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Pearson TA, Vitalis D, Pratt C, Campo R, Armoundas AA, Au D, Beech B, Brazhnik O, Chute CG, Davidson KW, Diez-Roux AV, Fine LJ, Gabriel D, Groenveld P, Hall J, Hamilton AB, Hu H, Ji H, Kind A, Kraus WE, Krumholz H, Mensah GA, Merchant RM, Mozaffarian D, Murray DM, Neumark-Sztainer D, Petersen M, Goff D. The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities. JACC Adv 2024; 3:100759. [PMID: 38375059 PMCID: PMC10876066 DOI: 10.1016/j.jacadv.2023.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities. Training in these approaches is important to create the next generation of scientists and practitioners in precision prevention. This state-of-the-art review is based on a workshop convened to identify current gaps in knowledge and methods used in precision prevention intervention research, discuss opportunities to expand trials of implementation science to close the health equity gaps, and expand the education and training of a diverse precision prevention workforce.
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Affiliation(s)
- Thomas A. Pearson
- College of Medicine and College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Debbie Vitalis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca Campo
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antonis A. Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital and Broad Institute, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - David Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington, Seattle, Washington, USA
| | - Bettina Beech
- UH Population Health, University of Houston, Houston, Texas, USA
| | - Olga Brazhnik
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G. Chute
- Johns Hopkins Medicine, Institute for Clinical and Translational Research, Baltimore, Maryland, USA
| | - Karina W. Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, New York, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Lawrence J. Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Davera Gabriel
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Groenveld
- Center for Health Care Transformation and Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Hui Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heng Ji
- Department of Computer Science, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Amy Kind
- Center for Health Disparities Research (CHDR), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William E. Kraus
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Harlan Krumholz
- Institute for Social and Policy Studies, of Investigative Medicine and of Public Health (Health Policy), Yale University, New Haven, Connecticut, USA
| | - George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Raina M. Merchant
- Center for Health Care Transformation and Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Medford, Massachusetts, USA
| | - David M. Murray
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maya Petersen
- Division of Biostatistics, and UCSF-UC Berkeley Program in Computational Precision Health, School of Public Health, University of California-Berkeley, Berkeley, California, USA
- University of California-San Francisco, San Francisco, California, USA
| | - David Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Commodore-Mensah Y, Loustalot F, Himmelfarb CD, Desvigne-Nickens P, Sachdev V, Bibbins-Domingo K, Clauser SB, Cohen DJ, Egan BM, Fendrick AM, Ferdinand KC, Goodman C, Graham GN, Jaffe MG, Krumholz HM, Levy PD, Mays GP, McNellis R, Muntner P, Ogedegbe G, Milani RV, Polgreen LA, Reisman L, Sanchez EJ, Sperling LS, Wall HK, Whitten L, Wright JT, Wright JS, Fine LJ. Proceedings From a National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention Workshop to Control Hypertension. Am J Hypertens 2022; 35:232-243. [PMID: 35259237 PMCID: PMC8903890 DOI: 10.1093/ajh/hpab182] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 01/09/2023] Open
Abstract
Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Vandana Sachdev
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Steven B Clauser
- Patient Centered Outcomes Research Institute, Washington, District of Columbia, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Brent M Egan
- American Medical Association, Greenville, South Carolina, USA
| | - A Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith C Ferdinand
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Marc G Jaffe
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Glen P Mays
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert McNellis
- Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Gbenga Ogedegbe
- New York University Grossman School of Medicine, New York, New York, USA
| | - Richard V Milani
- Department of Cardiology, Ochsner Health System, New Orleans, Louisiana, USA
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, USA
| | | | | | - Laurence S Sperling
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lori Whitten
- Synergy Enterprises, Inc, Silver Spring, Maryland, USA
| | - Jackson T Wright
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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Wright JT, Whelton PK, Johnson KC, Snyder JK, Reboussin DM, Cushman WC, Williamson JD, Pajewski NM, Cheung AK, Lewis CE, Oparil S, Rocco MV, Beddhu S, Fine LJ, Cutler JA, Ambrosius WT, Rahman M, Still CH, Chen Z, Tatsuoka C. SPRINT Revisited: Updated Results and Implications. Hypertension 2021; 78:1701-1710. [PMID: 34757768 PMCID: PMC8824314 DOI: 10.1161/hypertensionaha.121.17682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The SPRINT (Systolic Blood Pressure Intervention Trial) results have influenced clinical practice but have also generated discussion regarding the validity, generalizability, and importance of the findings. Following the SPRINT primary results manuscript in 2015, additional results and analyses of the data have addressed these concerns. The primary objective of this article is to respond to key questions that have been raised.
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Affiliation(s)
- Jackson T Wright
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joni K Snyder
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - David M Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeff D Williamson
- Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alfred K Cheung
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne Oparil
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael V Rocco
- Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Srinivasan Beddhu
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
| | - Lawrence J Fine
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Jeffrey A Cutler
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Curtis Tatsuoka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, School of Medicine, Cleveland, OH
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Lewis CE, Fine LJ, Beddhu S, Cheung AK, Cushman WC, Cutler JA, Evans GW, Johnson KC, Kitzman DW, Oparil S, Rahman M, Reboussin DM, Rocco MV, Sink KM, Snyder JK, Whelton PK, Williamson JD, Wright JT, Ambrosius WT. Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2021; 384:1921-1930. [PMID: 34010531 PMCID: PMC9907774 DOI: 10.1056/nejmoa1901281] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a previously reported randomized trial of standard and intensive systolic blood-pressure control, data on some outcome events had yet to be adjudicated and post-trial follow-up data had not yet been collected. METHODS We randomly assigned 9361 participants who were at increased risk for cardiovascular disease but did not have diabetes or previous stroke to adhere to an intensive treatment target (systolic blood pressure, <120 mm Hg) or a standard treatment target (systolic blood pressure, <140 mm Hg). The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. Additional primary outcome events occurring through the end of the intervention period (August 20, 2015) were adjudicated after data lock for the primary analysis. We also analyzed post-trial observational follow-up data through July 29, 2016. RESULTS At a median of 3.33 years of follow-up, the rate of the primary outcome and all-cause mortality during the trial were significantly lower in the intensive-treatment group than in the standard-treatment group (rate of the primary outcome, 1.77% per year vs. 2.40% per year; hazard ratio, 0.73; 95% confidence interval [CI], 0.63 to 0.86; all-cause mortality, 1.06% per year vs. 1.41% per year; hazard ratio, 0.75; 95% CI, 0.61 to 0.92). Serious adverse events of hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope were significantly more frequent in the intensive-treatment group. When trial and post-trial follow-up data were combined (3.88 years in total), similar patterns were found for treatment benefit and adverse events; however, rates of heart failure no longer differed between the groups. CONCLUSIONS Among patients who were at increased cardiovascular risk, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg, both during receipt of the randomly assigned therapy and after the trial. Rates of some adverse events were higher in the intensive-treatment group. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062.).
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Affiliation(s)
- Cora E Lewis
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Lawrence J Fine
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Srinivasan Beddhu
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Alfred K Cheung
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - William C Cushman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jeffrey A Cutler
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Gregory W Evans
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Karen C Johnson
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Dalane W Kitzman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Suzanne Oparil
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Mahboob Rahman
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - David M Reboussin
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Michael V Rocco
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Kaycee M Sink
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Joni K Snyder
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Paul K Whelton
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jeff D Williamson
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Jackson T Wright
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
| | - Walter T Ambrosius
- The affiliations of the members of the writing committee are as follows: the Department of Epidemiology, School of Public Health (C.E.L.), and the Divisions of Preventive Medicine (C.E.L.) and Cardiovascular Disease (S.O.), Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham; the Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (L.J.F., J.A.C., J.K.S.); the Division of Nephrology and Hypertension, University of Utah, and Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City (S.B., A.K.C.); the Department of Preventive Medicine, University of Tennessee Health Science Center (W.C.C., K.C.J.), and Medical Service, Veterans Affairs Medical Center (W.C.C.), Memphis; the Department of Biostatistics and Data Science (G.W.E., D.M.R., W.T.A.), the Division of Cardiovascular Medicine (D.W.K.) and Section of Nephrology (M.V.R.), Department of Internal Medicine, and the Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine (K.M.S., J.D.W.), Wake Forest School of Medicine, Winston Salem, NC; the Division of Nephrology and Hypertension, Louis Stokes Cleveland Veterans Affairs Medical Center (M.R.), and the Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University (M.R., J.T.W.), Cleveland; and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans (P.K.W.)
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5
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Newman JD, Bhatt DL, Rajagopalan S, Balmes JR, Brauer M, Breysse PN, Brown AGM, Carnethon MR, Cascio WE, Collman GW, Fine LJ, Hansel NN, Hernandez A, Hochman JS, Jerrett M, Joubert BR, Kaufman JD, Malik AO, Mensah GA, Newby DE, Peel JL, Siegel J, Siscovick D, Thompson BL, Zhang J, Brook RD. Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2878-2894. [PMID: 33303078 PMCID: PMC8040922 DOI: 10.1016/j.jacc.2020.10.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
Fine particulate air pollution <2.5 μm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- Jonathan D Newman
- Division of Cardiology and the Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, New York, USA.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/DLBhattMD
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - John R Balmes
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick N Breysse
- National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Durham, North Carolina, USA
| | - Gwen W Collman
- National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrian Hernandez
- Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Bonnie R Joubert
- Population Health Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ali O Malik
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jeffrey Siegel
- Department of Civil and Mineral Engineering, and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Siscovick
- Division of Research, Evaluation, and Policy, The New York Academy of Medicine, New York, New York, USA
| | - Betsy L Thompson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Junfeng Zhang
- Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, Michigan, USA
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6
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Abstract
IMPORTANCE Controlling blood pressure (BP) reduces the risk for cardiovascular disease. OBJECTIVE To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of National Health and Nutrition Examination Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018 (10 cycles), including 18 262 US adults aged 18 years or older with hypertension defined as systolic BP level of 140 mm Hg or higher, diastolic BP level of 90 mm Hg or higher, or use of antihypertensive medication. The date of final data collection was 2018. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Mean BP was computed using 3 measurements. The primary outcome of BP control was defined as systolic BP level lower than 140 mm Hg and diastolic BP level lower than 90 mm Hg. RESULTS Among the 51 761 participants included in this analysis, the mean (SD) age was 48 (19) years and 25 939 (50.1%) were women; 43.2% were non-Hispanic White adults; 21.6%, non-Hispanic Black adults; 5.3%, non-Hispanic Asian adults; and 26.1%, Hispanic adults. Among the 18 262 adults with hypertension, the age-adjusted estimated proportion with controlled BP increased from 31.8% (95% CI, 26.9%-36.7%) in 1999-2000 to 48.5% (95% CI, 45.5%-51.5%) in 2007-2008 (P < .001 for trend), remained stable and was 53.8% (95% CI, 48.7%-59.0%) in 2013-2014 (P = .14 for trend), and then declined to 43.7% (95% CI, 40.2%-47.2%) in 2017-2018 (P = .003 for trend). Compared with adults who were aged 18 years to 44 years, it was estimated that controlled BP was more likely among those aged 45 years to 64 years (49.7% vs 36.7%; multivariable-adjusted prevalence ratio, 1.18 [95% CI, 1.02-1.37]) and less likely among those aged 75 years or older (37.3% vs 36.7%; multivariable-adjusted prevalence ratio, 0.81 [95% CI, 0.65-0.97]). It was estimated that controlled BP was less likely among non-Hispanic Black adults vs non-Hispanic White adults (41.5% vs 48.2%, respectively; multivariable-adjusted prevalence ratio, 0.88; 95% CI, 0.81-0.96). Controlled BP was more likely among those with private insurance (48.2%), Medicare (53.4%), or government health insurance other than Medicare or Medicaid (43.2%) vs among those without health insurance (24.2%) (multivariable-adjusted prevalence ratio, 1.40 [95% CI, 1.08-1.80], 1.47 [95% CI, 1.15-1.89], and 1.36 [95% CI, 1.04-1.76], respectively). Controlled BP was more likely among those with vs those without a usual health care facility (48.4% vs 26.5%, respectively; multivariable-adjusted prevalence ratio, 1.48 [95% CI, 1.13-1.94]) and among those who had vs those who had not had a health care visit in the past year (49.1% vs 8.0%; multivariable-adjusted prevalence ratio, 5.23 [95% CI, 2.88-9.49]). CONCLUSIONS AND RELEVANCE In a series of cross-sectional surveys weighted to be representative of the adult US population, the prevalence of controlled BP increased between 1999-2000 and 2007-2008, did not significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
| | - Shakia T. Hardy
- Department of Epidemiology, University of Alabama at Birmingham
| | - Lawrence J. Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham
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7
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Greenland P, Michos ED, Redmond N, Fine LJ, Alexander KP, Ambrosius WT, Bibbins-Domingo K, Blaha MJ, Blankstein R, Fortmann SP, Khera A, Lloyd-Jones DM, Maron DJ, Min JK, Muhlestein JB, Nasir K, Sterling MR, Thanassoulis G. Primary Prevention Trial Designs Using Coronary Imaging: A National Heart, Lung, and Blood Institute Workshop. JACC Cardiovasc Imaging 2020; 14:1454-1465. [PMID: 32950442 DOI: 10.1016/j.jcmg.2020.06.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022]
Abstract
Coronary artery calcium (CAC) is considered a useful test for enhancing risk assessment in the primary prevention setting. Clinical trials are under consideration. The National Heart, Lung, and Blood Institute convened a multidisciplinary working group on August 26 to 27, 2019, in Bethesda, Maryland, to review available evidence and consider the appropriateness of conducting further research on coronary artery calcium (CAC) testing, or other coronary imaging studies, as a way of informing decisions for primary preventive treatments for cardiovascular disease. The working group concluded that additional evidence to support current guideline recommendations for use of CAC in middle-age adults is very likely to come from currently ongoing trials in that age group, and a new trial is not likely to be timely or cost effective. The current trials will not, however, address the role of CAC testing in younger adults or older adults, who are also not addressed in existing guidelines, nor will existing trials address the potential benefit of an opportunistic screening strategy made feasible by the application of artificial intelligence. Innovative trial designs for testing the value of CAC across the lifespan were strongly considered and represent important opportunities for additional research, particularly those that leverage existing trials or other real-world data streams including clinical computed tomography scans. Sex and racial/ethnic disparities in cardiovascular disease morbidity and mortality, and inclusion of diverse participants in future CAC trials, particularly those based in the United States, would enhance the potential impact of these studies.
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Affiliation(s)
- Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Erin D Michos
- Department of Medicine (Cardiology), Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicole Redmond
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Lawrence J Fine
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Karen P Alexander
- Department of Medicine (Cardiology), Duke University Medical Center, Durham, North Carolina, USA
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science in the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology & Biostatistics, University of California-San Francisco (UCSF) School of Medicine, San Francisco, California, USA
| | - Michael J Blaha
- Department of Medicine (Cardiovascular and Clinical Epidemiology), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Ron Blankstein
- Department of Medicine (Cardiovascular), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Amit Khera
- Department of Internal Medicine (Cardiology), University of Texas-Southwestern Medical Center, Dallas, Texas, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David J Maron
- Department of Medicine (Cardiovascular Medicine), Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | | | - J Brent Muhlestein
- Department of Internal Medicine (Cardiovascular Medicine), Intermountain Health Care and University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Khurram Nasir
- Center for Outcomes Research, Methodist Hospital and Baylor School of Medicine, Houston, Texas, USA
| | - Madeline R Sterling
- Department of Internal Medicine, Weill Cornell Medical College, New York, New York, USA
| | - George Thanassoulis
- Department of Medicine (Division of Experimental Medicine), McGill University Health Center, Montreal, Quebec, Canada
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Soliman EZ, Rahman AF, Zhang ZM, Rodriguez CJ, Chang TI, Bates JT, Ghazi L, Blackshear JL, Chonchol M, Fine LJ, Ambrosius WT, Lewis CE. Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation. Hypertension 2020; 75:1491-1496. [PMID: 32362229 DOI: 10.1161/hypertensionaha.120.14766] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It remains uncertain whether intensive control of blood pressure (BP) results in a lower risk of atrial fibrillation (AF) in patients with hypertension. Using data from SPRINT (Systolic Blood Pressure Intervention Trial), which enrolled participants with hypertension at increased risk of cardiovascular disease, we examined whether intensive BP lowering (target systolic BP [SBP] <120 mm Hg), compared with standard BP lowering (target SBP<140 mm Hg), results in a lower risk of AF. This analysis included 8022 participants (4003 randomized to the intensive arm and 4019 to standard BP arm) who were free of AF at the time of enrollment and with available baseline and follow-up electrocardiographic data. AF was ascertained from standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visit. During up to 5.2 years of follow-up and a total of 28 322 person-years, 206 incident AF cases occurred; 88 in the intensive BP-lowering arm and 118 in the standard BP-lowering arm. Intensive BP lowering was associated with a 26% lower risk of developing new AF (hazard ratio, 0.74 [95% CI, 0.56-0.98]; P=0.037). This effect was consistent among prespecified subgroups of SPRINT participants stratified by age, sex, race, SBP tertiles, prior cardiovascular disease, and prior chronic kidney disease when interactions between treatment effect and these subgroups were assessed using Hommel adjusted P values. In conclusion, intensive treatment to a target of SBP <120 mm Hg in patients with hypertension at high risk of cardiovascular disease has the potential to reduce the risk of AF. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
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Affiliation(s)
- Elsayed Z Soliman
- From the Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.)
| | - Akm F Rahman
- Department of Biostatistics (A.F.R.), University of Alabama at Birmingham, Birmingham, AL
| | - Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences (Z-M.Z.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Carlos J Rodriguez
- Department of Medicine/Cardiology, Albert Einstein College of Medicine, Bronx, NY (C.J.R.)
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA (T.I.C.)
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.)
| | - Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (L.G.)
| | - Joseph L Blackshear
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL (J.L.B.)
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO (M.C.)
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.)
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Cora E Lewis
- Department of Epidemiology, and Department of Medicine (C.E.L.), University of Alabama at Birmingham, Birmingham, AL
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Affiliation(s)
- Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - David C Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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10
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Yang S, Ambrosius WT, Fine LJ, Bress AP, Cushman WC, Raj DS, Rehman S, Tamariz L. A new modeling and inference approach for the Systolic Blood Pressure Intervention Trial outcomes. Clin Trials 2018; 15:305-312. [PMID: 29671345 DOI: 10.1177/1740774518769865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/aims In clinical trials with time-to-event outcomes, usually the significance tests and confidence intervals are based on a proportional hazards model. Thus, the temporal pattern of the treatment effect is not directly considered. This could be problematic if the proportional hazards assumption is violated, as such violation could impact both interim and final estimates of the treatment effect. Methods We describe the application of inference procedures developed recently in the literature for time-to-event outcomes when the treatment effect may or may not be time-dependent. The inference procedures are based on a new model which contains the proportional hazards model as a sub-model. The temporal pattern of the treatment effect can then be expressed and displayed. The average hazard ratio is used as the summary measure of the treatment effect. The test of the null hypothesis uses adaptive weights that often lead to improvement in power over the log-rank test. Results Without needing to assume proportional hazards, the new approach yields results consistent with previously published findings in the Systolic Blood Pressure Intervention Trial. It provides a visual display of the time course of the treatment effect. At four of the five scheduled interim looks, the new approach yields smaller p values than the log-rank test. The average hazard ratio and its confidence interval indicates a treatment effect nearly a year earlier than a restricted mean survival time-based approach. Conclusion When the hazards are proportional between the comparison groups, the new methods yield results very close to the traditional approaches. When the proportional hazards assumption is violated, the new methods continue to be applicable and can potentially be more sensitive to departure from the null hypothesis.
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Affiliation(s)
- Song Yang
- 1 Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Walter T Ambrosius
- 2 Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lawrence J Fine
- 3 Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute
| | - Adam P Bress
- 4 Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Dominic S Raj
- 6 Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC, USA
| | - Shakaib Rehman
- 7 Phoenix VA Healthcare Systems, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Leonardo Tamariz
- 8 Division of Population Health and Computational Medicine, University of Miami and GRECC, Miami, FL, USA
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11
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Sink KM, Evans GW, Shorr RI, Bates JT, Berlowitz D, Conroy MB, Felton DM, Gure T, Johnson KC, Kitzman D, Lyles MF, Servilla K, Supiano MA, Whittle J, Wiggers A, Fine LJ. Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the Randomized Clinical Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc 2018; 66:679-686. [PMID: 29601076 DOI: 10.1111/jgs.15236] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine predictors of serious adverse events (SAEs) involving syncope, hypotension, and falls, with particular attention to age, in the Systolic Blood Pressure Intervention Trial. DESIGN Randomized clinical trial. SETTING Academic and private practices across the United States (N = 102). PARTICIPANTS Adults aged 50 and older with a systolic blood pressure (SBP) of 130 to 180 mmHg at high risk of cardiovascular disease events, but without diabetes, history of stroke, symptomatic heart failure or ejection fraction less than 35%, dementia, or standing SBP less than 110 mmHg (N = 9,361). INTERVENTION Treatment of SBP to a goal of less than 120 mmHg or 140 mmHg. MEASUREMENTS Outcomes were SAEs involving syncope, hypotension, and falls. Predictors were treatment assignment, demographic characteristics, comorbidities, baseline measurements, and baseline use of cardiovascular medications. RESULTS One hundred seventy-two (1.8%) participants had SAEs involving syncope, 155 (1.6%) hypotension, and 203 (2.2%) falls. Randomization to intensive SBP control was associated with greater risk of an SAE involving hypotension (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.21-2.32, P = .002), and possibly syncope (HR = 1.32, 95% CI = 0.98-1.79, P = .07), but not falls (HR = 0.98, 95% CI = 0.75-1.29, P = .90). Risk of all three outcomes was higher for participants with chronic kidney disease or frailty. Older age was also associated with greater risk of syncope, hypotension, and falls, but there was no age-by-treatment interaction for any of the SAE outcomes. CONCLUSIONS Participants randomized to intensive SBP control had greater risk of hypotension and possibly syncope, but not falls. The greater risk of developing these events associated with intensive treatment did not vary according to age.
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Affiliation(s)
- Kaycee M Sink
- Department of Medicine, Section on Department of Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Gregory W Evans
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Ronald I Shorr
- Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.,Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Dan Berlowitz
- Bedford Veterans Affairs Hospital, Bedford, Massachusetts.,School of Medicine, Boston University, Boston, Massachusetts.,School of Public Health, Boston University, Boston, Massachusetts
| | - Molly B Conroy
- Division of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah M Felton
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Tanya Gure
- Division of General Internal Medicine and Geriatrics, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Dalane Kitzman
- Department of Cardiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Mary F Lyles
- Department of Medicine, Section on Department of Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Karen Servilla
- Renal Section, New Mexico VA Health Care System, Albuquerque, New Mexico
| | - Mark A Supiano
- Division of Geriatrics, School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Veterans, Geriatric Research, Education and Clinical Center, Salt Lake City, Utah
| | - Jeff Whittle
- Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alan Wiggers
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University Cleveland Campus, Cleveland, Ohio
| | - Lawrence J Fine
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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12
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Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK, Ambrosius WT, Beddhu S, Cheung AK, Fine LJ, Lewis CE, Rahman M, Reboussin DM, Rocco MV, Oparil S, Wright JT. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 2018. [PMID: 29531173 DOI: 10.1161/hypertensionaha.117.10479] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent publications have stated that the blood pressure (BP) measurement technique used in SPRINT (Systolic Blood Pressure Intervention Trial) was unattended. However, the SPRINT protocol does not address the issue of attendance. A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff. There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time (always alone), 2247 at 25 sites that had personnel in the room the entire time (never alone), 1746 at 19 sites that left the participant alone only during the rest period (alone for rest), and 570 at 6 sites that left the participant alone only during the BP readings (alone for BP measurement). Similar systolic and diastolic BPs within randomized groups were noted during follow-up at the majority of visits in all 4 measurement categories. In the always alone and never alone categories, the intensive group had a similarly reduced risk for the primary outcome compared with the standard group (hazard ratio, 0.62; 95% confidence interval, 0.51-0.76 and hazard ratio, 0.64; 95% confidence interval, 0.46-0.91, respectively; pairwise interaction P value, 0.88); risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories. Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Karen C Johnson
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH.
| | - Paul K Whelton
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - William C Cushman
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Jeffrey A Cutler
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Gregory W Evans
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Joni K Snyder
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Walter T Ambrosius
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Srinivasan Beddhu
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Alfred K Cheung
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Lawrence J Fine
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Cora E Lewis
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Mahboob Rahman
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - David M Reboussin
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Michael V Rocco
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Suzanne Oparil
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Jackson T Wright
- From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J., W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Preventive Medicine Section, Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Sciences (J.A.C., J.K.S.) and Clinical Applications and Prevention Branch (L.J.F.), National Heart, Lung, and Blood Institute; Division of Public Health Sciences, Department of Biostatistical Sciences (G.W.E., W.T.A., D.M.R.) and Section on Nephrology (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Nephrology and Hypertension and Medical Service (S.B.) and Division of Nephrology and Hypertension (A.K.C.), Veterans Affairs Salt Lake City Healthcare System, University of Utah; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Diseases (S.O.), University of Alabama at Birmingham; and Division of Nephrology and Hypertension, Louis Stokes Cleveland VA Medical Center (M.R.) and Division of Nephrology and Hypertension (J.T.W.), University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
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Upadhya B, Rocco M, Lewis CE, Oparil S, Lovato LC, Cushman WC, Bates JT, Bello NA, Aurigemma G, Fine LJ, Johnson KC, Rodriguez CJ, Raj DS, Rastogi A, Tamariz L, Wiggers A, Kitzman DW. Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003613. [PMID: 28364091 DOI: 10.1161/circheartfailure.116.003613] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/24/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg). METHODS AND RESULTS ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46-0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase (P<0.001) in cardiovascular death. CONCLUSIONS Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Bharathi Upadhya
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Michael Rocco
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Cora E Lewis
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Suzanne Oparil
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Laura C Lovato
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - William C Cushman
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Jeffrey T Bates
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Natalie A Bello
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Gerard Aurigemma
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Lawrence J Fine
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Karen C Johnson
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Carlos J Rodriguez
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Dominic S Raj
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Anjay Rastogi
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Leonardo Tamariz
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Alan Wiggers
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.)
| | - Dalane W Kitzman
- From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.).
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Soliman EZ, Ambrosius WT, Cushman WC, Zhang ZM, Bates JT, Neyra JA, Carson TY, Tamariz L, Ghazi L, Cho ME, Shapiro BP, He J, Fine LJ, Lewis CE. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation 2017; 136:440-450. [PMID: 28512184 DOI: 10.1161/circulationaha.117.028441] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP <120 mm Hg) and 4078 assigned to standard BP lowering (target SBP <140 mm Hg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead ECGs recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (versus standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjustment for LVH as a time-varying covariate. RESULTS Among SPRINT participants without baseline LVH (n=7559), intensive (versus standard) BP lowering was associated with a 46% lower risk of developing LVH (hazard ratio=0.54; 95% confidence interval, 0.43-0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (versus standard) BP lowering were 66% more likely to regress/improve their LVH (hazard ratio=1.66; 95% confidence interval, 1.31-2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (hazard ratio of intensive versus standard BP lowering on CVD, 0.76 [95% confidence interval, 0.64-0.90] and 0.77 [95% confidence interval, 0.65-0.91] before and after adjustment for LVH as a time-varying covariate, respectively). CONCLUSIONS Among patients with hypertension but no diabetes mellitus, intensive BP lowering (target systolic BP <120 mm Hg) compared with standard BP lowering (target systolic BP <140 mm Hg) resulted in lower rates of developing new LVH in those without LVH and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Elsayed Z Soliman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.).
| | - Walter T Ambrosius
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - William C Cushman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Zhu-Ming Zhang
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Jeffrey T Bates
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Javier A Neyra
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Thaddeus Y Carson
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Leonardo Tamariz
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Lama Ghazi
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Monique E Cho
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Brian P Shapiro
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Jiang He
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Lawrence J Fine
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
| | - Cora E Lewis
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S., Z.-M.Z.), Department of Medicine, Section on Cardiology (E.Z.S.), and Department of Biostatistical Sciences, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC; Preventive Medicine Section, Medical Service, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, TX (J.T.B.); Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington (J.A.N.); Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (J.A.N.); Department of Internal Medicine, Division of General Internal Medicine, Augusta University, GA (T.Y.C.); Division of Population Health and Computational Medicine, University of Miami, and Geriatric Research Education and Clinical Center, FL (L.T.); Department of Epidemiology, Division of Public Health, University of Minnesota, Minneapolis (L.G.); Division of Nephrology and Hypertension, University of Utah, Salt Lake City (M.E.C.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.P.S.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (J.H.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); and Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (C.E.L.)
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Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 2017; 120:366-380. [PMID: 28104770 PMCID: PMC5268076 DOI: 10.1161/circresaha.116.309115] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.
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Affiliation(s)
- George A Mensah
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD.
| | - Gina S Wei
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Paul D Sorlie
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lawrence J Fine
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Yves Rosenberg
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Peter G Kaufmann
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael E Mussolino
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lucy L Hsu
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Ebyan Addou
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael M Engelgau
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - David Gordon
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
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Drawz PE, Pajewski NM, Bates JT, Bello NA, Cushman WC, Dwyer JP, Fine LJ, Goff DC, Haley WE, Krousel-Wood M, McWilliams A, Rifkin DE, Slinin Y, Taylor A, Townsend R, Wall B, Wright JT, Rahman M. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension 2016; 69:42-50. [PMID: 27849563 DOI: 10.1161/hypertensionaha.116.08076] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 07/07/2016] [Accepted: 09/15/2016] [Indexed: 12/17/2022]
Abstract
The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249.
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Affiliation(s)
- Paul E Drawz
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.).
| | - Nicholas M Pajewski
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Jeffrey T Bates
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Natalie A Bello
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - William C Cushman
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Jamie P Dwyer
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Lawrence J Fine
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - David C Goff
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - William E Haley
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Marie Krousel-Wood
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Andrew McWilliams
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Dena E Rifkin
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Yelena Slinin
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Addison Taylor
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Raymond Townsend
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Barry Wall
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Jackson T Wright
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
| | - Mahboob Rahman
- From the Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis (P.E.D.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (N.M.P.); Michael E. DeBakey Veterans Affairs Medical Center and Division of General Internal Medicine, Baylor College of Medicine, Houston, TX (J.T.B.); Division of Cardiology, Columbia University Medical Center, New York, NY (N.A.B.); Department of Medicine, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN (J.P.D.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Nephrology and Hypertension Division, Mayo Clinic, Jacksonville, FL (W.E.H.); Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University New Orleans, LA (M.K.-W.); Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC (A.M.); Division of Nephrology, Veterans Affairs Health System and University of California, San Diego (D.E.R.); Division of Nephrology, Veterans Affairs Health System and University of Minnesota, Minneapolis (Y.S.); Michael E. DeBakey Veterans Affairs Medical Center and Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX (A.T.); Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia (R.T.); Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis (B.W.); Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.); and Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland VAMC, Case Western Reserve University, OH (M.R.)
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Affiliation(s)
- Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - David M. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lawrence J. Fine
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
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Wright JTJ, Fine LJ. SPRINT and Implications for Target Organ Protection in African Americans. Ethn Dis 2016; 26:271-4. [PMID: 27440964 DOI: 10.18865/ed.26.3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
<em>Ethn Dis.</em> 2016;26(3):271-274; doi:10.18865/ed.26.3.271
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Affiliation(s)
- Jackson T Jr Wright
- Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md
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Nicastro HL, Belter CW, Lauer MS, Coady SA, Fine LJ, Loria CM. The Productivity of NHLBI-Funded Obesity Research, 1983-2013. Obesity (Silver Spring) 2016; 24:1356-65. [PMID: 27145059 DOI: 10.1002/oby.21478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/13/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe and elucidate the time trends of the academic productivity of NHLBI's obesity-related research funding via bibliometric analysis of 30 years of NHLBI-supported obesity-related publications. METHODS In total, 3,545 NHLBI-funded obesity-related publications were identified in the Thomson Reuters InCites™ database. Shared references in a community detection algorithm were used to identify publication topics. Characteristics of publications and topical communities were analyzed based on citation count and percentile rank. A percentile rank >90 was considered "highly cited." RESULTS Obesity-related publications increased more than 10-fold over 30 years, whereas NHLBI-funded publications only increased twofold NHLBI-funded obesity publications were cited a median of 23 times (IQR 8-55, range 0-2,047, mean 52). Thirty percent of these publications were highly cited compared to the expected ten percent. Six topical communities were present in 1983 compared to 16 in 2013. The most highly cited topical areas were sleep (n = 199 publications, 38% highly cited), cardiovascular morbidity and mortality (n = 277, 36%), obesity correlates and consequences (n = 588, 35%), and asthma and inflammation (n = 283, 35%). CONCLUSIONS NHLBI-funded obesity publications have contributed substantially to the obesity literature, with many highly cited. Publications grew in number and topical diversity over 30 years and grew at a faster rate than total NHLBI publications.
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Affiliation(s)
- Holly L Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA
| | | | - Michael S Lauer
- Office of Extramural Research Activities, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sean A Coady
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA
| | - Catherine M Loria
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA
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Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103-16. [PMID: 26551272 PMCID: PMC4689591 DOI: 10.1056/nejmoa1511939] [Citation(s) in RCA: 3876] [Impact Index Per Article: 430.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. RESULTS At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group. CONCLUSIONS Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
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Affiliation(s)
- William C Cushman
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Paul K Whelton
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Lawrence J Fine
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Jackson T Wright
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - David M Reboussin
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Karen C Johnson
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
| | - Suzanne Oparil
- From Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Clinical Applications and Prevention Branch, National Heart Lung and Blood Institute, Bethesda, MD (L.J.F.); Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH (J.T.W.); Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Division of Cardiovascular Disease, University of Alabama at Birmingham (S.O.)
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Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC, Fine LJ, Goff DC, Johnson KC, Killeen AA, Lewis CE, Oparil S, Reboussin DM, Rocco MV, Snyder JK, Williamson JD, Wright JT, Whelton PK. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials 2014; 11:532-46. [PMID: 24902920 DOI: 10.1177/1740774514537404] [Citation(s) in RCA: 377] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure-related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial. PURPOSE To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of trial participants. METHODS The Systolic Blood Pressure Intervention Trial is a multicenter, randomized, controlled trial that compares two strategies for treating systolic blood pressure: one targets the standard target of <140 mm Hg, and the other targets a more intensive target of <120 mm Hg. Enrollment focused on volunteers of age ≥50 years (no upper limit) with an average baseline systolic blood pressure ≥130 mm Hg and evidence of cardiovascular disease, chronic kidney disease, 10-year Framingham cardiovascular disease risk score ≥15%, or age ≥75 years. The Systolic Blood Pressure Intervention Trial recruitment also targeted three pre-specified subgroups: participants with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m(2)), participants with a history of cardiovascular disease, and participants 75 years of age or older. The primary outcome is first the occurrence of a myocardial infarction (MI), acute coronary syndrome, stroke, heart failure, or cardiovascular disease death. Secondary outcomes include all-cause mortality, decline in kidney function or development of end-stage renal disease, incident dementia, decline in cognitive function, and small-vessel cerebral ischemic disease. RESULTS Between 8 November 2010 and 15 March 2013, Systolic Blood Pressure Intervention Trial recruited and randomized 9361 people at 102 clinics, including 3331 women, 2648 with chronic kidney disease, 1877 with a history of cardiovascular disease, 3962 minorities, and 2636 ≥75 years of age. LIMITATIONS Although the overall recruitment target was met, the numbers recruited in the high-risk subgroups were lower than planned. CONCLUSIONS The Systolic Blood Pressure Intervention Trial will provide important information on the risks and benefits of intensive blood pressure treatment targets in a diverse sample of high-risk participants, including those with prior cardiovascular disease, chronic kidney disease, and those aged ≥75 years.
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Affiliation(s)
- Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Capri G Foy
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dan R Berlowitz
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Hospital, Bedford, MA, USA
| | - Alfred K Cheung
- Department of Internal Medicine, University of Utah and Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - William C Cushman
- Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN, USA
| | - Lawrence J Fine
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - David C Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David M Reboussin
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael V Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joni K Snyder
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Bonds DE, Harrington M, Worrall BB, Bertoni AG, Eaton CB, Hsia J, Robinson J, Clemons TE, Fine LJ, Chew EY. Effect of long-chain ω-3 fatty acids and lutein + zeaxanthin supplements on cardiovascular outcomes: results of the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA Intern Med 2014; 174:763-71. [PMID: 24638908 DOI: 10.1001/jamainternmed.2014.328] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dietary supplements have been proposed as a mechanism to improve health and prevent disease. OBJECTIVE To determine if supplementing diet with long-chain ω-3 polyunsaturated fatty acids or with macular xanthophylls results in a reduced rate of cardiovascular disease (CVD). DESIGN, SETTING, AND PARTICIPANTS The Cardiovascular Outcome Study (COS) was an ancillary study of the Age-Related Eye Disease Study 2 (AREDS2), a factorial-designed randomized clinical trial of 4203 participants recruited from 82 US academic and community ophthalmology clinics, who were followed up for a median of 4.8 years. Individuals were eligible to participate if they were between the ages of 50 and 85 years, had intermediate or advanced age-related macular degeneration in 1 eye, and were willing to be randomized. Participants with stable, existing CVD (>12 months since initial event) were eligible to participate. Participants, staff, and outcome assessors were masked to intervention. INTERVENTIONS Daily supplementation with long-chain ω-3 polyunsaturated fatty acids (350-mg docosahexaenoic acid [DHA] + 650-mg eicosapentaenoic acid [EPA]), macular xanthophylls (10-mg lutein + 2-mg zeaxanthin), combination of the two, or matching placebos. These treatments were added to background therapy of the AREDS vitamin and mineral formulation for macular degeneration. MAIN OUTCOMES AND MEASURES A composite outcome of myocardial infarction, stroke, and cardiovascular death with 4 prespecified secondary combinations of the primary outcome with hospitalized heart failure, revascularization, or unstable angina. RESULTS Study participants were primarily white, married, and highly educated, with a median age at baseline of 74 years. A total of 602 cardiovascular events were adjudicated, and 459 were found to meet 1 of the study definitions for a CVD outcome. In intention-to-treat analysis, no reduction in the risk of CVD or secondary CVD outcomes was seen for the DHA + EPA (primary outcome: hazard ratio [HR], 0.95; 95% CI, 0.78-1.17) or lutein + zeaxanthin (primary outcome: HR, 0.94; 95% CI, 0.77-1.15) groups. No differences in adverse events or serious adverse event were seen by treatment group. The sample size was sufficient to detect a 25% reduction in CVD events with 80% power. CONCLUSIONS AND RELEVANCE Dietary supplementation of long-chain ω-3 polyunsaturated fatty acids or macular xanthophylls in addition to daily intake of minerals and vitamins did not reduce the risk of CVD in elderly participants with age-related macular degeneration. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00345176.
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Affiliation(s)
| | - Denise E Bonds
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Bradford B Worrall
- Department of Neurology, School of Medicine, University of Virginia, Charlottesville
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Charles B Eaton
- Department of Family Medicine and Epidemiology, Division of Biology and Medicine, Alpert Medical School and the School of Public Health of Brown University, Providence, Rhode Island
| | | | - Jennifer Robinson
- Department of Epidemiology, University of Iowa, Iowa City8Department of Medicine, University of Iowa, Iowa City
| | | | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Wright JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med 2014; 160:499-503. [PMID: 24424788 DOI: 10.7326/m13-2981] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sullivan MD, O'Connor P, Feeney P, Hire D, Simmons DL, Raisch DW, Fine LJ, Narayan KMV, Ali MK, Katon WJ. Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy. Diabetes Care 2012; 35:1708-15. [PMID: 22619083 PMCID: PMC3402260 DOI: 10.2337/dc11-1791] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression affects up to 20-25% of adults with type 2 diabetes and may increase all-cause mortality, but few well-designed studies have examined the effects of depression on the full range of cardiovascular disease outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 2,053 participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Health-Related Quality of Life substudy completed the Patient Health Questionnaire (PHQ)-9 measure of depression symptoms at baseline and 12, 36, and 48 months. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% CI) for the time-varying impact of depression on protocol-defined clinical outcomes with and without adjustment for demographic, trial-related, clinical, and behavioral variables. RESULTS In fully adjusted models, depression was not significantly related to the ACCORD primary composite outcome (cardiovascular death, nonfatal heart attack, or stroke) (HR 1.53 [95% CI 0.85-2.73]) or to the ACCORD microvascular composite outcome (0.93 [0.53-1.62]), but all-cause mortality was significantly increased both in those with PHQ-assessed probable major depression (2.24 [1.24-4.06]) and PHQ score of ≥ 10 (1.84 [1.17-2.89]). The effect of depression on all-cause mortality was not related to previous cardiovascular events or to assignment to intensive or standard glycemia control. Probable major depression (by PHQ-9) had a borderline impact on the ACCORD macrovascular end point (1.42 [0.99-2.04]). CONCLUSIONS Depression increases the risk of all-cause mortality and may increase the risk of macrovascular events among adults with type 2 diabetes at high risk for cardiovascular events.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
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Rahman M, Ford CE, Cutler JA, Davis BR, Piller LB, Whelton PK, Wright JT, Barzilay JI, Brown CD, Colon PJ, Fine LJ, Grimm RH, Gupta AK, Baimbridge C, Haywood LJ, Henriquez MA, Ilamaythi E, Oparil S, Preston R. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clin J Am Soc Nephrol 2012; 7:989-1002. [PMID: 22490878 PMCID: PMC3362309 DOI: 10.2215/cjn.07800811] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/28/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. RESULTS After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. CONCLUSIONS CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.
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Affiliation(s)
- Mahboob Rahman
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, USA
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Flynn KE, Lin L, Moe GW, Howlett JG, Fine LJ, Spertus JA, McConnell TR, Piña IL, Weinfurt KP. Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure. Am Heart J 2012; 163:88-94.e3. [PMID: 22172441 DOI: 10.1016/j.ahj.2011.09.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/29/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure trials use a variety of measures of functional capacity and quality of life. Lack of formal assessments of the relationships between changes in multiple aspects of patient-reported health status and measures of functional capacity over time limits the ability to compare results across studies. METHODS Using data from HF-ACTION (N = 2331), we used the Pearson correlation coefficients and predicted change scores from linear mixed-effects modeling to demonstrate the associations between changes in patient-reported health status measured with the EQ-5D visual analog scale and the Kansas City Cardiomyopathy Questionnaire (KCCQ) and changes in peak VO(2) and 6-minute walk distance at 3 and 12 months. We examined a 5-point change in KCCQ within individuals to provide a framework for interpreting changes in these measures. RESULTS After adjustment for baseline characteristics, correlations between changes in the visual analog scale and changes in peak VO(2) and 6-minute walk distance ranged from 0.13 to 0.28, and correlations between changes in the KCCQ overall and subscale scores and changes in peak VO(2) and 6-minute walk distance ranged from 0.18 to 0.34. A 5-point change in KCCQ was associated with a 2.50-mL kg(-1) min(-1) change in peak VO(2) (95% CI 2.21-2.86) and a 112-m change in 6-minute walk distance (95% CI 96-134). CONCLUSIONS Changes in patient-reported health status are not highly correlated with changes in functional capacity. Our findings generally support the current practice of considering a 5-point change in the KCCQ within individuals to be clinically meaningful.
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Affiliation(s)
- Kathryn E Flynn
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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Horwich TB, Broderick S, Chen L, McCullough PA, Strzelczyk T, Kitzman DW, Fletcher G, Safford RE, Ewald G, Fine LJ, Ellis SJ, Fonarow GC. Relation among body mass index, exercise training, and outcomes in chronic systolic heart failure. Am J Cardiol 2011; 108:1754-9. [PMID: 21907317 DOI: 10.1016/j.amjcard.2011.07.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 12/21/2022]
Abstract
Exercise training (ET) in patients with heart failure (HF), as demonstrated in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION), was associated with improved exercise tolerance and health status and a trend toward reduced mortality or hospitalization. The present analysis of the HF-ACTION cohort examined the effect of ET in overweight and obese subjects compared to normal weight subjects with HF. Of 2,331 subjects with systolic HF randomized to aerobic ET versus usual care in the HF-ACTION, 2,314 were analyzed to determine the effect of ET on all-cause mortality, hospitalizations, exercise parameters, quality of life, and body weight changes by subgroups of body mass index (BMI). The strata included normal weight (BMI 18.5 to 24.9 kg/m(2)), overweight (BMI 25.0 to 29.9 kg/m(2)), obese I (BMI 30 to 34.9 kg/m(2)), obese II (BMI 35 to 39.9 kg/m(2)), and obese III (BMI ≥40 kg/m(2)). At enrollment, 19.4% of subjects were normal weight, 31.3% were overweight, and 49.4% were obese. A greater BMI was associated with a nonsignificant increase in all-cause mortality or hospitalization. ET was associated with nonsignificant reductions in all-cause mortality and hospitalization in each weight category (hazard ratio 0.98, 0.95, 0.92, 0.89, and 0.86 in the normal weight, overweight, obese I, obese II, and obese III categories, respectively; all p >0.05). Modeled improvement in exercise capacity (peak oxygen consumption) and quality of life in the ET group was seen in all BMI categories. In conclusion, aerobic ET in subjects with HF was associated with a nonsignificant trend toward decreased mortality and hospitalization and a significant improvement in quality of life across the range of BMI categories.
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O'Connor CM, Whellan DJ, Wojdyla D, Leifer E, Clare RM, Ellis SJ, Fine LJ, Fleg JL, Zannad F, Keteyian SJ, Kitzman DW, Kraus WE, Rendall D, Piña IL, Cooper LS, Fiuzat M, Lee KL. Factors related to morbidity and mortality in patients with chronic heart failure with systolic dysfunction: the HF-ACTION predictive risk score model. Circ Heart Fail 2011; 5:63-71. [PMID: 22114101 DOI: 10.1161/circheartfailure.111.963462] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to develop a multivariable statistical model for risk stratification in patients with chronic heart failure with systolic dysfunction, using patient data that are routinely collected and easily obtained at the time of initial presentation. METHODS AND RESULTS In a cohort of 2331 patients enrolled in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise TraiNing) study (New York Heart Association class II-IV, left ventricular ejection fraction ≤0.35, randomized to exercise training and usual care versus usual care alone, median follow-up of 2.5 years), we performed risk modeling using Cox proportional hazards models and analyzed the relationship between baseline clinical factors and the primary composite end point of death or all-cause hospitalization and the secondary end point of all-cause death alone. Prognostic relationships for continuous variables were examined using restricted cubic spline functions, and key predictors were identified using a backward variable selection process and bootstrapping methods. For ease of use in clinical practice, point-based risk scores were developed from the risk models. Exercise duration on the baseline cardiopulmonary exercise test was the most important predictor of both the primary end point and all-cause death. Additional important predictors for the primary end point risk model (in descending strength) were Kansas City Cardiomyopathy Questionnaire symptom stability score, higher serum urea nitrogen, and male sex (all P<0.0001). Important additional predictors for the mortality risk model were higher serum urea nitrogen, male sex, and lower body mass index (all P<0.0001). CONCLUSIONS Risk models using simple, readily obtainable clinical characteristics can provide important prognostic information in ambulatory patients with chronic heart failure with systolic dysfunction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
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Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM, Hubbard L, Esser BA, Lovato JF, Perdue LH, Goff DC, Cushman WC, Ginsberg HN, Elam MB, Genuth S, Gerstein HC, Schubart U, Fine LJ. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 2010; 363:233-44. [PMID: 20587587 PMCID: PMC4026164 DOI: 10.1056/nejmoa1001288] [Citation(s) in RCA: 821] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. METHODS In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. RESULTS At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). CONCLUSIONS Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)
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Flynn KE, Lin L, Ellis SJ, Russell SD, Spertus JA, Whellan DJ, Piña IL, Fine LJ, Schulman KA, Weinfurt KP. Outcomes, health policy, and managed care: relationships between patient-reported outcome measures and clinical measures in outpatients with heart failure. Am Heart J 2009; 158:S64-71. [PMID: 19782791 DOI: 10.1016/j.ahj.2009.07.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-reported outcomes are increasingly used to assess the efficacy of new treatments. Understanding relationships between these and clinical measures can facilitate their interpretation. We examined associations between patient-reported measures of health-related quality of life and clinical indicators of disease severity in a large, heterogeneous sample of patients with heart failure. METHODS Patient-reported measures, including the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQol Visual Analog Scale (VAS), and clinical measures, including peak VO(2), 6-minute walk distance, and New York Heart Association (NYHA) class, were assessed at baseline in 2331 patients with heart failure. We used general linear models to regress patient-reported measures on each clinical measure. Final models included for significant sociodemographic variables and 2-way interactions. RESULTS The KCCQ was correlated with peak VO(2) (r = .21) and 6-minute walk distance (r = .27). The VAS was correlated with peak VO(2) (r = .09) and 6-minute walk distance (r = .11). Using the KCCQ as the response variable, a 1-SD difference in peak Vo(2) (4.7 mL/kg/min) was associated with a 2.86-point difference in the VAS (95% CI, 1.98-3.74) and a 4.75-point difference in the KCCQ (95% CI, 3.78-5.72). A 1-SD difference in 6-minute walk distance (105 m) was associated with a 2.78-point difference in the VAS (95% CI, 1.92-3.64) and a 5.92-point difference in the KCCQ (95% CI, 4.98-6.87); NYHA class III was associated with an 8.26-point lower VAS (95% CI, 6.59-9.93) and a 12.73-point lower KCCQ (95% CI, 10.92-14.53) than NYHA class II. CONCLUSIONS These data may inform deliberations about how to best measure benefits of heart failure interventions, and they generally support the practice of considering a 5-point difference on the KCCQ and a 3-point difference on the VAS to be clinically meaningful.
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Bairey Merz CN, Alberts MJ, Balady GJ, Ballantyne CM, Berra K, Black HR, Blumenthal RS, Davidson MH, Fazio SB, Ferdinand KC, Fine LJ, Fonseca V, Franklin BA, McBride PE, Mensah GA, Merli GJ, O'Gara PT, Thompson PD, Underberg JA. ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease. Circulation 2009; 120:e100-26. [DOI: 10.1161/circulationaha.109.192640] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O'Connor CM, Weinfurt KP. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301:1451-9. [PMID: 19351942 PMCID: PMC2690699 DOI: 10.1001/jama.2009.457] [Citation(s) in RCA: 537] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent. OBJECTIVE To test the effects of exercise training on health status among patients with heart failure. DESIGN, SETTING, AND PATIENTS Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with left ventricular ejection fraction of 35% or less. Patients were randomized from April 2003 through February 2007. INTERVENTIONS Usual care plus aerobic exercise training (n = 1172), consisting of 36 supervised sessions followed by home-based training, vs usual care alone (n = 1159). Randomization was stratified by heart failure etiology, which was a covariate in all models. MAIN OUTCOME MEASURES Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary scale and key subscales at baseline, every 3 months for 12 months, and annually thereafter for up to 4 years. The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status. Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle. RESULTS Median follow-up was 2.5 years. At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score (mean, 5.21; 95% confidence interval, 4.42 to 6.00) compared with usual care alone (3.28; 95% confidence interval, 2.48 to 4.09). The additional 1.93-point increase (95% confidence interval, 0.84 to 3.01) in the exercise training group was statistically significant (P < .001). After 3 months, there were no further significant changes in KCCQ score for either group (P = .85 for the difference between slopes), resulting in a sustained, greater improvement overall for the exercise group (P < .001). Results were similar on the KCCQ subscales, and no subgroup interactions were detected. CONCLUSIONS Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training. Improvements occurred early and persisted over time. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00047437.
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Affiliation(s)
- Kathryn E Flynn
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
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Mercer SL, DeVinney BJ, Fine LJ, Green LW, Dougherty D. Study designs for effectiveness and translation research :identifying trade-offs. Am J Prev Med 2007; 33:139-154. [PMID: 17673103 DOI: 10.1016/j.amepre.2007.04.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Practitioners and policymakers need credible evidence of effectiveness to justify allocating resources to complex, expensive health programs. Investigators, however, face challenges in designing sound effectiveness and translation research with relevance for "real-world" settings. METHODS Research experts and federal and foundation funders (n= approximately 120) prepared for and participated in a symposium, held May 4-5, 2004, to weigh the strengths, limitations, and trade-offs between alternate designs for studying the effectiveness and translation of complex, multilevel health interventions. RESULTS Symposium attendees acknowledged that research phases (hypothesis generating, efficacy, effectiveness, translation) are iterative and cyclical, not linear, since research in advanced phases may reveal unanswered questions in earlier phases. Research questions thus always need to drive the choice of study design. When randomization and experimental control are feasible, participants noted that the randomized controlled trial with individual random assignment remains the gold standard for safeguarding internal validity. Attendees highlighted trade-offs of randomized controlled trial variants, quasi-experimental designs, and natural experiments for use when randomization or experimental control or both are impossible or inadequately address external validity. Participants discussed enhancements to all designs to increase confidence in causal inference while accommodating greater external validity. Since no single study can establish causality, participants encouraged replication of studies and triangulation using different study designs. Participants also recommended participatory research approaches for building population relevance, acceptability, and usefulness. CONCLUSIONS Consideration of the study design choices, trade-offs, and enhancements discussed here can guide the design, funding, completion, and publication of appropriate policy- and practice-oriented effectiveness and translational research for complex, multilevel health interventions.
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Affiliation(s)
- Shawna L Mercer
- Guide to Community Preventive Services, National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Anderson LH, Martinson BC, Crain AL, Pronk NP, Whitebird RR, O''Connor PJ, Fine LJ. Health care charges associated with physical inactivity, overweight, and obesity. Prev Chronic Dis 2005; 2:A09. [PMID: 16164813 PMCID: PMC1435706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Physical inactivity, overweight, and obesity are associated with increased morbidity and mortality. The objective of this study was to estimate the proportion of total health care charges associated with physical inactivity, overweight, and obesity among U.S. populations aged 40 years and older. METHODS A predictive model of health care charges was developed using data from a cohort of 8000 health plan members aged 40 and older. Model cells were defined by physical activity status, body mass index, age, sex, smoking status, and selected chronic diseases. Total health care charges were estimated by multiplying the percentage of the population in each cell by the predicted charges per cell. Counterfactual estimates were computed by reclassifying all individuals as physically active and of normal weight while leaving other characteristics unchanged. Charges associated with physical inactivity, overweight, and obesity were computed as the difference between current risk profile total charges and counterfactual total charges. National population percentage estimates were derived from the National Health Interview Survey; those estimates were multiplied by the predicted charges per cell from the health plan analysis. RESULTS Physical inactivity, overweight, and obesity were associated with 23% (95% confidence interval [CI], 10%-34%) of health plan health care charges and 27% (95% CI, 10%-37%) of national health care charges. Although charges associated with these risk factors were highest for the oldest group (aged 65 years and older) and for individuals with chronic conditions, nearly half of aggregate charges were generated from the group aged 40 to 64 years without chronic disease. CONCLUSION Charges associated with physical inactivity, overweight, and obesity constitute a significant portion of total medical expenditures. The results underscore the importance of addressing these risk factors in all segments of the population.
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Affiliation(s)
- Louise H Anderson
- HealthPartners Research Foundation, 8100 34th Ave S, Minneapolis, MN 55440-1309, USA.
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Abstract
BACKGROUND Four common factors--cigarette smoking, risky drinking of alcoholic beverages, physical inactivity, and overweight--contribute substantially to chronic disease prevalence. METHODS We used data from the 2001 National Health Interview Survey to provide an up-to-date picture of multiple risk factor prevalence and clustering in the U.S. population. We conducted a multinomial logit analysis to examine the independent association between each covariate and the dependent ordinal risk factor variable with three levels (none or one risk factor, two risk factors, and three or four risk factors). RESULTS Seventeen percent of the sample of 29,183 subjects had three or more risk factors. For the entire sample, the mean number of risk factors was 1.68 (95% confidence interval [CI]=1.66-1.70). Many demographic and health factors were significantly associated with the mean number of risk factors including gender, age, ethnic/racial categories, education, martial status, presence of chronic diseases, level of mental distress, country of birth, and presence and type of health insurance. Using the risk factor score as the ordinal dependent variable, adjusted odds for having a risk score of three or four versus zero or one were as follows: men aged <65, 2.49 (95% CI=2.29-2.72); education attainment of high school graduate or less, 3.24 (95% CI=2.86-3.67); and individuals with high levels of mental distress, 2.06 (95% CI=1.65-2.58). CONCLUSIONS Our analyses confirm earlier reports of the high prevalence of multiple, clustered behavioral risk factors and underline the challenge this presents for primary care and public health systems.
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Affiliation(s)
- Lawrence J Fine
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA.
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Punnett L, Fine LJ, Keyserling WM, Herrin GD, Chaffin DB. Shoulder disorders and postural stress in automobile assembly work. Scand J Work Environ Health 2000; 26:283-91. [PMID: 10994793 DOI: 10.5271/sjweh.544] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES A case-referent study was conducted in an automobile assembly plant to evaluate the risk of shoulder disorders associated with nonneutral postures. METHODS The cases were workers who reported shoulder pain to the plant clinic during a 10-month period and met symptom criteria (pain frequency or duration in the past year) in an interview; more than one-half also had positive findings in a physical examination. The referents were randomly selected workers who were free of shoulder disorders according to the clinic records, the interview, and the physical examination. For each of the 79 cases and 124 referents, 1 job was analyzed for postural and biomechanical demands by an analyst blinded to the case-referent status. RESULTS Forty-one percent of the subjects flexed or abducted the right arm "severely" (above 90 degrees) during the job cycle, and 35% did so with the left arm. The peak torques at the shoulder were rather low. Shoulder disorders were associated with severe flexion or abduction of the left [odds ratio (OR) 3.2, 95% confidence interval (95% CI) 1.5-6.5] and the right (OR 2.3, 95% CI 1.2-4.8) shoulder. The risk increased as the proportion of the work cycle exposed increased. The relationships were similar for the cases with and without physical findings. Use of hand-held tools increased the risk and also modified the association with postural stress, although the joint exposure distributions limited full analysis of this finding. CONCLUSIONS The findings support the conclusion that severe shoulder flexion or abduction, especially for 10% or more of the work cycle, is predictive of chronic or recurrent shoulder disorders.
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Affiliation(s)
- L Punnett
- Center for Ergonomics, The University of Michigan, Ann Arbor, Michigan, United States.
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Waters TR, Baron SL, Piacitelli LA, Anderson VP, Skov T, Haring-Sweeney M, Wall DK, Fine LJ. Evaluation of the revised NIOSH lifting equation. A cross-sectional epidemiologic study. Spine (Phila Pa 1976) 1999; 24:386-94; discussion 395. [PMID: 10065524 DOI: 10.1097/00007632-199902150-00019] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study of the 1-year prevalence of low back pain was conducted in workers employed in manual lifting jobs. OBJECTIVES To provide epidemiologic data to determine the correlation between the prevalence of low back pain and exposure to manual lifting stressors, measured with the lifting index component of the revised lifting equation from the National Institute for Occupational Safety and Health (NIOSH). SUMMARY OF BACKGROUND DATA The NIOSH lifting equation has been proposed as a practical, yet valid tool for assessing the risks of low back pain caused by manual lifting. To date, however, there have been few studies in which the effectiveness of the equation to identify jobs with elevated rates of low back pain has been evaluated. METHODS Fifty jobs from four industrial sites were evaluated with the NIOSH lifting equation. A symptom and occupational history questionnaire was administered to 204 people employed in lifting jobs and 80 people employed in nonlifting jobs. Regression analysis was used to determine whether there was a correlation between the lifting index and reported low back pain. RESULTS As the lifting index increased from 1.0 to 3.0, the odds of low back pain increased, with a peak and statistically significant odds ratio occurring in the 2 < lifting index < or = 3 category (odds ratio = 2.45). For jobs with a lifting index higher than 3.0, however, the odds ratio was lower (odds ratio = 1.45). CONCLUSIONS Although low back pain is a common disorder, the lifting index appears be a useful indicator for determining the risk of low back pain caused by manual lifting.
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Affiliation(s)
- T R Waters
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Abstract
This report explains the basics of two important uses of surveillance data: determining the magnitude of a specific occupational health or injury problem and examining temporal trends to determine whether the problem is increasing or decreasing. Types of data available for the purpose and some of their strengths and weaknesses are described. The utility of surveillance data is illustrated with examples from surveillance of acute injuries, musculoskeletal disorders, lead overexposures, and hazard surveillance data sets. Increasingly, surveillance systems may be used to evaluate the effectiveness of interventions. Surveillance is most important in times of rapid change in the economy and when resources for prevention may be limited. Both conditions are common in the world today.
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Affiliation(s)
- L J Fine
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Marras WS, Fine LJ, Ferguson SA, Waters TR. The effectiveness of commonly used lifting assessment methods to identify industrial jobs associated with elevated risk of low-back disorders. Ergonomics 1999; 42:229-245. [PMID: 9973881 DOI: 10.1080/001401399185919] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Low-back disorders (LBD) continue to be the most costly and common musculoskeletal problem facing society today. Investigators have developed tools or measures that are intended to identify jobs that will probably be associated with an elevated risk of low-back disorders. However, an important and not widely discussed issue associated with these tools and procedures has been that of the validity or effectiveness of the tools. Therefore the objective of this study was to evaluate the validity and effectiveness of two commonly used types of LBD assessment methods in terms of their ability to correctly associate jobs with LBD risk. The 1981 NIOSH Work Practices Guide for Manual Lifting and the 1991 NIOSH revised lifting equation, along with psychophysical measures were assessed for their ability to correctly identify high-, medium-, and low-risk (of LBD) jobs. Risk was defined according to a database of 353 industrial jobs representing over 21 million person-hours of exposure. The results indicated that both NIOSH measures were predictive and resulted in odds ratios between 3.1 and 4.6. Higher odds ratios were found when the maximum horizontal distance was used to assess a job compared to the average horizontal distance. Further analyses indicated that the two NIOSH assessment methods classified risk in very different ways. The 1981 NIOSH Guide demonstrated good specificity (91%) in that it identified low-risk jobs well but it also displayed low sensitivity by only correctly identifying 10% of the high-risk jobs. The 1993 NIOSH revised lifting equation, on the other hand, had better sensitivity. It correctly identified 73% of the high-risk jobs but did not identify low- and medium-risk jobs well. Using psychophysical criteria it was observed that 60% of the high-risk jobs would be judged to be acceptable, whereas, 64% and 91% of the medium- and low-risk jobs, respectively, would be judged to be acceptable. This study indicates that the different measures have various strengths and weaknesses. When controlling for occupational LBD it should be recognized that a variety of measures exist and that the measure that most appropriately assesses risk depends upon the characteristics of the job.
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Affiliation(s)
- W S Marras
- Biodynamics Laboratory, Ohio State University, Columbus 43210, USA
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Abstract
Metalworking fluids (MWFs) are commonly used in a variety of industrial machining and grinding operations. The National Institute for Occupational Safety and Health (NIOSH) estimates that more that one million workers are exposed to MWFs. NIOSH conducted a comprehensive and systematic review of the epidemiologic studies that examined the association between MWF exposure and cancer. Substantial evidence was found for an increased risk of cancer at several sites (larynx, rectum, pancreas, skin, scrotum, and bladder) associated with at least some MWFs used prior to the mid-1970s. This paper provides the evidence pertaining to cancer at these sites. Cancer at those sites found to have more limited or less consistent evidence for an association with MWF (stomach, esophagus, lung, prostate, brain, colon, and hematopoietic system) will not be discussed in this paper but are discussed in the recent NIOSH Criteria for a Recommended Standard-Occupational Exposure to MWFs. Because the changes in MWF composition that have occurred over the last several decades may not be sufficient to eliminate the cancer risks associated with MWF exposure, reductions in airborne MWF exposures are recommended.
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Affiliation(s)
- G M Calvert
- Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
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Abstract
Occupational injuries continue to exact a great toll on American workers and their employers--the physical and financial costs are enormous. However, in the current political climate, few employers or regulatory agencies will implement injury prevention interventions without specific evidence of their effectiveness. This paper reviews the literature on the design, conduct, and evaluation of occupational injury interventions. Our review suggests that randomized controlled trials are rare and also notes that the quasi-experimental studies in the literature often use the weakest designs. We recommend a hierarchical approach to evaluating occupational injury interventions--beginning with qualitative studies, following up with simple quasi-experimental designs using historical controls, continuing with more elaborate quasi-experimental designs comparing different firms' experience, and, when necessary, implementing randomized controlled trials.
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Affiliation(s)
- C Zwerling
- University of Iowa Injury Prevention Research Center, Iowa City 52242, USA
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Abstract
Work-related upper extremity musculoskeletal disorders "associated with repeated trauma" account for more than 60% of all newly reported occupational illness, 332,000 in 1994 according to the U.S. Department of Labor. These numbers do not include, for example, those disorders categorized as "injuries due to overexertion in lifting," approximately 370,000. Early identification of potential disorders and associated risk factors is needed to reduce these disorders. There are a number of possible methods for conducting surveillance for work-related musculoskeletal disorders (WMDs) based on health outcome: workers' compensation, sickness and accident insurance, OSHA 200 logs, plant medical records, self-administered questionnaires, professional interviews, and physical examinations. In addition, hazard surveillance based on evaluation of job exposures to physical stressors by nonoccupational health personnel is possible. As part of a large labor-management-initiated intervention study to reduce the incidence of WMDs in four automotive plants, we were able to compare the strengths and limitations of each of these surveillance tools. University administered health interviews yielded the highest rate of symptoms; combined physical examinations plus interview (point prevalence) rates were similar to self-administered questionnaires (period prevalence) rates. Plant medical records yielded the lowest rate of WMDs. WMD status on self-administered questionnaire and on physical examination were associated with risk factor exposure scores. This study suggests that symptoms questionnaires and checklist-based hazard surveillance are feasible within the context of joint labor-management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources.
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Affiliation(s)
- B A Silverstein
- University of Michigan School of Public Health, Ann Arbor, USA
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Wegman DH, Fine LJ. Occupational and environmental medicine. JAMA 1996; 275:1831-2. [PMID: 8642735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D H Wegman
- University of Massachusetts, Lowell, USA
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Abstract
It is assumed that prevention of occupational cancer depends upon dissemination of research findings, resulting in changes in work processes and reduction of occupational exposures to carcinogens. Examples of successes and failures of information dissemination are found in the results of research on silicosis. Better assessment of the effectiveness of information dissemination is needed, along with greater understanding of the barriers to implementation of the information by workers and management and improved hazard surveillance.
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Affiliation(s)
- L J Fine
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Department of Health and Human Services, Cincinnati, Ohio, USA
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