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Alnazer RM, Veldhuizen GP, de Leeuw PW, Kroon AA. Reply to 'Could we be missing something when calculating the aldosterone-to-renin ratio?'. J Hypertens 2023; 41:1500. [PMID: 37545372 DOI: 10.1097/hjh.0000000000003474] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Rawan M Alnazer
- Maastricht University Medical Centre+: Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
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Alnazer RM, Veldhuizen GP, de Leeuw PW, Kroon AA. The effect of age, sex and BMI on the aldosterone-to-renin ratio in essential hypertensive individuals. J Hypertens 2023; 41:618-623. [PMID: 36723461 DOI: 10.1097/hjh.0000000000003377] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aldosterone-to-renin ratio (ARR) is widely used as a screening test for primary aldosteronism, but its determinants in patients with essential hypertension are not fully known. The purpose of the present investigation is to identify the impact of age, sex and BMI on renin, aldosterone and the ARR when measured under strict, standardized conditions in hypertensive patients without primary aldosteronism. METHODS We analysed the data of 423 consecutive hypertensive patients with no concomitant cardiac or renal disorders from two different hospitals (Rotterdam and Maastricht) who had been referred for evaluation of their hypertension. Those who were diagnosed with secondary causes of hypertension, including primary aldosteronism, were excluded from analysis. Patients who used oral contraceptives or had hormonal replacement therapy were excluded as well. Plasma aldosterone concentration (PAC), active plasma renin concentration (APRC) and the ARR were measured under standardized conditions. All measurements were taken in the supine position at 10.00 h in the morning, with one subgroup of patients adhering to a sodium-restricted diet (55 mmol/day) for no less than 3 weeks, and the other subgroup maintaining an ad libitum diet. In those who were receiving antihypertensive treatment, all medications were discontinued at least 3 weeks before testing. RESULTS In neither group did aldosterone correlate with age. Renin, however, was inversely related to age both during low-salt diet ( P < 0.001) and during ad lib salt intake ( P = 0.05). This resulted in a significant positive correlation between age and the ARR in both groups. Although on both dietary regimens, PAC and APRC were significantly higher in men when compared with women, the ARR was not significantly different between the two sexes. The age-relationships of renin and the ARR were comparable in men and women on both diets, albeit with greater variability in women. There was an upward trend between BMI and the ARR, which reached statistical significance only in men on low-salt diet. In multivariable regression analysis, age remained the only independent determinant of the ARR. CONCLUSION In our essential hypertensive population, the ARR increased significantly with age but was not affected by sex or BMI.
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Affiliation(s)
- Rawan M Alnazer
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Zhou TL, Schütten MTJ, Kroon AA, Henry RMA, Houben AJHM, van der Kallen CJH, van Greevenbroek MMJ, de Leeuw PW, Stehouwer CDA. Urinary Sodium Excretion and Salt Intake Are Not Associated With Blood Pressure Variability in a White General Population. J Am Heart Assoc 2022; 12:e026578. [PMID: 36565181 PMCID: PMC9973596 DOI: 10.1161/jaha.122.026578] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Salt restriction may lower blood pressure variability (BPV), but previous studies have shown inconsistent results. Therefore, we investigated in an observational study and intervention trial whether urinary sodium excretion and salt intake are associated with 24-hour BPV. Methods and Results We used data from the cross-sectional population-based Maastricht Study (n=2652; 60±8 years; 52% men) and from a randomized crossover trial (n=40; 49±11 years; 33% men). In the observational study, we measured 24-hour urinary sodium excretion and 24-hour BPV and performed linear regression adjusted for age, sex, mean blood pressure, lifestyle, and cardiovascular risk factors. In the intervention study, participants adhered to a 7-day low- and high-salt diet (50 and 250 mmol NaCl/24 h) with a washout period of 14 days, 24-hour BPV was measured during each diet. We used linear mixed models adjusted for order of diet, mean blood pressure, and body mass index. In the observational study, 24-hour urinary sodium excretion was not associated with 24-hour systolic or diastolic BPV (β, per 1 g/24 h urinary sodium excretion: 0.05 mm Hg [95% CI, -0.02 to 0.11] and 0.04 mm Hg [95% CI, -0.01 to 0.09], respectively). In the intervention trial, mean difference in 24-hour systolic and diastolic BPV between the low- and high-salt diet was not statistically significantly different (0.62 mm Hg [95% CI, -0.10 to 1.35] and 0.04 mm Hg [95% CI, -0.54 to 0.63], respectively). Conclusions Urinary sodium excretion and salt intake are not independently associated with 24-hour BPV. These findings suggest that salt restriction is not an effective strategy to lower BPV in the White general population. Registration URL: https://clinicaltrials.gov/ct2/show/NCT02068781.
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Affiliation(s)
- Tan Lai Zhou
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Monica T. J. Schütten
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Abraham A. Kroon
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Ronald M. A. Henry
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands,Heart and Vascular Center Maastricht University Medical Center+MaastrichtThe Netherlands
| | - Alfonsius J. H. M. Houben
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. J. van Greevenbroek
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Peter W. de Leeuw
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
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Veldhuizen GP, Alnazer RM, Kroon AA, de Leeuw PW. Variability of aldosterone, renin and the aldosterone-to-renin ratio in hypertensive patients without primary aldosteronism. J Hypertens 2022; 40:2256-2262. [PMID: 35950999 DOI: 10.1097/hjh.0000000000003257] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aldosterone-to-renin ratio (ARR) is commonly used in the screening of primary aldosteronism. However, limited information is available with regard to the intra-patient variability in this ratio. Our objective is to determine whether ARR measurements are reliably consistent over both the short- and long-term. METHODS We assessed the short-term variability of the aldosterone-to-renin ratio in 116 unmedicated, essential hypertensive participants who had two blood samples taken in the morning of the same day for measurement of aldosterone and active plasma renin concentration. Long-term variability was studied in 22 unmedicated, essential hypertensive participants who had two blood samples taken approximately 1 year apart. All samples were taken under highly standardized conditions. RESULTS Our data show that renin, aldosterone and the aldosterone-to-renin ratio show marked variations, both when measured on the same day and when assessed at a longer interval. The ARR becomes increasingly variable as its mean value increases. Its degree of variability is similar in both the short-term and the long-term. CONCLUSIONS Based on our findings, we conclude that the aldosterone-to-renin has acceptable short-term variability in the lower ranges, but increasingly dubious reliability as aldosterone-to-renin values rise. Thus, in a clinical context, great caution should be taken in interpreting point-measurements of moderate to high aldosterone-to-renin ratio values.
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Affiliation(s)
- Gregory P Veldhuizen
- Department of Internal Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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5
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Sharma S, Katz R, Ginsberg C, Bullen A, Vallon V, Thomson S, Moe OW, Hoofnagle AN, de Leeuw PW, Kroon AA, Houben AJHM, Ix JH. Renal Clearance of Fibroblast Growth Factor-23 (FGF23) and its Fragments in Humans. J Bone Miner Res 2022; 37:1170-1178. [PMID: 35373859 PMCID: PMC9177785 DOI: 10.1002/jbmr.4553] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022]
Abstract
Relative abundance of fibroblast growth factor-23 (FGF23) measured by the C-terminal (cFGF23, which measures both intact FGF23 and C-terminal fragments) versus intact (iFGF23, measures only intact hormone) assays varies by kidney function in humans. Differential kidney clearance may explain this finding. We measured cFGF23 and iFGF23 in the aorta and bilateral renal veins of 162 patients with essential hypertension undergoing renal angiography. Using multivariable linear regression, we examined factors associated with aorta to renal vein reduction of FGF23 using both assays. Similar parameters and with addition of urine concentrations of cFGF23 and iFGF23 were measured in six Wistar rats. Mean ± standard deviation (SD) age was 54 ± 12 years, 54% were women, and mean creatinine clearance was 72 ± 48 mL/min/100 g. The human kidney reduced the concentrations of both cFGF23 (16% ± 12%) and iFGF23 (21% ± 16%), but reduction was higher for iFGF23. Greater kidney creatinine and PTH reductions were each independently associated with greater reductions of both cFGF23 and iFGF23. The greater kidney reduction of iFGF23 compared to cFGF23 appeared stable and consistent across the range of creatinine clearance evaluated. Kidney clearance was similar, and urine concentrations of both assays were low in the rat models, suggesting kidney metabolism of both cFGF23 and iFGF23. Renal reduction of iFGF23 is higher than that of creatinine and cFGF23. Our data suggest that FGF23 is metabolized by the kidney. However, the major cell types involved in metabolization of FGF23 requires future study. Kidney clearance of FGF23 does not explain differences in C-terminal and intact moieties across the range of kidney function. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Nephrology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ronit Katz
- University of Washington, Seattle, WA, USA
| | - Charles Ginsberg
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Alexander Bullen
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Volker Vallon
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.,Department of Pharmacology, University of California-San Diego, La Jolla, CA, USA
| | - Scott Thomson
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.,Department of Pharmacology, University of California-San Diego, La Jolla, CA, USA
| | - Orson W Moe
- Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Departments of Internal Medicine and Physiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Peter W de Leeuw
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
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de Leeuw PW. Night shifts and hypertension. J Clin Hypertens (Greenwich) 2022; 24:609-610. [PMID: 35285144 PMCID: PMC9106084 DOI: 10.1111/jch.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
Shift workers may develop increased blood pressure.
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Affiliation(s)
- Peter W. de Leeuw
- Department of Medicine Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM) Maastricht The Netherlands
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7
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Linkens AEMJH, Milosevic V, van Nie N, Zwietering A, de Leeuw PW, van den Akker M, Schols JMGA, Evers SMAA, Gonzalvo CM, Winkens B, van de Loo BPA, de Wolf L, Peeters L, de Ree M, Spaetgens B, Hurkens KPGM, van der Kuy HM. Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study. BMC Geriatr 2022; 22:36. [PMID: 35012478 PMCID: PMC8744034 DOI: 10.1186/s12877-021-02723-8] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02723-8.
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Affiliation(s)
- Aimée E M J H Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands. .,Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands.
| | - Vanja Milosevic
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Noémi van Nie
- Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Anne Zwietering
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Institute of General Practice, Goethe University, Frankfurt am Main, Germany.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos M G A Schols
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Carlota Mestres Gonzalvo
- Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | | | | | | | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kim P G M Hurkens
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands
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Woittiez AJJ, de Vogel MC, de Leeuw PW. Can low-grade renal artery stenosis be considered as cause for renovascular hypertension? J Hum Hypertens 2021; 36:420-422. [PMID: 34697407 DOI: 10.1038/s41371-021-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Arend J J Woittiez
- Department of Medicine, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
| | - Michaël C de Vogel
- Department of Medicine, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.,Department of Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - Peter W de Leeuw
- Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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9
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de Leeuw PW. Home and office blood pressure: time to look at the individual patient. Hypertens Res 2021; 44:473-474. [PMID: 33526914 DOI: 10.1038/s41440-020-00586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 08/29/2020] [Accepted: 08/30/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Peter W de Leeuw
- Dept of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
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10
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Alnazer RM, Veldhuizen GP, Kroon AA, de Leeuw PW. The effect of medication on the aldosterone-to-renin ratio. A critical review of the literature. J Clin Hypertens (Greenwich) 2021; 23:208-214. [PMID: 33460525 PMCID: PMC8029867 DOI: 10.1111/jch.14173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 01/07/2023]
Abstract
The aldosterone-to-renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, patients often use medications that could confound the ARR and, thereby, reduce the interpretability of the test. Since it is not always feasible to stop such medication, several drugs that are supposedly neutral with respect to the ARR have been recommended as alternative treatment. The objective of the present review is to explore whether sufficient evidence exists to justify the recommendations. To this end, we performed a systematic PubMed and Cochrane literature search regarding medications that may influence the ARR. Our review revealed that many commonly prescribed antihypertensives seem to have significant effects on renin, aldosterone, and resulting ARR values. However, the magnitude of these effects is poorly quantifiable with the present level of research. We conclude that several medications can affect the ARR. Not taking this into account could lead to misinterpretation of the ARR. Therefore, standardization of the medications used during ARR measurement is advisable for a reliable and accurate interpretation. Further research is needed to ascertain how to best optimize these medications.
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Affiliation(s)
- Rawan M Alnazer
- Department of Internal Medicine, Maastricht University Medical Center+ & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Gregory P Veldhuizen
- Department of Internal Medicine, Maastricht University Medical Center+ & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center+ & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Center+ & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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11
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Soeters PB, de Leeuw PW. Nutritional assessment and the role of preexisting inflammation with a bearing on COVID-19. Reciprocal Translation Between Pathophysiology and Practice in Health and Disease 2021. [PMCID: PMC8014981 DOI: 10.1016/b978-0-12-820205-0.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although there is consensus in the European, American, Latin-American, and Asiatic nutrition and metabolic scientific societies regarding the definition of malnutrition, this definition has not been operationalized. This means that in different countries, the risk of malnutrition on outcome cannot be adequately determined or predicted. In patients with inflammatory activity, the preexistent nutritional status is an important predictor of outcome. Malnutrition is characterized by three crucial elements: undernutrition, inflammation, and diminished function. Malnutrition in our countries as well as in countries with famine almost always is caused by varying degrees of deficient nutritional intake in combination with disease or other damaging inflammatory causes of varying severity. The female genome appears to be better equipped to survive intercurrent trauma or illness than the male one, which impacts on longevity and the ability to overcome certain infections like COVID-19 at higher ages.
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12
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Veldhuizen GP, Alnazer RM, Kroon AA, de Leeuw PW. Confounders of the aldosterone-to-renin ratio when used as a screening test in hypertensive patients: A critical analysis of the literature. J Clin Hypertens (Greenwich) 2020; 23:201-207. [PMID: 33368994 PMCID: PMC8030008 DOI: 10.1111/jch.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
The aldosterone‐to‐renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, there are many factors which could confound the ARR test result and reduce the accuracy of this test. The present review's objective is to identify these factors and to describe to what extent they affect the ARR. Our analysis revealed that sex, age, posture, and sodium‐intake influence the ARR, whereas assay techniques do not. Race and body mass index have an uncertain effect on the ARR. We conclude that several factors can affect the ARR. Not taking these factors into account could lead to misinterpretation of the ARR.
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Affiliation(s)
- Gregory P Veldhuizen
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Rawan M Alnazer
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Sharma S, Katz R, Bullen AL, Chaves PHM, de Leeuw PW, Kroon AA, Houben AJHM, Shlipak MG, Ix JH. Intact and C-Terminal FGF23 Assays-Do Kidney Function, Inflammation, and Low Iron Influence Relationships With Outcomes? J Clin Endocrinol Metab 2020; 105:5909159. [PMID: 32951052 PMCID: PMC7571450 DOI: 10.1210/clinem/dgaa665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/16/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Higher fibroblast growth factor-23 (FGF23) concentrations are associated with heart failure and mortality in diverse populations, but the strengths of associations differ markedly depending up on which assay is used. OBJECTIVE We sought to evaluate whether iron deficiency, inflammation, or kidney function account for differences in the strengths of associations between these 2 FGF23 assays with clinical outcomes. DESIGN Case cohort study from the Cardiovascular Health Study. SETTING A total of 844 community-dwelling individuals aged 65 years or older with and without chronic kidney disease were followed for 10 years. OUTCOMES Outcomes included death, incident heart failure (HF), and incident myocardial infarction (MI). Exposure was baseline intact and C-terminal FGF23. Using modified Cox models, adjusting sequentially we tested whether observed associations of each assay with outcomes were attenuated by iron status, inflammation, kidney function, or their combinations. RESULTS FGF23 measured by either assay was associated with mortality in unadjusted analysis (intact FGF23 hazard ratio [HR] per 2-fold higher 1.45; 95% CI, 1.25-1.68; C-terminal FGF23 HR 1.38; 95% CI, 1.26-1.50). Adjustment for kidney function completely attenuated associations of intact FGF23 with mortality (HR 1.00; 95% CI, 0.85-1.17), but had much less influence on the association of C-terminal FGF23, for which results remained significant after adjustment (HR 1.15; 95% CI, 1.04-1.28). Attenuation was much less with adjustment for iron status or inflammation. Results were similar for the HF end point. Neither C-terminal or intact FGF23 was associated with MI risk. CONCLUSIONS The relationship of FGF23 with clinical end points is markedly different depending on the type of FGF23 assay used. The associations of biologically active FGF23 with clinical end points may be confounded by kidney disease, and thus much weaker than previously thought.
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Affiliation(s)
- Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Nephrology Section, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ronit Katz
- University of Washington, Seattle, Washington
| | - Alexander L Bullen
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Peter W de Leeuw
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, MD Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, MD Maastricht, the Netherlands
| | - Alfons J H M Houben
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, MD Maastricht, the Netherlands
| | | | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
- Correspondence and Reprint Requests: Joachim H. Ix, MD, MAS, University of California San Diego, San Diego, CA 92103, USA. E-mail:
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Zelis N, Buijs J, de Leeuw PW, Stassen PM. Do biomarkers add anything to clinical prediction of mortality in older medical emergency department patients? Eur J Intern Med 2020; 81:106-107. [PMID: 32718878 DOI: 10.1016/j.ejim.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Noortje Zelis
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, The Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.
| | - Jacqueline Buijs
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, The Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Patricia M Stassen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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15
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Gommans DHF, Nas J, Pinto-Sietsma SJ, Koop Y, Konst RE, Mensink F, Aarts GW, Konijnenberg LS, Cortenbach K, Verhaert DV, Thannhauser J, Mol JQ, Rooijakkers MJ, Vos JL, van Rumund A, Vart P, Hassing RJ, Cornel JH, de Jager CPC, van den Heuvel MM, van der Hoeven HG, Verbon A, Pinto YM, van Royen N, van Kimmenade RR, de Leeuw PW, van Agtmael MA, Bresser P, van Gilst WH, Vonk-Noordergraaf A, Tijssen JG, van Royen N, de Jager CPC, van den Heuvel MM, van der Hoeven HG, Verbon A, Pinto YM, van Kimmenade RR, Verbon A, Pinto YM, van Kimmenade RRJ. Rationale and design of the PRAETORIAN-COVID trial: A double-blind, placebo-controlled randomized clinical trial with valsartan for PRevention of Acute rEspiraTORy dIstress syndrome in hospitAlized patieNts with SARS-COV-2 Infection Disease. Am Heart J 2020; 226:60-68. [PMID: 32512291 PMCID: PMC7239793 DOI: 10.1016/j.ahj.2020.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 04/15/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
There is much debate on the use of angiotensin receptor blockers (ARBs) in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-infected patients. Although it has been suggested that ARBs might lead to a higher susceptibility and severity of SARS-CoV-2 infection, experimental data suggest that ARBs may reduce acute lung injury via blocking angiotensin-II-mediated pulmonary permeability, inflammation, and fibrosis. However, despite these hypotheses, specific studies on ARBs in SARS-CoV-2 patients are lacking. METHODS: The PRAETORIAN-COVID trial is a multicenter, double-blind, placebo-controlled 1:1 randomized clinical trial in adult hospitalized SARS-CoV-2-infected patients (n = 651). The primary aim is to investigate the effect of the ARB valsartan compared to placebo on the composite end point of admission to an intensive care unit, mechanical ventilation, or death within 14 days of randomization. The active-treatment arm will receive valsartan in a dosage titrated to blood pressure up to a maximum of 160 mg bid, and the placebo arm will receive matching placebo. Treatment duration will be 14 days, or until the occurrence of the primary end point or until hospital discharge, if either of these occurs within 14 days. The trial is registered at clinicaltrials.gov (NCT04335786, 2020). SUMMARY: The PRAETORIAN-COVID trial is a double-blind, placebo-controlled 1:1 randomized trial to assess the effect of valsartan compared to placebo on the occurrence of ICU admission, mechanical ventilation, and death in hospitalized SARS-CoV-2-infected patients. The results of this study might impact the treatment of SARS-CoV-2 patients globally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC, Rotterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
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16
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Zelis N, Huisman SE, Mauritz AN, Buijs J, de Leeuw PW, Stassen PM. Concerns of older patients and their caregivers in the emergency department. PLoS One 2020; 15:e0235708. [PMID: 32645113 PMCID: PMC7347152 DOI: 10.1371/journal.pone.0235708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Older emergency department (ED) patients often have complex problems and severe illnesses with a high risk of adverse outcomes. It is likely that these older patients are troubled with concerns, which might reflect their preferences and needs concerning medical care. However, data regarding this topic are lacking. Methods This study is a sub study of a prospective, multicenter, observational cohort study among older medical ED patients (≥65 years). Patients or their caregivers were asked about their illness-related concerns during the first stage of the ED visit using a questionnaire. All concerns were categorized into 10 categories, and differences between patients and caregivers, and between age groups were analyzed. Odds Ratios were calculated to determine the association of the concerns for different adverse outcomes. Results Most of the 594 included patients (or their caregivers) were concerned (88%) about some aspects of their illness or their need for medical care. The most often reported concerns were about the severity of disease (43.6%), functional decline (9.4%) and dying (5.6%). Caregivers were more frequently concerned than patients (p<0.001) especially regarding the severity of disease (50.5 vs 39.6%, p = 0.016) and cognitive decline (10.8 vs. 0.3%, p <0.001). We found no difference between age groups. The concern about dying was associated with 30-day mortality (OR 2.89; 95%CI: 1.24–6.70) and the composite endpoint (intensive- or medium care admission, length of hospital stay >7 days, loss of independent living and unplanned readmission within 30 days) (OR 2.32; 95%CI: 1.12–4.82). In addition, unspecified concerns were associated with mortality (OR 1.88; 95%CI: 1.09–3.22). Conclusion The majority of older patients and especially their caregivers are concerned about their medical condition or need for medical care when they visit the ED. These concerns are associated with adverse outcomes and most likely reflect their needs regarding medical care. More attention should be paid to these concerns because they may offer opportunities to reduce anxiety and provide care that is adjusted to their needs. Trial registration This study was registered on clinicalTriagls.gov (NCT02946398).
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Affiliation(s)
- Noortje Zelis
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Sarah E. Huisman
- Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Arisja N. Mauritz
- Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Peter W. de Leeuw
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Patricia M. Stassen
- Division of General Internal Medicine, Department of Internal Medicine, Section Acute Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- School of CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
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17
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Zelis N, Buijs J, de Leeuw PW, van Kuijk SMJ, Stassen PM. A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score. Eur J Intern Med 2020; 77:36-43. [PMID: 32113943 DOI: 10.1016/j.ejim.2020.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Currently, accurate clinical models that predict short-term mortality in older (≥ 65 years) emergency department (ED) patients are lacking. We aimed to develop and validate a prediction model for 30-day mortality in older ED patients that is easy to apply using variables that are readily available and reliably retrievable during the short phase of an ED stay. METHODS Prospective multi-centre cohort study in older medical ED patients. The model was derived through logistic regression analyses, externally validated and compared with other well-known prediction models (Identification of Seniors at Risk (ISAR), ISAR-Hospitalised Patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Early Warning Score (MEWS)). RESULTS Within 30 days after presentation, 66 (10.9%) of 603 patients in the derivation cohort and 105 (13.3%) of 792 patients in the validation cohort died. The newly developed model included 6 predictors: age, ≥2 abnormal vital signs, serum albumin, blood urea nitrogen, lactate dehydrogenase, and bilirubin. The discriminatory value of the model for mortality was very good with an AUC of 0.84 in the derivation and 0.83 in the validation cohort. The final model was excellently calibrated (Hosmer-Lemeshow p-value 0.89). The discriminatory value of the model was significantly higher than that of the four risk stratification scores (highest AUC of 0.69 for ISAR score, p-value 0.007). CONCLUSION We developed and externally validated an accurate and simplified prediction model for 30-day mortality in older ED patients. This model may be useful to identify patients at risk of short-term mortality and to apply personalised medical care.
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Affiliation(s)
- Noortje Zelis
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands.
| | - Jacqueline Buijs
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands; Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
| | - Patricia M Stassen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands; School of CAPHRI, Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
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18
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Schütten MT, Kusters YH, Houben AJ, Niessen HE, Op 't Roodt J, Scheijen JL, van de Waardenburg MP, Schalkwijk CG, de Leeuw PW, Stehouwer CDA. Glucocorticoids affect metabolic but not muscle microvascular insulin sensitivity following high versus low salt intake. JCI Insight 2020; 5:127530. [PMID: 32107343 DOI: 10.1172/jci.insight.127530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUNDSalt-sensitive hypertension is often accompanied by insulin resistance in obese individuals, but the underlying mechanisms are obscure. Microvascular function is known to affect both salt sensitivity of blood pressure and metabolic insulin sensitivity. We hypothesized that excessive salt intake increases blood pressure and decreases insulin-mediated glucose disposal, at least in part by impairing insulin-mediated muscle microvascular recruitment (IMMR).METHODSIn 20 lean and 20 abdominally obese individuals, we assessed mean arterial pressure (MAP; 24-hour ambulatory blood pressure measurements), insulin-mediated whole-body glucose disposal (M/I value; hyperinsulinemic-euglycemic clamp technique), IMMR (contrast-enhanced ultrasound), osmolyte and water balance, and excretion of mineralocorticoids, glucocorticoids, and amino and organic acids after a low- and high-salt diet during 7 days in a randomized, double-blind, crossover design.RESULTSOn a low-, as compared with a high-salt, intake, MAP was lower, M/I value was lower, and IMMR was greater in both lean and abdominally obese individuals. In addition, natural logarithm IMMR was inversely associated with MAP in lean participants on a low-salt diet only. On a high-salt diet, free water clearance decreased, and excretion of glucocorticoids and of amino acids involved in the urea cycle increased.CONCLUSIONOur findings imply that hemodynamic and metabolic changes resulting from alterations in salt intake are not necessarily associated. Moreover, they are consistent with the concept that a high-salt intake increases muscle glucose uptake as a response to high salt-induced, glucocorticoid-driven muscle catabolism to stimulate urea production and thereby renal water conservation.TRIAL REGISTRATIONClinicalTrials.gov, NCT02068781.
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van Twist DJL, de Leeuw PW, Spiering W, Rossi GP, Dominiczak AF, Jennings GLR, Barigou M, Persu A, Kroon AA. Unifocal and Multifocal Fibromuscular Dysplasia. Hypertension 2019; 73:7-12. [PMID: 30571541 DOI: 10.1161/hypertensionaha.118.12004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Daan J L van Twist
- From the Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (D.J.L.v.T, P.W.d.L.)
| | - Peter W de Leeuw
- From the Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (D.J.L.v.T, P.W.d.L.).,Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (P.W.d.L., A.A.K.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands (W.S.)
| | - Gian Paolo Rossi
- Department of Medicine, Hypertension Unit, University of Padova, Italy (G.P.R.)
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (A.F.D.)
| | - Garry L R Jennings
- Sydney Health Partners, Sydney Medical School, University of Sydney, New South Wales, Australia (G.L.R.J.)
| | - Mohammed Barigou
- Assistance Publique-Hôpitaux de Paris, Hypertension Unit, Hospital European Georges Pompidou, University Paris Descartes, France (M.B.)
| | - Alexandre Persu
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.).,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.)
| | - Abraham A Kroon
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (P.W.d.L., A.A.K.)
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Affiliation(s)
- Giuseppe Maiolino
- From the Hypertension Unit, Department of Medicine (G.M., G.P.R.), University of Padua, Italy
| | - Peter W de Leeuw
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (P.W.d.L.).,Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (P.W.d.L., D.J.L.v.T.)
| | - Daan J L van Twist
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, the Netherlands (P.W.d.L., D.J.L.v.T.)
| | - Giulio Barbiero
- Department of Medicine, Institute of Radiology (G.B., M.B.), University of Padua, Italy
| | - Michele Battistel
- Department of Medicine, Institute of Radiology (G.B., M.B.), University of Padua, Italy
| | - Garry L R Jennings
- Sydney Health Partners, Sydney Medical School, University of Sydney, NSW, Australia (G.L.R.J.)
| | - Gian Paolo Rossi
- From the Hypertension Unit, Department of Medicine (G.M., G.P.R.), University of Padua, Italy
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Abstract
Laparoscopy has become the procedure of choice for routine gallbladder removal. A serious complication of this technique is the occurrence of gas emboli due to insufflation. It is associated with a high mortality rate of around 28%. The present systematic review intends to provide more insight into causes, symptoms and risk factors for this specific complication and to explore which measures should be taken to treat and prevent it. The Cochrane library and Pubmed were used as sources. Articles and their references were selected when they were related to the subject in sufficient detail. The course of this complication can vary from asymptomatic up to impairment of normal flow through the right ventricle (RV) or pulmonary artery, potentially leading to acute heart failure. The severity depends on the amount of gas, the rate of accumulation and the ability to remove the gas bubbles. It is difficult to estimate the true incidence of venous gas embolism during laparoscopic cholecystectomy as there are various diagnostic tools, each with different sensitivity. Precautions that need to be taken are: correct positioning of the needle, low insufflation pressure, low insufflation speed, screening for hypovolemia, Trendelenburg positioning, availability of intervention equipment at operation table, no placement of venous catheters during inspiration and catheter removing during expiration. Physicians need to be more aware of this harmful complication and the preventative measurements that need to be taken. As there are virtually no prospective data, future studies are needed to gain more knowledge on gas emboli during laparoscopic cholecystectomy.
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Affiliation(s)
- Kiki I F de Jong
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Peter W de Leeuw
- Department of Medicine, Zuyderland Medical Center, Sittard/Heerlen and Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
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22
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Uiterwijk R, Staals J, Huijts M, van Kuijk SMJ, de Leeuw PW, Kroon AA, van Oostenbrugge RJ. Hypertensive organ damage predicts future cognitive performance: A 9-year follow-up study in patients with hypertension. J Clin Hypertens (Greenwich) 2018; 20:1458-1463. [PMID: 30277642 PMCID: PMC6220879 DOI: 10.1111/jch.13372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/16/2018] [Accepted: 08/04/2018] [Indexed: 01/10/2023]
Abstract
Hypertension is associated with cognitive deficits, probably caused by cerebral small vessel disease. The authors examined whether additional presence of cardiac and renal organ damages, and their combined presence, are associated with future cognitive performance. In 78 patients with essential hypertension (mean age 51.2 ± 12.0 years), brain damage was determined by MRI features, cardiac damage by left ventricular mass index (LVMI), and renal damage by estimated glomerular filtration rate (eGFR) and albuminuria. At 9‐year follow‐up, neuropsychological assessment was performed. LVMI was associated with future lower cognition (P = 0.032), independent of age, sex, premorbid cognition, and brain damage, but eGFR and albuminuria were not. The presence of 2 or 3 types of organ damage compared to none was associated with future lower cognition. Increasing number of hypertensive organ damages, and cardiac damage independently of brain damage, might indicate a more severe hypertensive disease burden and could help to identify patients at risk of cognitive problems.
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Affiliation(s)
- Renske Uiterwijk
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marjolein Huijts
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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van Twist DJL, de Leeuw PW, Kroon AA. Renal artery fibromuscular dysplasia and its effect on the kidney. Hypertens Res 2018; 41:639-648. [DOI: 10.1038/s41440-018-0063-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
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Schütten MTJ, Kusters YHAM, Houben AJHM, Scheijen JLJM, van de Waarenburg MPH, Schalkwijk CG, Joris PJ, Plat J, Mensink RP, de Leeuw PW, Stehouwer CDA. Aldosterone Is Not Associated With Metabolic and Microvascular Insulin Sensitivity in Abdominally Obese Men. J Clin Endocrinol Metab 2018; 103:759-767. [PMID: 29211893 DOI: 10.1210/jc.2017-01541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/07/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Impaired insulin-mediated muscle microvascular recruitment (IMMR) may add to the development of insulin resistance and hypertension. Increased aldosterone levels have been linked to these obesity-related complications in severely to morbidly obese individuals and to impaired microvascular function in experimental studies. OBJECTIVES To investigate whether aldosterone levels are associated with IMMR, insulin sensitivity, and blood pressure in lean and moderately abdominally obese men, and to study the effect of weight loss. DESIGN, SETTING, PARTICIPANTS, INTERVENTION, MAIN OUTCOME MEASURES In 25 lean and 53 abdominally obese men, 24-hour blood pressure measurement was performed, and aldosterone levels were measured using ultra-performance liquid chromatography tandem mass spectrometry. Insulin sensitivity was assessed by determining whole-body glucose disposal during a hyperinsulinemic clamp. IMMR in forearm skeletal muscle was measured with contrast-enhanced ultrasonography. These assessments were repeated in the abdominally obese men following an 8-week weight loss or weight stable period. RESULTS Sodium excretion and aldosterone levels were similar in lean and abdominally obese participants, but sodium excretion was inversely associated with aldosterone concentration only in the lean individuals [lean, β/100 mmol sodium excretion (adjusted for age and urinary potassium excretion) = -0.481 (95% confidence interval, -0.949 to -0.013); abdominally obese, β/100 mmol sodium excretion = -0.081 (95% confidence interval, -0.433 to 0.271); P for interaction = 0.02]. Aldosterone was not associated with IMMR, insulin sensitivity, or blood pressure and was unaffected by weight loss. CONCLUSION In moderately abdominally obese men, the inverse relationship between sodium excretion and aldosterone concentration is less than that in lean men but does not translate into higher aldosterone levels. The absolute aldosterone level does not explain differences in microvascular and metabolic insulin sensitivity and blood pressure between lean and moderately abdominally obese men.
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Affiliation(s)
- Monica T J Schütten
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yvo H A M Kusters
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jean L J M Scheijen
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjo P H van de Waarenburg
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter J Joris
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, School for Cardiovascular Diseases, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
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Uiterwijk R, Staals J, Huijts M, de Leeuw PW, Kroon AA, van Oostenbrugge RJ. Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension. J Clin Hypertens (Greenwich) 2018; 20:240-245. [PMID: 29357202 DOI: 10.1111/jch.13175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
The Framingham Stroke Risk Profile (FSRP) was developed to predict clinical stroke. We investigated if FSRP is associated with more "silent" effects of cerebrovascular disease, namely progression of cerebral small vessel disease (cSVD)-related brain damage and cognitive performance in hypertensive patients. Ninety patients with essential hypertension underwent a brain MRI scan and FSRP assessment at baseline, and a second brain MRI scan and neuropsychological assessment at 9-year follow-up. We visually rated progression of cSVD-related MRI markers. FSRP was associated with progressive periventricular white matter hyperintensities (P = .017) and new microbleeds (P = .031), but not after correction for the FSRP age component. FSRP was associated with lower overall cognitive performance (P < .001) and this remained significant after correction for the FSRP age component. A vascular risk score might be useful in predicting progression of cSVD-related brain damage or future cognitive performance in hypertensive patients. Age seems to be the most important component in FSRP.
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Affiliation(s)
- Renske Uiterwijk
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Marjolein Huijts
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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26
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Deckers K, Camerino I, van Boxtel MP, Verhey FR, Irving K, Brayne C, Kivipelto M, Starr JM, Yaffe K, de Leeuw PW, Köhler S. Author response: Dementia risk in renal dysfunction: A systematic review and meta-analysis of prospective studies. Neurology 2017; 89:2214-2215. [DOI: 10.1212/wnl.0000000000004664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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van Twist DJL, de Leeuw PW, Kroon AA. Coronary Tortuosity: A Clue to the Diagnosis of Fibromuscular Dysplasia? Am J Hypertens 2017; 30:776-780. [PMID: 28472222 DOI: 10.1093/ajh/hpx069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/30/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) is a systemic, nonatherosclerotic, noninflammatory vasculopathy that is often overlooked by clinicians. Clinical clues could help in selecting patients for further evaluation for the presence of FMD. Recently, it was observed that tortuosity of the coronary arteries is often present in patients with FMD-related abnormalities of the coronary artery. Therefore, we wondered if the presence of coronary tortuosity might provide a clinical clue to the diagnosis of extracoronary FMD. CASES We describe 5 cases of FMD in whom diagnostic studies for FMD were initiated because of the presence of coronary tortuosity. FMD was found in all 5 patients in the renal and/or cervical arteries. CONCLUSIONS Our 5 cases suggest that exertional chest pain in the presence of coronary tortuosity may be helpful in selecting patients for further evaluation for the presence of FMD. Further research should focus on the prevalence of FMD among patients with coronary tortuosity and whether the presence of additional clinical clues (such as the presence of hypertension at young age or pulsatile tinnitus) next to coronary tortuosity can predict the risk for FMD in individual patients.
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Affiliation(s)
- Daan J L van Twist
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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de Leeuw PW. Review: Targeting SBP lowering to < 140 mm Hg reduces MACE more than targeting SBP to > 140 in hypertensive patients ≥ 65 y. Ann Intern Med 2017; 166:JC55. [PMID: 28505639 DOI: 10.7326/acpjc-2017-166-10-055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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29
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Schütten MTJ, Houben AJHM, de Leeuw PW, Stehouwer CDA. The Link Between Adipose Tissue Renin-Angiotensin-Aldosterone System Signaling and Obesity-Associated Hypertension. Physiology (Bethesda) 2017; 32:197-209. [PMID: 28404736 DOI: 10.1152/physiol.00037.2016] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/22/2022] Open
Abstract
Obese individuals frequently develop hypertension, which is for an important part attributable to renin-angiotensin-aldosterone system (RAAS) overactivity. This review summarizes preclinical and clinical evidence on the involvement of dysfunctional adipose tissue in RAAS activation and on the renal, central, and vascular mechanisms linking RAAS components to obesity-associated hypertension.
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Affiliation(s)
- Monica T J Schütten
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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30
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de Leeuw PW, Bisognano JD, Bakris GL, Nadim MK, Haller H, Kroon AA. Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up. Hypertension 2017; 69:836-843. [PMID: 28320856 DOI: 10.1161/hypertensionaha.117.09086] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 01/25/2017] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues.
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Affiliation(s)
- Peter W de Leeuw
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
| | - John D Bisognano
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - George L Bakris
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Mitra K Nadim
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Hermann Haller
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
| | - Abraham A Kroon
- From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.)
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Wachter R, Halbach M, Bakris GL, Bisognano JD, Haller H, Beige J, Kroon AA, Nadim MK, Lovett EG, Schafer JE, de Leeuw PW. An exploratory propensity score matched comparison of second-generation and first-generation baroreflex activation therapy systems. ACTA ACUST UNITED AC 2017; 11:81-91. [DOI: 10.1016/j.jash.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle F, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu SN. Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors. Chin Med J (Engl) 2017; 129:127-8. [PMID: 26830980 PMCID: PMC4799536 DOI: 10.4103/0366-6999.173420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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de Leeuw PW, Fagard R, Kroon AA. The effects of missed doses of amlodipine and losartan on blood pressure in older hypertensive patients. Hypertens Res 2017; 40:568-572. [PMID: 28100922 DOI: 10.1038/hr.2016.190] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022]
Abstract
This randomized, double-blind, parallel-group, multicenter study compared the efficacy of amlodipine and losartan in an older hypertensive population, focusing on therapeutic coverage in the case of missed doses. Following a 4-week, single-blind, placebo washout period, 211 patients were randomly assigned to receive either 5 mg of amlodipine once daily or 50 mg of losartan once daily. Doses were doubled after 6 weeks of treatment if the diastolic blood pressure exceeded 90 mm Hg. After the 12-week treatment period, patients received the placebo for 2 days (drug holiday) to simulate two missed doses of antihypertensive medication. Twenty-four-hour ambulatory blood pressure monitoring was conducted at the end of the placebo washout period (baseline), upon completion of the 12-week treatment period (steady state), and after the 2-day drug holiday. Amlodipine was more effective than losartan in reducing patients' 24-h ambulatory blood pressure at the steady-state sampling time. The increases in 24-h blood pressure during the drug holiday averaged 6±2/2±1 mm Hg (P<0.0001) in the amlodipine group and 3±2/2±1 mm Hg (P<0.0001) in the losartan group. The rise in systolic pressure was greater in patients on amlodipine than in those on losartan (P<0.0001). For diastolic pressure, the changes did not differ. Owing to the lower pressure during treatment, patients in the amlodipine group remained at a significantly lower blood pressure level after the 2-day drug holiday. Amlodipine was more effective than losartan in lowering blood pressure and in maintaining blood pressure control after two missed doses, and the difference was most significant for systolic blood pressure.
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Affiliation(s)
- Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands
| | - Robert Fagard
- Hypertension Unit, Leuven University, Leuven, Belgium
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Slot MC, Kroon AA, Damoiseaux JGMC, Theunissen R, Houben AJHM, de Leeuw PW, Tervaert JWC. CD4 +CD28 null T Cells are related to previous cytomegalovirus infection but not to accelerated atherosclerosis in ANCA-associated vasculitis. Rheumatol Int 2017; 37:791-798. [PMID: 28084533 PMCID: PMC5397454 DOI: 10.1007/s00296-016-3643-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Previous studies have suggested an increased risk for cardiovascular events in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). We analyzed the presence of atherosclerotic damage in patients with AAV in relation to the presence of CD4+CD28null T cells and antibodies against cytomegalovirus (CMV) and human Heat-Shock Protein 60 (hHSP60). In this cross-sectional study, patients with inactive AAV were compared with healthy controls (HC). Carotid intima-media thickness (IMT) and aortic pulse-wave velocity (PWV) were measured. In addition, CD4+CD28null T cells, anti-CMV, and anti-hHSP60 levels were determined. Forty patients with AAV were included. Patients’ spouses were recruited as HC (N = 38). CD4+CD28null T cells are present in patients with AAV in a higher percentage (median 3.1, range 0.01–85) than in HC (0.28, 0–36, P < 0.0001). No significant difference in IMT (mm) between patients and controls was detected (mean 0.77 ± standard deviation 0.15 and 0.73 ± 0.11, respectively, P = 0.20). PWV standardized for MAP was increased in AAV patients (9.80 ± 2.50 m/s, compared to 8.72 ± 1.68 in HC, P = 0.04). There was a strong association between a previous CMV infection and the presence and percentage of CD4+CD28null T cells (0.33 vs 13.8, P < 0.001). There was no relationship between CD4+CD28null T cells and/or a previous CMV infection and IMT or PWV. There was no relation between anti-hHSP60 and CD4+CD28null T cells. Increased PWV values suggest atherosclerotic damage in patients with AAV. Plaque size, as determined by IMT, did not differ. CD4+CD28null T cells are increased in AAV and related to the previous CMV infection.
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Affiliation(s)
- Marjan C Slot
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands. .,Department of Internal Medicine, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Abraham A Kroon
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan G M C Damoiseaux
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Ruud Theunissen
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Jan Willem Cohen Tervaert
- Department of Clinical and Experimental Immunology, University Hospital Maastricht, Maastricht, The Netherlands
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35
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Deckers K, Camerino I, van Boxtel MPJ, Verhey FRJ, Irving K, Brayne C, Kivipelto M, Starr JM, Yaffe K, de Leeuw PW, Köhler S. Dementia risk in renal dysfunction: A systematic review and meta-analysis of prospective studies. Neurology 2016; 88:198-208. [PMID: 27974647 DOI: 10.1212/wnl.0000000000003482] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Renal dysfunction has been linked with increased risk for cognitive impairment and dementia, but studies are conflicting. For that reason, the aim of the present systematic review and meta-analysis is to summarize the best available evidence on the prospective association between potential markers of renal dysfunction and development of cognitive impairment or dementia. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched for potential publications until August 1, 2016. Studies were eligible if they fulfilled the following criteria: population-based study, prospective design, ≥100 participants, aged ≥45 years, ≥1 year follow-up, and cognition/dementia outcomes. Where appropriate, random effects meta-analyses were conducted yielding pooled odds ratios (OR) and 95% confidence intervals (CI). RESULTS Twenty-two out of 8,494 abstracts fulfilled the eligibility criteria. Sufficient evidence was found for albuminuria, mixed results for estimated glomerular filtration rate (eGFR), insufficient support for cystatin C, and tentative evidence for serum creatinine and creatinine clearance. Meta-analyses of 5 studies representing 27,805 persons showed a 35% increased risk of cognitive impairment or dementia in those with albuminuria (OR 1.35, 95% CI 1.06-1.73, p = 0.015), whereas eGFR <60 mL/min/1.73 m2 showed no significant association (OR 1.28, 95% CI 0.99-1.65, p = 0.063). No meta-analyses could be done for serum creatinine, creatinine clearance, or cystatin C. CONCLUSIONS The overall evidence for an association between renal dysfunction and cognitive impairment or dementia is modest. Evidence suggests that albuminuria is associated with higher odds of developing cognitive impairment or dementia.
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Affiliation(s)
- Kay Deckers
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands.
| | - Ileana Camerino
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Martin P J van Boxtel
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Frans R J Verhey
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Kate Irving
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Carol Brayne
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Miia Kivipelto
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - John M Starr
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Kristine Yaffe
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Peter W de Leeuw
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
| | - Sebastian Köhler
- From Alzheimer Centrum Limburg (K.D., I.C., M.P.J.v.B., F.R.J.V., S.K.), School for Mental Health and Neuroscience, Maastricht University; Alzheimer Centre and Department of Neurology (I.C.), VU University Medical Centre, Amsterdam, the Netherlands; School of Nursing and Human Sciences (K.I.), Dublin City University, Ireland; Department of Public Health and Primary Care (C.B.), University of Cambridge, UK; Alzheimer Disease Research Center (M.K.), Karolinska Institute, Stockholm, Sweden; Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.S.), University of Edinburgh, UK; Departments of Psychiatry, Neurology, Epidemiology and Biostatistics (K.Y.), School of Medicine, University of California, San Francisco; Department of Medicine (P.W.d.L.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre; and Department of Medicine (P.W.d.L.), Zuyderland MC, Sittard-Geleen/Heerlen, the Netherlands
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors. Ethiop J Health Sci 2016; 26:2-4. [PMID: 26949309 PMCID: PMC4762952 DOI: 10.4314/ejhs.v26i1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Darren B Taichman
- Darren B. Taichman, MD, PhD, Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine
| | - Joyce Backus
- Joyce Backus, MSLS, Representative and Associate Director for Library Operations, National Library of Medicine
| | - Christopher Baethge
- Christopher Baethge, MD, Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal)
| | - Howard Bauchner
- Howard Bauchner, MD, Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network
| | - Peter W de Leeuw
- Peter W. de Leeuw, MD, Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal)
| | - Jeffrey M Drazen
- Jeffrey M. Drazen, MD, Editor-in-Chief, New England Journal of Medicine
| | - John Fletcher
- John Fletcher, MB, BChir, MPH, Editor-in-Chief, Canadian Medical Association Journal
| | - Frank A Frizelle
- Frank A. Frizelle, MBChB, FRACS, Editor-in-Chief, New Zealand Medical Journal
| | - Trish Groves
- Trish Groves, MBBS, MRCPsych, Head of Research, British Medical Journal
| | - Abraham Haileamlak
- Abraham Haileamlak, MD, Editor-in-Chief, Ethiopian Journal of Health Sciences
| | | | - Christine Laine
- Christine Laine, MD, MPH, Editor-in-Chief, Annals of Internal Medicine
| | | | - Anja Pinborg
- Anja Pinborg, MD, Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal)
| | - Peush Sahni
- Peush Sahni, MBBS, MS, PhD, Representative and Past President, World Association of Medical Editors
| | - Sinan Wu
- Sinan Wu, MD, Representative, Chinese Medical Journal
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Schütten MTJ, Houben AJHM, Kroon AA, Stehouwer CDA, de Leeuw PW. Aldosterone-Renin Ratio and Side-Selective Renal Perfusion in Essential Hypertension. Am J Hypertens 2016; 29:1311-1316. [PMID: 27431788 DOI: 10.1093/ajh/hpw077] [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] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The decrease in kidney perfusion as often observed in hypertensive individuals does not necessarily occur in a symmetrical fashion, thereby potentially introducing left-right differences in response to vasoactive agents. Increased aldosterone levels have been associated with reduced renal perfusion in normotensive and hypertensive individuals, but it is unknown whether both kidneys are equally affected in this respect and how angiotensin II is involved in this relationship. Therefore, our aim was to investigate the association of both aldosterone and the aldosterone-renin ratio with side-selective renal blood flow in essential hypertension. METHODS We studied 146 essential hypertensive patients with patent renal arteries who had undergone renal angiography for exclusion of renal artery stenosis. Prior to contrast administration, blood samples were drawn for the determination of renin and aldosterone levels, and side-selective renal blood flow was measured using the 133Xenon washout technique. RESULTS Left mean renal blood flow (MRBF) was significantly lower than right MRBF (227±74 vs. 250±76mL * min-1 * 100g kidney-1, P = 0.01). We could not demonstrate a correlation of ln aldosterone or ln renin with left or right kidney perfusion. Ln aldosterone-renin ratio (ARR), however, was inversely and independently associated with left MRBF (β = -13.993, P = 0.02; fully adjusted model) but not with right MRBF. CONCLUSIONS A higher ARR corresponds to reduced perfusion of the left kidney, yet is not associated with right kidney perfusion. Especially under circumstances of diminished right renal blood flow, this may affect blood pressure and kidney function.
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Affiliation(s)
- Monica T J Schütten
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Alphons J H M Houben
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
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Teunissen-Beekman KFM, Dopheide J, Geleijnse JM, Bakker SJL, Brink EJ, de Leeuw PW, van Baak MA. Effect of increased protein intake on renal acid load and renal hemodynamic responses. Physiol Rep 2016; 4:4/5/e12687. [PMID: 26997623 PMCID: PMC4823604 DOI: 10.14814/phy2.12687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Increased protein intake versus maltodextrin intake for 4 weeks lowers blood pressure. Concerns exist that high‐protein diets reduce renal function. Effects of acute and 4‐week protein intake versus maltodextrin intake on renal acid load, glomerular filtration rate and related parameters were compared in this study. Seventy‐nine overweight individuals with untreated elevated blood pressure and normal kidney function were randomized to consume a mix of protein isolates (60 g/day) or maltodextrin (60 g/day) for 4 weeks in energy balance. Twenty‐four‐hour urinary potential renal acid load (uPRAL) was compared between groups. A subgroup (maltodextrin N = 27, protein mix N = 25) participated in extra test days investigating fasting levels and postprandial effects of meals supplemented with a moderate protein‐ or maltodextrin‐load on glomerular filtration rate, effective renal plasma flow, plasma renin, aldosterone, pH, and bicarbonate. uPRAL was significantly higher in the protein group after 4 weeks (P ≤ 0.001). Postprandial filtration fraction decreased further after the protein‐supplemented breakfast than after the maltodextrin‐supplemented breakfast after 4 weeks of supplementation (P ≤ 0.001). Fasting and postprandial levels of glomerular filtration rate, effective renal plasma flow, renin, aldosterone, angiotensin‐converting enzyme, pH and bicarbonate did not differ between groups. In conclusion, 4 weeks on an increased protein diet (25% of energy intake) increased renal acid load, but did not affect renal function. Postprandial changes, except for filtration fraction, also did not differ between groups. These data suggest that a moderate increase in protein intake by consumption of a protein mix for 4 weeks causes no (undesirable) effects on kidney function in overweight and obese individuals with normal kidney function.
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Affiliation(s)
- Karianna F M Teunissen-Beekman
- Top Institute Food and Nutrition, Wageningen, The Netherlands Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University, Maastricht, The Netherlands
| | - Janneke Dopheide
- Top Institute Food and Nutrition, Wageningen, The Netherlands Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University, Maastricht, The Netherlands
| | - Johanna M Geleijnse
- Top Institute Food and Nutrition, Wageningen, The Netherlands Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Stephan J L Bakker
- Top Institute Food and Nutrition, Wageningen, The Netherlands Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Peter W de Leeuw
- Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Marleen A van Baak
- Top Institute Food and Nutrition, Wageningen, The Netherlands Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism Maastricht University, Maastricht, The Netherlands
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van Varik BJ, Vossen LM, Rennenberg RJ, Stoffers HE, Kessels AG, de Leeuw PW, Kroon AA. Arterial stiffness and decline of renal function in a primary care population. Hypertens Res 2016; 40:73-78. [PMID: 27604344 DOI: 10.1038/hr.2016.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/01/2016] [Accepted: 07/15/2016] [Indexed: 01/07/2023]
Abstract
Arterial stiffness is an important pathophysiological factor linking cardiovascular disease and kidney disease. Controversy exists as to whether arterial stiffness causes renal function decline, or kidney dysfunction leads to stiffening or whether the association is mutual. We aimed to investigate the longitudinal association between arterial stiffness and annual rate of renal function decline. We prospectively investigated in a primary care population whether carotid-femoral pulse wave velocity (PWV) was associated with estimated glomerular filtration rate (eGFR) and annual decline in eGFR in participants aged ⩾40 years without overt kidney disease. Baseline data on PWV and eGFR were available for 587 participants; follow-up measurements with a mean duration of 5.6 years were available for 222 patients. PWV, female gender and mean arterial pressure were independently associated with eGFR at baseline, although age confounded this association. More importantly, baseline PWV, age and eGFR were independent predictors of renal function decline. Stratification for age showed that the effect of PWV on rate of eGFR decline was amplified with advancing age. On the other hand, baseline eGFR did not determine annual change in PWV, suggesting a unidirectional association between arterial stiffness and eGFR. Arterial stiffness amplifies age-related renal function decline, suggesting that arterial stiffness plays a causal role in the development of renal damage, at least at later stages of age-related renal function decline, possibly through impaired renal autoregulation and increased arterial blood pressure pulsatility.
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Affiliation(s)
- Bernard J van Varik
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Zuyderland Medical Center, Sittard, The Netherlands
| | - Liv M Vossen
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Zuyderland Medical Center, Sittard, The Netherlands
| | - Roger J Rennenberg
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Henri E Stoffers
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Alfons G Kessels
- Department of Clinical Epidemiology and Technology Assessment Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Zuyderland Medical Center, Sittard, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Aardenburg R, Spaanderman ME, van Eijndhoven HW, de Leeuw PW, Peeters LL. Formerly Preeclamptic Women With a Subnormal Plasma Volume Are Unable to Maintain a Rise in Stroke Volume During Moderate Exercise. ACTA ACUST UNITED AC 2016; 12:599-603. [PMID: 16198607 DOI: 10.1016/j.jsgi.2005.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In formerly preeclamptic women with a low plasma volume, the recurrence rate of preeclampsia is higher than in women with a normal prepregnant plasma volume. In a recent study, we demonstrated that the low plasma volume subgroup also had a subnormal venous capacitance. In the present study, we determined the impact of subnormal plasma volume on the hemodynamic response to moderate exercise. PATIENTS AND METHODS We performed this study in the follicular phase of the menstrual cycle, in 31 formerly preeclamptic women with a subnormal plasma volume (low-PV) and eight parous controls. The exercise consisted of 60 minutes of cycling in the supine position at 35% of the individualized maximum capacity. Before, during, and after cycling, we measured the percentage change in heart rate, stroke volume, and cardiac output. Before and after exercise, we measured the effective renal plasma flow (ERPF, para-amino-hippurate [PAH] clearance), glomerular filtration rate (GFR, inulin clearance), circulating levels of alpha-atrial natriuretic peptide (alpha-ANP), and active plasma renin concentration (APRC). RESULTS The response to exercise of formerly preeclamptic women with a subnormal plasma volume differed from that in controls by a lack of rise in stroke volume, a smaller rise in cardiac output and alpha-ANP, and a greater fall in GFR. The responses in heart rate, ERPF, and APRC did not differ between the two groups. CONCLUSION The response to moderate exercise of formerly preeclamptic women with a subnormal plasma volume differs from that in healthy parous controls with a normal plasma volume and suggests a lower capacity to raise venous return in conditions of a higher demand for systemic flow. The lower capacity to raise venous return in these conditions is associated with more cardiovascular drift. The physiologic consequence is a lower aerobic endurance performance during moderate exercise.
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Affiliation(s)
- Robert Aardenburg
- Department of Obstetrics and Gynecology, University Hospital Maastricht, Maastricht, The Netherlands.
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Spaanderman MEA, Aardenburg R, Ekhart THA, van Eyndhoven HWF, de Leeuw PW, Peeters LLH. Pre-pregnant Prediction of Recurrent Preeclampsia in Normotensive Thrombophilic Formerly Preeclamptic Women Receiving Prophylactic Antithrombotic Medication. ACTA ACUST UNITED AC 2016; 12:112-7. [PMID: 15695106 DOI: 10.1016/j.jsgi.2004.10.009] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both hemodynamic abnormalities and thrombophilia predispose to pregnancy-associated vascular complications such as fetal growth restriction, stillbirth, preeclampsia, and placental abruption. Antithrombotic treatment may reduce the risk for these events. In this study we tested the hypothesis that in normotensive thrombophilic formerly preeclamptic women certain alterations in hemodynamic function as measured under nonpregnant conditions predict the development of hypertensive disorders and/or fetal growth restriction in the subsequent pregnancy. METHODS In 350 nondiabetic formerly preeclamptic women, we measured in the follicular phase of the menstrual cycle at least 5 months postpartum central hemodynamic, metabolic, and hemostatic variables. In the subsequent ongoing pregnancy we determined fetal outcome variables and the incidence of maternal vascular complications. In addition to a normotensive thrombophilic profile, inclusion for final analysis required a subsequent singleton pregnancy, established within 1 year following the pre-pregnant evaluation and ongoing beyond 16 weeks' gestation. As a consequence, 47 normotensive thrombophilic formerly preeclamptic women could be included for final analysis. All formerly preeclamptic participants received aspirin throughout pregnancy. Additionally, those with thrombophilia or hyperhomocysteinemia were treated with low molecular weight heparin and with pyridoxine and folic acid supplementation, respectively. RESULTS Among 350 formerly preeclamptic women, 266 (76%) were normotensive and 84 (24%) hypertensive. About half (140/266) of normotensive formerly preeclamptic participants were thrombophilic. One hundred eighteen formerly preeclamptic participants succeeded in establishing an ongoing pregnancy within 1 year. From this subset of formerly preeclamptic women, 47 were normotensive thrombophilic; 23 remained normotensive (THROMB), whereas 24 developed at least gestational hypertension (COMPLITHROMB). Participants in the latter subgroup were more obese than those remaining normotensive. In addition, this former subset of women had a higher vascular resistance index, and a lower plasma volume and cardiac index. With respect to fetal outcome, COMPLITHROMB gave birth to an infant with a lower birth weight relative to THROMB. Preeclampsia with or without the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome recurred in 26% of the participants in the whole thrombophilic group, in which a low pre-pregnant plasma volume and a raised vascular resistance predisposed for recurrent hypertensive disorders. CONCLUSION Pre-pregnant hemodynamic, metabolic, and clotting variables in formerly preeclamptic women can predict hypertension in the subsequent pregnancy.
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Affiliation(s)
- Marc E A Spaanderman
- Department of Obstetrics and Gynecology, University Medical Center Nijmegen St. Radboud, Nijmegen.
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Aardenburg R, Spaanderman ME, van Eijndhoven HW, de Leeuw PW, Peeters LL. A Low Plasma Volume in Formerly Preeclamptic Women Predisposes to the Recurrence of Hypertensive Complications in the Next Pregnancy. ACTA ACUST UNITED AC 2016; 13:598-603. [DOI: 10.1016/j.jsgi.2006.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Robert Aardenburg
- Department of Obstetrics and Gynecology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | | | | | | | - Louis L. Peeters
- Departments of Obstetrics and Gynecology and Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
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Spaanderman MEA, Ekhart THA, de Leeuw PW, Peeters LLH. Angiotensin II Sensitivity in Nonpregnant Formerly Preeclamptic Women and Halthy Parous Contorls. ACTA ACUST UNITED AC 2016; 11:416-22. [PMID: 15350256 DOI: 10.1016/j.jsgi.2004.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/16/2023]
Abstract
BACKGROUND In women prone to develop hypertensive complications, vascular reactivity fails to decrease in early pregnancy. Since hypertensive syndromes of pregnancy seem to be superimposed on a preexisting disorder, we tested the hypothesis that in formerly preeclamptic women, as compared to healthy parous controls, circulatory reactivity to angiotensin II is enhanced in the follicular phase of the menstrual cycle. METHODS Sixty formerly preeclamptic women were subdivided into a hypertensive (HYPERT, n = 14), a normotensive thrombophilic (THROMB, n = 26), and a normotensive nonthrombophilic (ASYMPT, n = 20) subgroup. In these women and in 11 healthy parous controls we assessed at least 5 months postpartum at day 5 (+/-2) of the menstrual cycle the following variables: body weight, height, plasma volume, reactivity to infused angiotensin II of arterial blood pressure, heart rate, glomerular filtration rate (GFR), effective renal blood flow, and the hormones of the renin-angiotensin-aldosterone (RAAS) axis. RESULTS At baseline, THROMB did not differ from controls. In contrast, ASYMPT exhibited slight overweight, reduced plasma volume, and reduced renal blood flow. HYPERT much resembled ASYMPT except for the overweight, renal perfusion, and GFR. Infusion of angiotensin II led to comparable decreases in renal perfusion and filtration, and to increases in blood pressure. However, sensitivity to this substance correlated inversely with relative and absolute sizes of the plasma volume compartment. CONCLUSION Circulatory sensitivity to infused angiotensin II is comparable between nonpregnant formerly preeclamptic women and healthy parous controls. However, responsiveness to this agent is enhanced among women with a contracted plasma volume compartment, a condition commonly observed among formerly preeclamptic women.
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data: A Proposal From the International Committee of Medical Journal Editors. Ann Intern Med 2016; 164:505-6. [PMID: 26792258 DOI: 10.7326/m15-2928] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors. CMAJ 2016; 188:91-92. [PMID: 26792811 DOI: 10.1503/cmaj.151465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Darren B Taichman
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Joyce Backus
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Christopher Baethge
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Howard Bauchner
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Peter W de Leeuw
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Jeffrey M Drazen
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - John Fletcher
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Frank A Frizelle
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Trish Groves
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Abraham Haileamlak
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Astrid James
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Christine Laine
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Larry Peiperl
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Anja Pinborg
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Peush Sahni
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
| | - Sinan Wu
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine (Taichman); Representative and Associate Director for Library Operations, National Library of Medicine (Backus); Chief Scientific Editor, Deutsches Ärzteblatt (German Medical Journal) (Baethge); Editor-in-Chief, JAMA (Journal of the American Medical Association) and the JAMA Network (Bauchner); Editor-in-Chief, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal) (de Leeuw); Editor-in-Chief, New England Journal of Medicine (Drazen); Editor-in-Chief, Canadian Medical Association Journal (Fletcher); Editor-in-Chief, New Zealand Medical Journal (Frizelle); Head of Research, British Medical Journal (Groves); Editor-in-Chief, Ethiopian Journal of Health Sciences (Haileamlak); Deputy Editor, The Lancet (James); Editor-in-Chief, Annals of Internal Medicine (Laine); Chief Editor, PLOS Medicine (Peiperl); Scientific Editor-in-Chief, Ugeskrift for Laeger (Danish Medical Journal) (Pinborg); Representative and Past President, World Association of Medical Editors (Sahni); Representative, Chinese Medical Journal (Wu)
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data: A Proposal From the International Committee of Medical Journal Editors. JAMA 2016; 315:467-8. [PMID: 26792562 DOI: 10.1001/jama.2015.18164] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Joyce Backus
- Associate Director for Library Operations, US National Library of Medicine
| | | | | | | | | | - John Fletcher
- Editor in Chief, Canadian Medical Association Journal
| | | | | | | | | | | | | | - Anja Pinborg
- Scientific Editor in Chief, Ugeskrift for Laeger (Danish Medical Journal
| | - Peush Sahni
- Representative and Past President, World Association of Medical Editors
| | - Sinan Wu
- Representative, Chinese Medical Journal
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing clinical trial data: a proposal from the International Committee of Medical Journal Editors. Dan Med J 2016; 63:A5205. [PMID: 26836791] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle F, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors. N Z Med J 2016; 129:7-9. [PMID: 26914293] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Darren B Taichman
- American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Lain C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data. Dtsch Arztebl Int 2016; 113:41-3. [PMID: 26883412 DOI: 10.3238/arztebl.2016.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Darren B Taichman
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine, Representative and Associate Director for Library Operations, National Library of Medicine, Section Science and CME, Deutsches Ärzteblatt,(Journal of the American Medical Association) and the JAMA Network, Nederlands Tijdschrift voor Geneeskunde (The Dutch Medical Journal), New England Journal of Medicine, John Fletcher, MB, BChir, MPH, Editor-in-Chief, Canadian Medical Association Journal, New Zealand Medical Journal, Head of Research, British Medical Journal, Ethiopian Journal of Health Sciences, The Lancet, Annals of Internal Medicine, PLOS Medicine, Ugeskrift for Laeger (Danish Medical Journal), Representative and Past President, World Association of Medical Editors, Representative, Chinese Medical Journal
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Taichman DB, Backus J, Baethge C, Bauchner H, de Leeuw PW, Drazen JM, Fletcher J, Frizelle FA, Groves T, Haileamlak A, James A, Laine C, Peiperl L, Pinborg A, Sahni P, Wu S. Sharing Clinical Trial Data--A Proposal from the International Committee of Medical Journal Editors. N Engl J Med 2016; 374:384-6. [PMID: 26786954 DOI: 10.1056/nejme1515172] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Darren B Taichman
- Secretary, ICMJE, Executive Deputy Editor, Annals of Internal Medicine
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