology/Hypertension guideline advises to prevent low DBP. Although it remains to be examined at which BP levels the harms of low DBP outweigh the benefits of lowering SBP, our observations are aimed to increase awareness among physicians.
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Affiliation(s)
- Emma E F Kleipool
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Eva S Rozendaal
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Shaya K N Mahadew
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Mike J L Peters
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Majon Muller
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
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Predictive value of achieved blood pressure for cardiac events in the long-term follow-up of heart transplant recipients. Blood Press Monit 2018; 24:7-11. [PMID: 30431482 DOI: 10.1097/mbp.0000000000000353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A low diastolic blood pressure (DBP) is associated with increased cardiovascular events in patients with coronary artery disease or chronic kidney disease. AIM The aim of this study was to assess the association of blood pressure with cardiac events during the long-term follow-up of heart transplant recipients. PATIENTS AND METHODS In this prospective cohort study, we performed ambulatory blood pressure monitoring and home blood pressure monitoring in 76 transplant heart recipients 13.5±6.6 years after transplantation. The patients were followed for 54±17 months after blood pressure monitoring. RESULTS Twenty-one patients had a cardiac event (cardiac death, acute coronary event, coronary revascularization procedure, and hospitalization for heart failure) during the follow-up. In the Kaplan-Meier survival analysis, we found that a DBP below the median value (<81 mmHg) was associated significantly with cardiac events (log-rank: P=0.01). In a multivariate model, plasma creatinine and left ventricular ejection fraction (LVEF), but not DBP, were associated significantly with cardiac events. Low DBP was associated significantly with LVEF less than 55% (P=0.004). CONCLUSION A DBP below the median value predicts cardiac events during the long-term follow-up of heart transplant recipients, but is not an independent predictor. The association between low DBP and low LVEF explains at least in part the predictive value of low DBP.
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Navar AM, Gallup DS, Lokhnygina Y, Green JB, McGuire DK, Armstrong PW, Buse JB, Engel SS, Lachin JM, Standl E, Van de Werf F, Holman RR, Peterson ED. Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin. Hypertension 2017; 70:907-914. [PMID: 28847886 PMCID: PMC5638706 DOI: 10.1161/hypertensionaha.117.09482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/19/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023]
Abstract
Systolic blood pressure (SBP) treatment targets for adults with diabetes mellitus remain unclear. SBP levels among 12 275 adults with diabetes mellitus, prior cardiovascular disease, and treated hypertension were evaluated in the TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) randomized trial of sitagliptin versus placebo. The association between baseline SBP and recurrent cardiovascular disease was evaluated using multivariable Cox proportional hazards modeling with restricted cubic splines, adjusting for clinical characteristics. Kaplan-Meier curves by baseline SBP were created to assess time to cardiovascular disease and 2 potential hypotension-related adverse events: worsening kidney function and fractures. The association between time-updated SBP and outcomes was examined using multivariable Cox proportional hazards models. Overall, 42.2% of adults with diabetes mellitus, cardiovascular disease, and hypertension had an SBP ≥140 mm Hg. The association between SBP and cardiovascular disease risk was U shaped, with a nadir ≈130 mm Hg. When the analysis was restricted to those with baseline SBP of 110 to 150 mm Hg, the adjusted association between SBP and cardiovascular disease risk was flat (hazard ratio per 10-mm Hg increase, 0.96; 95% confidence interval, 0.91-1.02). There was no association between SBP and risk of fracture. Above 150 mm Hg, higher SBP was associated with increasing risk of worsening kidney function (hazard ratio per 10-mm Hg increase, 1.10; 95% confidence interval, 1.02-1.18). Many patients with diabetes mellitus have uncontrolled hypertension. The U-shaped association between SBP and cardiovascular disease events was largely driven by those with very high or low SBP, with no difference in cardiovascular disease risk between 110 and 150 mm Hg. Lower SBP was not associated with higher risks of fractures or worsening kidney function.
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Affiliation(s)
- Ann Marie Navar
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.).
| | - Dianne S Gallup
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Yuliya Lokhnygina
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Jennifer B Green
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Darren K McGuire
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Paul W Armstrong
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - John B Buse
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Samuel S Engel
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - John M Lachin
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Eberhard Standl
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Frans Van de Werf
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Rury R Holman
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
| | - Eric D Peterson
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., D.S.G., Y.L., J.B.G., E.D.P.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.); Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill (J.B.B.); Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ (S.S.E.); The George Washington University Biostatistics Center, Rockville, MD (J.M.L.); Munich Diabetes Research Institute, Helmholtz Center, Germany (E.S.); Department of Cardiovascular Sciences, University of Leuven, Belgium (F.V.d.W.); and Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, United Kingdom (R.R.H.)
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Svensson MK, Afghahi H, Franzen S, Björk S, Gudbjörnsdottir S, Svensson AM, Eliasson B. Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register. Diab Vasc Dis Res 2017; 14:226-235. [PMID: 28467201 DOI: 10.1177/1479164116683637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. AIMS To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. PATIENTS AND METHODS A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. RESULTS A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13-1.40 and hazard ratio: 1.26, 1.17-1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32). CONCLUSION Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.
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Affiliation(s)
- Maria K Svensson
- 1 Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Henri Afghahi
- 2 Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Stefan Franzen
- 3 Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Staffan Björk
- 3 Centre of Registers Västra Götaland, Gothenburg, Sweden
| | | | | | - Björn Eliasson
- 4 Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Calcagnini G, Mattei E, Quaglione R, De Ruvo E, Biancalana G, Pavone G, Gargaro A, Calo L, Ammirati F, Censi F. A telemonitoring platform for the investigation of blood pressure profiles in pacemaker patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:211-214. [PMID: 28268314 DOI: 10.1109/embc.2016.7590677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rate responsive pacemakers (PM) use different strategies to adapt the patient paced rate, with the aim of having the best hemodynamic performance in response to internal or external conditions. Closed-loop stimulation (CLS) uses intracardiac impedance as a sensor principle. The evaluation of impact of different pacing modalities and technologies on the blood pressure (BP) profiles is mainly investigated in short-term laboratory settings, mainly due to the need of reliable daily-based BP values. The impact of CLS pacing on systemic blood pressure (BP) has been studied on short term basis, but data on long term effects are scarse. This study present a telemedicine platform designed for evaluating the effect of the rate responsive technology on daily systolic and diastolic BP data. BP and pacemaker data were collected daily from fourteen patients during a 3 month period. The total number of monitoring days was 1277 (91 day/patient), for a total number of 4455 BP measures. On average 3.5 measure/day/patient were received). The analysis of the BP data showed that CLS pacing results in diastolic pressure closer to the normal values than accelerometer-based pacing, which were associated to lower diastolic pressures.
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Moise N, Huang C, Rodgers A, Kohli-Lynch CN, Tzong KY, Coxson PG, Bibbins-Domingo K, Goldman L, Moran AE. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model. Hypertension 2016; 68:88-96. [PMID: 27181996 PMCID: PMC5027989 DOI: 10.1161/hypertensionaha.115.06814] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/15/2016] [Indexed: 11/16/2022]
Abstract
The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled.
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Affiliation(s)
- Nathalie Moise
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Chen Huang
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Anthony Rodgers
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Ciaran N Kohli-Lynch
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Keane Y Tzong
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Pamela G Coxson
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Kirsten Bibbins-Domingo
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Lee Goldman
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.)
| | - Andrew E Moran
- From the Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY (N.M., C.N.K.-L., K.Y.T., A.E.M.); Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China (C.H.); Department of Epidemiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medicine Science, Beijing, China (C.H.); George Institute for Global Health, Sydney, New South Wales, Australia (A.R.); Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences and College of Social Sciences, University of Glasgow, Glasgow, United Kingdom (C.N.K.-L.); Division of General Medicine, Department of Medicine, University of California at San Francisco (P.G.C., K.B.-D); and College of Physicians and Surgeons, Columbia University, New York, NY (L.G., A.E.M.).
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Affiliation(s)
- Rhian M. Touyz
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Anna F. Dominiczak
- From the Institute of Cardiovascular and Medical Sciences, British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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Abstract
PURPOSE OF REVIEW Hypertension is the eminent risk factor for renal and cardiovascular disease (CVD). Its management is a topic of public health priority. As either too high or too low blood pressure (BP) levels can have detrimental effects on health, optimal targets for BP continue to be controversial. The current manuscript will review relevant data published over the last year that add to this topic of controversy. RECENT FINDINGS Recent studies confirm increased CVD-related risk with increasing SBP levels more than 140 mmHg among patients with hypertension and CVD as well as those over the age of 60 years. A SBP target less than 140 mmHg conveyed lessened risk of CVD-related events. There is some evidence suggesting that the ideal BP target lies between 120 and 140 mmHg. SUMMARY Recent data support a target SBP of less than 140 mmHg among patients with hypertension or CVD, and achievement of this target might benefit those older than 60 years of age as well. Treating to SBPs below 120 mmHg may not result in further benefit. Data from randomized controlled trials specifically addressing the question whether lower BPs are associated with better outcomes are needed to further define ideal BP-target goals.
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Argulian E, Grossman E, Messerli FH. Misconceptions and facts about treating hypertension. Am J Med 2015; 128:450-5. [PMID: 25486449 DOI: 10.1016/j.amjmed.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
Hypertension is a powerful risk factor strongly linked to adverse cardiovascular outcomes. Because of its high prevalence, health care providers at many levels are involved in treating hypertension. Distinct progress has been made in improving the rates of hypertension awareness and treatment over years, but the overall control of hypertension remains inadequate. Several recent guidelines from different sources have been put forward in an attempt to bridge the gap between existing evidence and clinical practice. Despite this effort, several misconceptions about treating hypertensive cardiovascular disease continue to persist among clinicians. This review highlights some of the misconceptions regarding antihypertensive therapy.
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Affiliation(s)
- Edgar Argulian
- Mt Sinai St Luke's and Roosevelt Hospitals, New York, NY.
| | - Ehud Grossman
- The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Rifkin DE, Kiernan M, Sarnak MJ. Hitting the mark: blood pressure targets and agents in those with prevalent cardiovascular disease and heart failure. Adv Chronic Kidney Dis 2015; 22:140-4. [PMID: 25704351 DOI: 10.1053/j.ackd.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 01/13/2023]
Abstract
Blood pressure (BP) is one of the key modifiable risk factors for cardiovascular disease (CVD) both in primary and secondary prevention of disease. In this review, we discuss BP treatment in prevalent CVD and heart failure. Evidence for specific agents based on their neurohormonal effects and evidence for target values for systolic or diastolic BP are covered. The potential adverse effects of overtreatment of BP are also discussed. BP targets for those with CVD should generally be less than 140/90 mm Hg but require individualization of therapy for any further reduction based on the clinical setting.
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Muller M, Jochemsen HM, Visseren FLJ, Grool AM, Launer LJ, van der Graaf Y, Geerlings MI. Low blood pressure and antihypertensive treatment are independently associated with physical and mental health status in patients with arterial disease: the SMART study. J Intern Med 2013; 274:241-51. [PMID: 23527863 PMCID: PMC3750200 DOI: 10.1111/joim.12069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the independent effects of antihypertensive treatment and blood pressure (BP) levels on physical and mental health status in patients with arterial disease. DESIGN AND SETTING Cross-sectional analyses were conducted within the single-centre Secondary Manifestations of ARTerial disease (SMART) study, in a hospital care setting. SUBJECTS A total of 5877 patients (mean age 57 years) with symptomatic and asymptomatic arterial disease underwent standardized vascular screening. MAIN OUTCOME MEASURE The primary outcome was self-rated physical and mental health assessed using the 36-item short-form health survey. RESULTS In the total population, antihypertensive drug use and increased intensity of antihypertensive treatment were associated with poorer health status independent of important confounders including BP levels; adjusted mean differences [95% confidence interval (CI)] in physical and mental health between n = 0 and n ≥ 3 antihypertensives were -1.2 (-2.1; -0.3) and -3.5 (-4.4; -2.6), respectively. Furthermore, both lower systolic and lower diastolic BP levels were related to poorer physical and mental health status independent of antihypertensive treatment. Mean differences (95% CI) in physical and mental health status per SD decrease in systolic BP were -0.56 (-0.84; -0.27) and -0.32 (-0.61; -0.03) and per SD decrease in diastolic BP were -0.50 (-0.78; -0.23) and -0.08 (-0.36; 0.20), respectively. The association between low BP and poor health status was particularly present in patients with coronary artery disease. CONCLUSIONS In a population of patients with asymptomatic and symptomatic arterial disease, antihypertensive treatment and lower BP levels are independently associated with poorer self-rated physical and mental health. These findings suggest that different underlying mechanisms may explain these independent associations.
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Affiliation(s)
- M Muller
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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15
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Hipertensão arterial, doença coronária e acidente vascular cerebral. A curva em J deve preocupar-nos? Rev Port Cardiol 2013; 32:139-44. [DOI: 10.1016/j.repc.2012.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 06/18/2012] [Indexed: 12/31/2022] Open
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Braz Nogueira J. Hypertension, coronary heart disease and stroke: Should the blood pressure J-curve be a concern? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
The blood pressure (BP) J-curve debate started in 1979, and we still cannot definitively answer all the questions. However, available studies of antihypertensive treatment provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main outcomes in the general population of hypertensive patients, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and elderly patients. However, further studies are still necessary in order to clarify this issue. This is connected to the fact that most available studies were observational, and randomized trials did not have or lost their statistical power and were inconclusive. Perhaps only the Systolic Blood Pressure Intervention Trial (SPRINT) and Optimal Blood Pressure and Cholesterol Targets for Preventing Recurrent Stroke in Hypertensives (ESH-CHL-SHOT) will be able to finally answer all the questions. According to the current state of knowledge, it seems reasonable to suggest lowering BP to values within the 130-139/80-85 mmHg range, possibly close to the lower values in this range, in all hypertensive patients and to be very careful with further BP level reductions, especially in high-risk hypertensive patients.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland.
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