P798Automated blood pressure measurements: optimal diastolic blood pressure range in treated hypertensives at high cardiovascular risk

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Sobieraj ◽  
J Lewandowski ◽  
M Sinski
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Diastolic Blood Pressure ◽  
Pressure Measurements ◽  
Clinical Endpoint ◽  
High Cardiovascular Risk ◽  
Hazard Risk ◽  
Automated Office Blood Pressure

Abstract Background/Introduction Automated office blood pressure measurements (AOBPM) is recommended for the diagnosis of arterial hypertension. Nevertheless, use of automated office blood pressure in monitoring of treated patients with hypertension is limited by the discrepancies between AOBPM, auscultatory and research grade measurements of blood pressure. The treatment targets using AOBPM are not well-determined. Purpose This post-hoc analysis is aimed to establish the optimal range for on-treatment diastolic blood pressure (DBP) measured with AOBPM in hypertensive patients without cardiovascular disease but at high risk, who achieved systolic blood pressure treatment goal (SBP). Methods Data of 3715 subjects without prior cardiovascular disease treated to achieve SBP goal <120 mm Hg were selected from SPRINT trial database obtained from National Heart, Lung and Blood Institute. Clinical endpoint was defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. On-treatment blood pressure was computed as mean of AOBPM readings in a period from 6th month until to end of the study, which was considered as with a stable blood pressure. Optimal on-treatment DBP range was established on the basis of hazard ratio plot for clinical endpoint after adjustment for age, sex, SBP, smoking habits and history of chronic kidney disease. The target DBP range was set to be 10 mm Hg wide, what is line with current ESC/ESH guidelines. To evaluate nonlinear relationship between continuous variables and outcome cubic spline methods were used. Results Data of 3715 (38.3% female and 61.7% male) subjects aged 67.3±9.2 mm Hg were analysed. Mean on-treatment SBP and DBP were 120.8±8.5 mm Hg and 68.2±8.1 mm Hg, respectively. Lowest hazard risk of primary endpoint was found in on-treatment DBP range 62.8–72.8 mm Hg with a minimum at 67.8 mm Hg (Figure 1). Hazard risk increased linearly toward lower and higher values than selected optimal DBP range. Figure 1 Conclusion(s) In treated hypertensives at high cardiovascular risk, but without prior cardiovascular disease who achieved SBP treatment goal, on treatment DBP 62.8–72.8 mm Hg range should be considered when treatment is monitored using AOBPM.

scholarly journals Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

2020 ◽  
pp. 204748732090869 ◽  
Author(s):  
Kornelia Kotseva ◽  
Guy De Backer ◽  
Dirk De Bacquer ◽  
Lars Rydén ◽  
Arno Hoes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
European Society ◽  
Research Programme ◽  
European Countries ◽  
High Cardiovascular Risk ◽  
European Society Of Cardiology

Background European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. Results A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.

scholarly journals Hypertension Management in the High Cardiovascular Risk Population

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ilir Maraj ◽  
John N. Makaryus ◽  
Anthony Ashkar ◽  
Samy I. McFarlane ◽  
Amgad N. Makaryus
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Diabetic Patients ◽  
Hypertension Management ◽  
High Cardiovascular Risk ◽  
Risk Population ◽  
Real Challenge ◽  
Prevention Of Cardiovascular Disease

The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascular risk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more and more people survive acute myocardial infarction. We will review hypertension management in the high cardiovascular risk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients.

scholarly journals Low on-treatment diastolic blood pressure and cardiovascular outcome: A post-hoc analysis using NHLBI SPRINT Research Materials

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Piotr Sobieraj ◽  
Jacek Lewandowski ◽  
Maciej Siński ◽  
Zbigniew Gaciong
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Diastolic Blood Pressure ◽  
Acute Decompensated Heart Failure ◽  
Blood Pressure Reduction ◽  
Clinical Effects ◽  
Pressure Reduction ◽  
Blood Pressure Targets ◽  
Coronary Syndrome

Abstract Recent studies including the SPRINT trial have shown beneficial effects of intensive systolic blood pressure reduction over the standard approach. The awareness of the J-curve for diastolic blood pressure (DBP) causes some uncertainty regarding the net clinical effects of blood pressure reduction. The current analysis was performed to investigate effects of low on-treatment DBP on cardiovascular risk in the SPRINT population. The primary composite outcome was the occurrence of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. The prevalence of primary outcomes was significantly higher in subjects within low DBP in both standard (44–67 mmHg [10.8%] vs 67–73 mmHg [6.7%] vs 73–78 mmHg [5.1%] vs 78–83 mmHg [4.4%] vs 83–113 mmHg [4.3%], p < 0.001) and intensive treatment (38–61 mmHg [6.7%] vs 61–66 mmHg [4.1%] vs 66–70 mmHg [4.5%] vs 70–74 mmHg [2.7%] vs 74–113 mmHg [3.4%], p < 0.001) arms. After adjusting for covariates, low DBP showed no significant effects on cardiovascular risk. Therefore, while reaching blood pressure targets, low DBP should not be a matter of concern.

scholarly journals Differences of Cardiovascular Risk-based on Atherogenic Index Plasma Dan Framingham Risk Score in Postpartum with Preeclampsia and Normotensive

2020 ◽  
Vol 8 (B) ◽  
pp. 389-394
Author(s):  
Cinthya Ayu Meritha Siregar ◽  
Makmur Sitepu ◽  
M. Rhiza Z Tala ◽  
Johny Marpaung ◽  
Henry Salim Siregar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Diastolic Blood Pressure ◽  
Risk Score ◽  
Framingham Risk Score ◽  
Atherogenic Index ◽  
Control Group ◽  
Framingham Risk ◽  
Significant Difference

BACKGROUND: Cardiovascular disease is the number one cause of death in women worldwide. Preeclampsia may be more than just risk factor for the development of cardiovascular disease later in life. Systematic reviews suggested approximately double the risk of ischemic heart disease, cerebrovascular incidents, and mortality of cardiovascular disease after preeclampsia. AIM: The aim of the study was to analyze the differences of cardiovascular risk later in life-based on atherogenic index plasma and Framingham risk score (FRS) in postpartum women with preeclampsia compared with normotensive women. METHODS: This is study a comparative analytic study with case–control design on 46 subjects, divided by 23 postpartum preeclampsia patients as a case sample subject and 23 postpartum with no history of hypertension as the control group. Subjects were examined for blood pressure, height, weight, and asked to fast for at least 8 h before blood lipid profile and glucose were examined with laboratory methods. Atherogenic index plasma and FRS were measured. Data were analyzed using SPSS version 25. p < 0.05 was considered significant. RESULTS: Based on the results, the study found significant differences between systolic and diastolic blood pressure in preeclampsia compared to the control group. Median systolic and diastolic blood pressure in the preeclampsia group compared to control group were 180 versus 110 in systolic blood pressure; 100 versus 80 in diastolic blood pressure with p < 0.000. Total cholesterol, low-density lipid, high-density lipoprotein, and triglycerides levels in preeclampsia were 218.38 ± 23.26 mg/dL, 128.60 ± 22.74 mg/dL, 38.60 ± 5.99 mg/dL, and 252.73 ± 47.16 mg/dL, respectively, with p < 0.05 and non-preeclampsia group were 143.0 ± 16.82 mg/dL, 69.17 ± 23.03 mg/dL, 51.73 ± 8.65 mg/dL, and 121.30 ± 14.65 mg/dL, respectively, with p < 0.05. Differences in plasma atherogenic index values can clearly be observed in the preeclampsia and control groups (p < 0.05). A similar interpretation was found in the FRS (p < 0.05). There was a significant positive correlation between age and body mass index with atherogenic index plasma and FRS in preeclamptic group. CONCLUSION: There was a significant difference in atherogenic index plasma and Framingham risk score of postpartum preeclampsia and normotensive women.

scholarly journals Associations between Five-Year Blood Pressure Variability and Risk of Cardiovascular Events and Mortality

2020 ◽  
Author(s):  
Jiandong Zhou ◽  
Sharen Lee ◽  
Wing Tak Wong ◽  
William KK Wu ◽  
Wai Kit Ming ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Pressure Measurements ◽  
Time To Death ◽  
All Cause Mortality ◽  
Maximum Minimum

AbstractIntroductionBlood pressure variability, in addition to blood pressure itself, has been used as a predictor for mortality. This study examined the predictive power of baseline/latest/mean/median blood pressure and blood pressure variability measures for all-cause mortality and adverse cardiovascular outcomes.MethodsThe retrospective observational study analyzed patients who presented to family medicine clinics between 1st January, 2000 and 31st December, 2001. Blood pressure measurements were obtained over a five-year period. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) and a variability score (number of >=5 mmHg blood pressure change) were used as measures of blood pressure variability. The primary outcome was all-cause mortality and the secondary outcomes were heart failure, acute myocardial infarction, and transient ischemic attack (TIA)/stroke, with follow-up until 31 December 2019.ResultsThis study included 37540 patients (n=29597 patients with >=3 blood pressure measurements). A nonlinear inverse U-shaped relationship was observed between baseline/latest/maximum/minimum/mean/median/RMS measures of diastolic blood pressure and time-to-death for all-cause mortality (P<0.001). Higher variance/SD/CV/variability score of both systolic and diastolic blood pressure was significantly associated with increased risks of all-cause mortality and heart failure, acute myocardial infarction and TIA/stroke (P<0.001). Low baseline/latest/maximum/minimum/mean/median/RMS systolic blood pressure was significantly associated with shorter time-to-death for all-cause mortality (P<0.001).ConclusionNonlinear inverse U-shaped relationships were observed between blood pressure and its variability measures and all-cause mortality. Higher blood pressure variability was associated with increased risk of all-cause mortality, heart failure, acute myocardial infarction and TIA/stroke.

scholarly journals Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk

Hypertension ◽  
2015 ◽  
Vol 66 (3) ◽  
pp. 489-495 ◽  
Author(s):  
Martin G. Myers ◽  
Janusz Kaczorowski ◽  
J. Michael Paterson ◽  
Lisa Dolovich ◽  
Karen Tu
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Office Blood Pressure ◽  
Pressure Measurements ◽  
Automated Office Blood Pressure

Hyperuricemia as risk factor for cardiovascular disease – what’s new?

2020 ◽  
pp. 5-11
Author(s):  
Yu. V. Zhernakova
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Cardiovascular Risk ◽  
Epidemiological Studies ◽  
Point Of View ◽  
Medical Society ◽  
High Cardiovascular Risk ◽  
Management Algorithm ◽  
Russian Medical

A significant number of epidemiological studies have shown that hyperuricemia is highly associated with the risk of developing cardiovascular disease, chronic kidney disease, and diabetes. In this connection, increased attention is required to monitor serum uric acid levels in patients, not only from a rheumatological point of view, but also with regard to reducing cardiovascular and renal risks. This article is a review of studies on the association of hyperuricemia with cardiovascular risk and a new consensus for the management of patients with hyperuricemia and high cardiovascular risk, published in december 2019 by a group of experts of the Russian Medical Society for Arterial Hypertension, which, among other things, includes a management algorithm of this category of patients.

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