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Thomas Manapurathe D, Moxon JV, Krishna SM, Quigley F, Bourke M, Bourke B, Jones RE, Golledge J. Cohort Study Examining the Association of Optimal Blood Pressure Control at Entry With Infrarenal Abdominal Aortic Aneurysm Growth. Front Cardiovasc Med 2022; 9:868889. [PMID: 35592396 PMCID: PMC9110652 DOI: 10.3389/fcvm.2022.868889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Aim The benefit of controlling cardiovascular risk factors in slowing the progression of small abdominal aortic aneurysm (AAA) is controversial. This study investigated the association of optimal blood pressure control at entry with the growth of small AAA. Methods and Results A total of 1,293 patients with initial AAA diameter <50 mm were followed by a median 5 (inter-quartile range, IQR, 3–7) ultrasound scans for a median of 3.6 years (IQR 1.8, 5.3). Optimal blood pressure control was defined as blood pressure ≤140/90 mmHg at recruitment. The association of optimal blood pressure control at entry with AAA growth was assessed using linear mixed effects models adjusted for established risk factors of AAA growth and factors which were unequally distributed among the blood pressure groups. Optimal blood pressure control at entry was not significantly associated with AAA growth. In the risk factor adjusted model the mean difference in AAA growth between blood pressure groups was 0.04 mm/year (95% CI −0.20, 0.13; p = 0.65). The results were similar in sensitivity analyses excluding outliers or focused on systolic or diastolic blood pressure alone. Conclusions This observational study suggests that optimal blood pressure control at entry is not associated with slower AAA growth.
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Affiliation(s)
- Diana Thomas Manapurathe
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Joseph Vaughan Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Smriti Murali Krishna
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | | | - Michael Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Gosford Vascular Services, Gosford, NSW, Australia
| | - Bernard Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Gosford Vascular Services, Gosford, NSW, Australia
| | - Rhondda E. Jones
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, QLD, Australia
- *Correspondence: Jonathan Golledge
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Thomas Manapurathe D, Moxon JV, Krishna SM, Rowbotham S, Quigley F, Jenkins J, Bourke M, Bourke B, Jones RE, Golledge J. Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients With Peripheral Artery Disease. J Am Heart Assoc 2020; 8:e010748. [PMID: 30845872 PMCID: PMC6475052 DOI: 10.1161/jaha.118.010748] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hypertension is an important risk factor for cardiovascular events in patients with peripheral artery disease; however, optimal blood pressure targets for these patients are poorly defined. This study investigated the association between systolic blood pressure ( SBP ) and cardiovascular events in a prospectively recruited patient cohort with peripheral artery disease. Methods and Results A total of 2773 patients were included and were grouped according to SBP at recruitment (≤120 mm Hg, n=604; 121-140 mm Hg, n=1065; and >140 mm Hg, n=1104). Adjusted Cox proportional hazards analyses suggested that patients with SBP ≤120 mm Hg were at greater risk of having a major cardiovascular event (myocardial infarction, stroke, or cardiovascular death) than patients with SBP of 121-140 mm Hg (adjusted hazard ratio, 1.36; 95% CI, 1.08-1.72; P=0.009). Patients with SBP >140 mm Hg had an adjusted hazard ratio of 1.23 (95% CI, 1.00-1.51; P=0.051) of major cardiovascular events compared with patients with SBP of 121-140 mm Hg. These findings were similar in sensitivity analyses only including patients receiving antihypertensive medications or focused on patients with a minimum of 3 months of follow-up. Conclusions This cohort study suggests that patients with peripheral artery disease and SBP ≤120 mm Hg are at increased risk of major cardiovascular events. The findings suggest caution in intensive SBP lowering in this patient group.
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Affiliation(s)
- Diana Thomas Manapurathe
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Joseph Vaughan Moxon
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Smriti Murali Krishna
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Sophie Rowbotham
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,4 School of Medicine University of Queensland Brisbane Australia.,5 Department of Vascular and Endovascular Surgery Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Frank Quigley
- 6 Department of Vascular and Endovascular Surgery Mater Hospital Townsville Australia
| | - Jason Jenkins
- 5 Department of Vascular and Endovascular Surgery Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Michael Bourke
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,7 Gosford Vascular Services Gosford New South Wales Australia
| | - Bernard Bourke
- 7 Gosford Vascular Services Gosford New South Wales Australia
| | - Rhondda E Jones
- 3 Division of Tropical Health and Medicine James Cook University Townsville Queensland Australia
| | - Jonathan Golledge
- 1 Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia.,2 The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia.,8 The Department of Vascular and Endovascular Surgery The Townsville Hospital Townsville Queensland Australia
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Dewdney B, Trollope A, Moxon J, Thomas Manapurathe D, Biros E, Golledge J. Circulating MicroRNAs as Biomarkers for Acute Ischemic Stroke: A Systematic Review. J Stroke Cerebrovasc Dis 2017; 27:522-530. [PMID: 29128328 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 09/24/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Acute ischemic stroke is a leading cause of death and disability worldwide. Unlike myocardial infarction, there is no current blood test to diagnose acute ischemic stroke. MicroRNAs (miRNAs) are very stable in the blood and have been suggested as potential diagnostic markers. MATERIALS AND METHODS This review aimed to systematically assess case-control studies investigating the association of circulating miRNAs with acute ischemic stroke. Medline, CINAHL, Cochrane Library, Web of Science, Scopus, and PubMed were searched for studies that examined the association of circulating miRNAs in patients with acute ischemic stroke. Studies meeting specific inclusion and exclusion criteria (such as blood samples obtained within 24 hours of an acute ischemic stroke) were selected for data extraction. Two authors extracted data from the included studies relevant to the study design, the patient characteristics, and the relative miRNA expression. RESULTS Eight studies were included involving 572 cases and 431 healthy controls. Twenty-two miRNAs (12 upregulated and 10 downregulated) were reported as differentially expressed. Only 1 miRNA, miR-106b, was reported as differentially expressed in at least 2 studies. Significant heterogeneity in the design and methods of the included studies was noted. CONCLUSIONS Differential expression of a large number of miRNAs has been reported early following acute ischemic stroke. More research is required in larger patient populations to further evaluate the diagnostic potential of the reported miRNAs.
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Affiliation(s)
- Brittany Dewdney
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Alexandra Trollope
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Joseph Moxon
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Diana Thomas Manapurathe
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Erik Biros
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia.
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Thomas Manapurathe D, Krishna SM, Dewdney B, Moxon JV, Biros E, Golledge J. Effect of blood pressure lowering medications on leg ischemia in peripheral artery disease patients: A meta-analysis of randomised controlled trials. PLoS One 2017; 12:e0178713. [PMID: 28575088 PMCID: PMC5456103 DOI: 10.1371/journal.pone.0178713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It has been suggested that anti-hypertensive medications may worsen leg ischemia in peripheral artery disease (PAD) patients. We undertook a meta-analysis to assess the effect of anti-hypertensive medications on measures of leg ischemia including maximum walking distance (MWD), pain free walking distance (PFWD) and ankle brachial pressure index (ABPI). A meta-regression was performed to evaluate whether the effect of the anti-hypertensive medications on mean arterial pressure (MAP) was associated with changes in ABPI, MWD or PFWD. METHOD A systematic literature search was performed to identify placebo controlled randomized control trials (RCT) testing anti-hypertensive medications, which reported baseline and follow-up measurements of: MAP and MWD, PFWD or ABPI in patients with intermittent claudication (IC) due to PAD. RESULT A meta-analysis was performed on 5 RCTs comprising a total of 180 and 127 patients receiving anti-hypertensive medications and placebo respectively. This analysis suggested that anti-hypertensive medication did not significantly affect MWD, PFWD or ABPI. In contrast, the meta-regression analysis showed that the reduction in MAP due to the anti-hypertensive drugs was positively correlated with increased MWD during follow-up (β = 8.371, p = 0.035). Heterogeneity across studies, as assessed by I2, was high. The follow-up period within the included trials was generally short with 3 out of 5 studies having a follow-up period of ≤ 6 weeks. CONCLUSION This study suggests that anti-hypertensive treatment does not worsen but may improve leg ischemia in PAD patients. Larger multicenter trials with longer anti-hypertensive treatment periods are required to clarify the effect of anti-hypertensives on leg ischemia in PAD patients.
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Affiliation(s)
- Diana Thomas Manapurathe
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
| | - Smriti Murali Krishna
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
| | - Brittany Dewdney
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
| | - Joseph Vaughan Moxon
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
| | - Erik Biros
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Arterial Diseases, College of Medicine & Dentistry, James Cook University, Townsville, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
- * E-mail:
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