scholarly journals BLOOD PRESSURE, SUBCLINICAL MYOCARDIAL INJURY AND CARDIOVASCULAR OUTCOMES AMONG PATIENTS WITH DIABETES AND HIGH CARDIOVASCULAR RISK: OBSERVATIONS FROM THE SAVOR-TIMI 53 TRIAL

2017 ◽  
Vol 69 (11) ◽  
pp. 1653
Author(s):  
Brian Bergmark ◽  
Deepak Bhatt ◽  
Philippe Steg ◽  
Christina Fanola ◽  
Ofri Mosenzon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Myocardial Injury ◽  
Cardiovascular Outcomes ◽  
High Cardiovascular Risk ◽  
Patients With Diabetes

scholarly journals Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk

2018 ◽  
Vol 39 (24) ◽  
pp. 2255-2262 ◽  
Author(s):  
Brian A Bergmark ◽  
Benjamin M Scirica ◽  
Ph Gabriel Steg ◽  
Christina L Fanola ◽  
Yared Gurmu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Outcomes ◽  
High Cardiovascular Risk ◽  
Patients With Diabetes

Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk

2019 ◽  
Vol 40 (25) ◽  
pp. 2032-2043 ◽  
Author(s):  
Michael Böhm ◽  
Helmut Schumacher ◽  
Koon K Teo ◽  
Eva M Lonn ◽  
Felix Mahfoud ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Composite Outcome ◽  
High Cardiovascular Risk ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract Aims Studies have shown a non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and outcomes, with increased risk observed at both low and high blood pressure (BP) levels. We hypothesized that the BP-risk association is different in individuals with and without diabetes at high cardiovascular risk. Methods and results We identified patients with (N = 11 487) or without diabetes (N = 19 450), from 30 937 patients, from 133 centres in 44 countries with a median follow-up of 56 months in the ONTARGET/TRANSCEND studies. Patients had a prior history of stroke, myocardial infarction (MI), peripheral artery disease, or were high-risk diabetics. Patients in ONTARGET had been randomized to ramipril 10 mg daily, telmisartan 80 mg daily, or the combination of both. Patients in TRANSCEND were ACE intolerant and randomized to telmisartan 80 mg daily or matching placebo. We analysed the association of mean achieved in-trial SBP and DBP with the composite outcome of cardiovascular death, MI, stroke and hospitalization for congestive heart failure (CHF), the components of the composite, and all-cause death. Data were analysed by Cox regression and restricted cubic splines, adjusting for risk markers including treatment allocation and accompanying cardiovascular treatments. In patients with diabetes, event rates were higher across the whole spectrum of SBP and DBP compared with those without diabetes (P < 0.0001 for the primary composite outcome, P < 0.01 for all other endpoints). Mean achieved in-trial SBP ≥160 mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: adjusted hazard ratio (HR) 2.31 (1.93–2.76)/1.66 (1.36–2.02) compared with non-diabetics with SBP 120 to <140 mmHg], with similar findings for all other endpoints in patients with diabetes, and for MI and stroke in patients without diabetes. In-trial SBP <120 mmHg was associated with increased risk for the combined outcome in patients with diabetes [HR 1.53 (1.27–1.85)], and for cardiovascular death and all-cause death in all patients. In-trial DBP ≥90 mmHg was associated with increased risk for the primary outcome [diabetes/no diabetes: HR 2.32 (1.91–2.82)/1.61 (1.35–1.93) compared with non-diabetics with DBP 70 to <80 mmHg], with similar findings for all other endpoints, but not for CHF hospitalizations in patients without diabetes. In-trial DBP <70 mmHg was associated with increased risk for the combined outcome in all patients [diabetes/no diabetes: HR 1.77 (1.51–2.06)/1.30 (1.16–1.46)], and also for all other endpoints except stroke. Conclusion High on treatment BP levels (≥160 or ≥90 mmHg) are associated with increased risk of cardiovascular outcomes and death. Also low levels (<120 or <70 mmHg) are associated with increased cardiovascular outcomes (except stroke) and death. Patients with diabetes have consistently higher risks over the whole BP range, indicating that achieving optimal BP goals is most impactful in this group. These data favour guidelines taking lower BP boundaries into consideration, in particular in diabetes. Clinical trial registration http://clinicaltrials.gov.Unique identifier: NCT00153101.

Management of high blood pressure in patients with high cardiovascular risk

Medic ro ◽  
2018 ◽  
Vol 4 (124) ◽  
pp. 48
Author(s):  
Svetlana Moșteoru ◽  
Roxana Pleavă ◽  
Claudia Hudrea ◽  
Laura Gaiţă ◽  
Dan Gaiţă
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
High Blood Pressure ◽  
High Cardiovascular Risk

Therapieziele bei der Hypertoniebehandlung

2017 ◽  
Vol 142 (19) ◽  
pp. 1420-1429 ◽  
Author(s):  
Rainer Düsing
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Measurement Procedure ◽  
Treatment Goals ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Optimal Target ◽  
Elderly Hypertensive ◽  
Intervention Trials

AbstractThe optimal target blood pressure (BP) in the treatment of hypertensive patients remains controversial. Recently, the systolic blood pressure trial (SPRINT) has proposed that a target systolic blood pressure of < 120 mmHg provides prognostic benefit in elderly hypertensive patients at high cardiovascular risk. The results of SPRINT contrast with several other intervention trials which have investigated the effect of intense BP lowering (Secondary Prevention of Small Subcortical Strokes [SPS3], Action to Control Cardiovascular Risk in Diabetes [ACCORD], Heart Outcomes Prevention Evaluation [HOPE]-3). The differences in outcomes in SPRINT vs. other intervention trials are, to a large extend, due to an "unobserved" BP measurement procedure utilized in the SPRINT trial. Thus, a BP goal of < 120 mmHg, at least by conventional BP measurement, remains unproven. Independent of SPRINT the controversial evidence with respect to BP targets calls for further studies and, possibly, for more individualized treatment goals.

Abstract 003: Personalizing the Intensity of Blood Pressure Control: Modeling the Heterogeneity of Risks and Benefits From the SPRINT Trial

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Krishna K Patel ◽  
Suzanne V Arnold ◽  
Paul S Chan ◽  
Yuanyuan Tang ◽  
Yashashwi Pokharel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Prediction Models ◽  
Risk Model ◽  
Treatment Strategies ◽  
Intensive Treatment ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
High Cardiovascular Risk ◽  
Serious Adverse Events

Introduction: In SPRINT (Systolic blood PRessure INtervention Trial), non-diabetic patients with hypertension at high cardiovascular risk treated with intensive blood pressure (BP) control (<120mmHg) had fewer major adverse cardiovascular events (MACE) and all-cause deaths but higher rates of serious adverse events (SAE) compared with patients treated with standard BP control (<140mmHg). However, the degree of benefit or harm for an individual patient could vary due to heterogeneity in treatment effect. Methods: Using patient-level data from SPRINT, we developed predictive models for benefit (freedom from death or MACE) and harm (increased SAE) to allow for individualized BP treatment goals based on projected risk-benefit for each patient. Interactions between candidate variable and treatment were evaluated in the models to identify differential treatment effects. We performed 10 fold cross-validation for both the models. Results: Among 9361 patients, 8606 (92%) patients had no MACE or death event (benefit) and 3529 (38%) patients had a SAE (harm) over a median follow-up of 3.3 years. The benefit model showed good discrimination (c-index= 0.72; cross-validated c-index= 0.72) with treatment interactions of age, sex, and baseline systolic BP (Figure A), with more benefit of intensive BP treatment in patients who are older, male, and have lower baseline SBP. The SAE risk model showed moderate discrimination (c-index=0.66; cross-validated c-index= 0.65) with a treatment interaction of baseline renal function (Figure B), indicating less harm of intensive treatment in patients with a higher baseline creatinine. The mean predicted absolute benefit of intensive BP treatment was of 2.2% ± 2.5% compared with standard treatment, but ranged from 10.7% lower benefit to 17% greater benefit in individual patients. Similarly, mean predicted absolute harm with intensive treatment was 1.0% ± 1.9%, but ranged from 15.9% lesser harm to 4.9% more harm. Conclusion: Among non-diabetic patients with hypertension at high cardiovascular risk, we developed prediction models using basic clinical data that can identify patients with higher likelihood of benefit vs. harm with BP treatment strategies. These models could be used to tailor the treatment approach based on the projected risk and benefit for each unique patient.

Assessment of the carotid artery intima-media complex through ultrasonography and the relationship with Pathobiological Determinants of Atherosclerosis in Youth

2015 ◽  
Vol 26 (7) ◽  
pp. 1333-1342 ◽  
Author(s):  
Thacira D. A. Ramos ◽  
Tatianne M. E. Dantas ◽  
Mônica O. S. Simões ◽  
Danielle F. Carvalho ◽  
Carla C. M. Medeiros
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Cardiovascular Risk ◽  
Carotid Artery ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Z Score ◽  
High Cardiovascular Risk

AbstractObjectiveTo evaluate the presence of carotid thickening and its relationship with the Pathobiological Determinants of Atherosclerosis in Youth score.MethodsWe carried out a cross-sectional study involving 512 brazilian adolescents. Variables such as sex, body mass index, concentrations of non-high-density lipoprotein and high-density lipoprotein cholesterol, blood pressure, blood glucose and glycated haemoglobin A1c levels that make up the score, and carotid thickening through the intima-media complex measured by ultrasound were evaluated. We adopted two cut-off points to evaluate carotid thickening, being considered altered for those higher or equal to the z-score 2+ and ⩾75th percentile. The association was assessed using the χ2 test and univariate and multivariate logistic regression analyses.ResultsHigh cardiovascular risk was present in 10.2% of the adolescents; carotid thickness was present in 4.3% determined by the z-score 2+ and in 25.0% determined by the 75th percentile. When measured by the z-score, carotid thickening was associated with high systolic blood pressure (p=0.024), high-non-high density lipoprotein cholesterol (p=0.039), and high cardiovascular risk assessed by the score and by the 75th percentile, with body mass index >30 (p=0.005). In the multivariate analysis, high cardiovascular risk was found to be independently associated with the presence of carotid thickness evaluated by the z-score, with risk four times greater (p=0.010) of presenting with this condition compared with individuals with low risk, and this fact was not observed when factors were analysed alone.ConclusionThe presence of high cardiovascular risk in adolescents assessed by the Pathobiological Determinants of Atherosclerosis in Youth score was associated with marked thickening of the carotid artery in healthy adolescents.

Sign in / Sign up

Export Citation Format

Share Document