scholarly journals Elevated blood pressure in the emergency department – a risk factor for incident cardiovascular disease: An EHR-based cohort study

2019 ◽  
Author(s):  
P. Oras ◽  
H. Häbel ◽  
P. H. Skoglund ◽  
P. Svensson
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Emergency Department ◽  
Cohort Study ◽  
Cox Regression ◽  
University Hospital ◽  
Atherosclerotic Cardiovascular Disease ◽  
Number Needed To Screen ◽  
Increased Risk

ABSTRACTObjectivesIn the emergency department (ED), high blood pressure (BP) is commonly observed but mostly used to evaluate patients’ health in the short-term. We aimed to study whether ED-measured BP is associated with incident atherosclerotic cardiovascular disease (ASCVD), myocardial infarction (MI), or stroke in long-term, and to estimate the number needed to screen (NNS) to prevent ASCVD.DesignElectronic Health Records (EHR) and national register-based cohort study. The association between BP and incident ASCVD was studied with Cox-regression.SettingTwo university hospital emergency departments in Sweden.Data sourcesBP data were obtained from EDs EHR, and outcome information was acquired through the Swedish National Patient Register for all participants.ParticipantsAll patients ≥18 years old who visited the EDs between 2010 to 2016, with an obtained BP (n=300,193).Main outcome measuresIncident ASCVD, MI, and stroke during follow-up.ResultsThe subjects were followed for a median of 42 months. 8,999 incident ASCVD events occurred (MI: 4,847, stroke: 6,661). Both diastolic and systolic BP (SBP) was associated with incident ASCVD, MI, and stroke with a progressively increased risk for SBP within hypertension grade 1 (HR 1.15, 95% CI 1.06 to 1.24), 2 (HR 1.35, 95% CI 1.25 to 1.47), and 3 (HR 1.63, 95% CI 1.49 to 1.77). The six-year cumulative incidence of ASCVD was 12% for patients with SBP ≥180 mmHg compared to 2% for normal levels. To prevent one ASCVD event during the median follow-up, NNS was estimated to 151, whereas NNT to 71.ConclusionsBP in the ED is associated with incident ASCVD, MI, and stroke. High BP recordings in EDs should not be disregarded as isolated events, but an opportunity to detect and improve treatment of hypertension. ED-measured BP provides an important and under-used tool with great potential to reduce morbidity and mortality associated with hypertension.

scholarly journals Blood Pressure Classification of 2017 Associated With Cardiovascular Disease and Mortality in Young Chinese Adults

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Shouling Wu ◽  
Yongjian Song ◽  
Shuohua Chen ◽  
Mengyi Zheng ◽  
Yihan Ma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cox Regression ◽  
Chinese Adults ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
New Guidelines ◽  
Stage 1

The American College of Cardiology/American Heart Association introduced new guidelines for blood pressure (BP) classification in 2017. We explored associations between the newly defined categories and eventual cardiovascular disease (CVD) events, stroke, and all-cause mortality in young Chinese adults. In the community-based Kailuan Study, 16 006 participants aged 18 to 40 years and examined at baseline in 2006/2007 underwent 2-yearly follow-up examinations up to 2016 to 2017. Taking the highest BP reading recorded by manual sphygmomanometry at baseline in 2006 to 2007, we categorized the BP according to the new guidelines. Outcome parameters were CVD events, stroke, and all-cause mortality. During follow-up (mean: 10.9±0.63 years), we observed 458 events (CVD, 167; stroke, 119; and all-cause death, 172). After multivariable adjustment, hazard ratios for CVD events were for elevated BP 0.80 (95% CI, 0.28–2.30), stage 1 hypertension 1.82 (95% CI, 1.12–2.94), and stage 2 hypertension 3.54 (95% CI, 2.18–5.77) versus normal BP. Similar results were obtained for stroke and all-cause death. In Cox regression analysis with BP category entered as time-dependent covariate, stage 1 hypertension was not associated with increased risk ( P >0.10). In the subgroup of individuals taking antihypertensive medication during follow-up, none of the BP categories was significantly associated with the incidence of CVD events. During a mean follow-up of 10.9 years, the newly defined category of stage 1 hypertension in young untreated Chinese adults aged <40 years at baseline was associated with an increased risk for CVD, stroke, and all-cause mortality. This increased risk occurred, however, after progression to stage 2 hypertension. The data may help validating the new BP classification system for young adult Chinese.

Abstract P142: The CKD273 Urinary Peptidomic Biomarker is Associated with Mortality in People at Early Stages of Diabetic Nephropathy Independent of Traditional Risk Factors

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Gemma E Currie ◽  
Sheon Mary ◽  
Bernt J von Scholten ◽  
Morten Lindhardt ◽  
Harald Mischak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Diabetic Nephropathy ◽  
Cox Regression ◽  
Outcome Data ◽  
Diagnostic Purpose ◽  
Urine Albumin ◽  
Geometrical Mean ◽  
Traditional Risk Factors

Background: Mortality in type 2 diabetes (T2D) is primarily driven by cardiovascular disease. This is amplified in diabetic nephropathy (DN), even in early ‘pre-clinical’ stages. A urinary peptidomic classifier (CKD273) has been found to predict DN development in advance of detectable microalbuminuria. Whether it is also a determinant of mortality and cardiovascular disease in patients with established albuminuria is unknown. Methods: We studied 155 subjects with T2D, albuminuria (geometrical mean [IQR]: 85 [34;194] mg/24hrs), controlled blood pressure (129±16/74±11 mmHg) and preserved renal function (eGFR 88±17 ml/min/1.73m 2 ). Blood and urine samples were collected for measurement of estimated glomerular filtration rate (eGFR), urine albumin excretion (UAE), N-terminal pro-brain natriuretic peptide (NT-proBNP; ELISA) and urinary proteomics (capillary electrophoresis coupled to mass spectrometry). Computed tomography imaging was performed to assess coronary artery calcium (CAC) score. Outcome data were collected through national disease registries over a 6 year follow up period. Results: CKD273 correlated with UAE (r=0.481, p=<0.001), age (r=0.238, p=0.003), CAC score (r=0.236, p=0.003), NT-proBNP (r=0.190, p=0.018) and eGFR (r=0.265, p=0.001). On multiple regression only UAE (β=0.402, p<0.001) and eGFR (β=-0.184, p=0.039) were statistically significant determinants. Twenty participants died during follow-up. CKD273 was a determinant of mortality (log rank [Mantel-Cox] p=0.004), and retained significance (p=0.050) after adjustment for age, sex, blood pressure, NT-proBNP and CAC score in a Cox regression model. Neither eGFR nor UAE were determinants of mortality in this cohort. Conclusions: A multidimensional biomarker can provide information on outcomes associated with its primary diagnostic purpose. Here we demonstrate that the peptidomics-based classifier CKD273 is associated with mortality in albuminuric people with T2D in even when adjusted for other established cardiovascular and renal biomarkers.

Cardiovascular Risk Based on ASCVD and KDIGO Categories in Chinese Adults: A Nationwide, Population-Based, Prospective Cohort Study

2021 ◽  
pp. ASN.2020060856
Author(s):  
Yu Xu ◽  
Mian Li ◽  
Guijun Qin ◽  
Jieli Lu ◽  
Li Yan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Risk Prediction ◽  
Cox Regression ◽  
Rank Test ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
Ascvd Risk ◽  
Risk Categories

BackgroundThe Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline used eGFR and urinary albumin-creatinine ratio (ACR) to categorize risks for CKD prognosis. The utility of KDIGO’s stratification of major CVD risks and predictive ability beyond traditional CVD risk prediction scores are unknown.MethodsTo evaluate CVD risks on the basis of ACR and eGFR (individually, together, and in combination using the KDIGO risk categories) and with the atherosclerotic cardiovascular disease (ASCVD) score, we studied 115,366 participants in the China Cardiometabolic Disease and Cancer Cohort study. Participants (aged ≥40 years and without a history of cardiovascular disease) were examined prospectively for major CVD events, including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death.ResultsDuring 415,111 person-years of follow-up, 2866 major CVD events occurred. Incidence rates and multivariable-adjusted hazard ratios of CVD events increased significantly across the KDIGO risk categories in ASCVD risk strata (all P values for log-rank test and most P values for trend in Cox regression analysis <0.01). Increases in c statistic for CVD risk prediction were 0.01 (0.01 to 0.02) in the overall study population and 0.03 (0.01 to 0.04) in participants with diabetes, after adding eGFR and log(ACR) to a model including the ASCVD risk score. In addition, adding eGFR and log(ACR) to a model with the ASCVD score resulted in significantly improved reclassification of CVD risks (net reclassification improvements, 4.78%; 95% confidence interval, 3.03% to 6.41%).ConclusionsUrinary ACR and eGFR (individually, together, and in combination using KDIGO risk categories) may be important nontraditional risk factors in stratifying and predicting major CVD events in the Chinese population.

scholarly journals Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study

2020 ◽  
Vol 77 (3) ◽  
pp. 1157-1167
Author(s):  
Zhirong Yang ◽  
Duncan Edwards ◽  
Stephen Burgess ◽  
Carol Brayne ◽  
Jonathan Mant
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Atherosclerotic Cardiovascular Disease ◽  
Stroke Patients ◽  
Post Stroke ◽  
Increased Risk ◽  
The Impact

Background: Prior atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD) and peripheral artery disease (PAD), are common among patients with stroke, a known risk factor for dementia. However, whether these conditions further increase the risk of post-stroke dementia remains uncertain. Objective: To examine whether prior ASCVD is associated with increased risk of dementia among stroke patients. Methods: A retrospective cohort study was conducted using the Clinical Practice Research Datalink with linkage to hospital data. Patients with first-ever stroke between 2006 and 2017 were followed up to 10 years. We used multi-variable Cox regression models to examine the associations of prior ASCVD with dementia and the impact of prior ASCVD onset and duration. Results: Among 63,959 patients, 7,265 cases (11.4%) developed post-stroke dementia during a median of 3.6-year follow-up. The hazard ratio (HR) of dementia adjusted for demographics and lifestyle was 1.18 (95% CI: 1.12–1.25) for ASCVD, 1.16 (1.10–1.23) for CHD, and 1.25 (1.13–1.37) for PAD. The HRs additionally adjusted for multimorbidity and medications were 1.07 (1.00–1.13), 1.04 (0.98–1.11), and 1.11 (1.00–1.22), respectively. Based on the fully adjusted estimates, there was no linear relationship between the age of ASCVD onset and post-stroke dementia (all p-trend >0.05). The adjusted risk of dementia was not increased with the duration of pre-stroke ASCVD (all p-trend >0.05). Conclusion: Stroke patients with prior ASCVD are more likely to develop subsequent dementia. After full adjustment for confounding, however, the risk of post-stroke dementia is attenuated, with only a slight increase with prior ASCVD.

Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Knut Hagen ◽  
Eystein Stordal ◽  
Mattias Linde ◽  
Timothy J Steiner ◽  
John-Anker Zwart ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Cox Regression ◽  
Subsequent Development ◽  
Population Based ◽  
Health Study ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

scholarly journals Awaking Blood Pressure Surge and Progression to Microalbuminuria in Type 2 Normotensive Diabetic Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Michelangela Barbieri ◽  
Maria Rosaria Rizzo ◽  
Ilaria Fava ◽  
Celestino Sardu ◽  
Nicola Angelico ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Blood Pressure Monitoring ◽  
Adult Patients ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Pressure Surge

Background. We investigated the predictive value of morning blood pressure surge (MBPS) on the development of microalbuminuria in normotensive adults with a recent diagnosis of type 2 diabetes.Methods. Prospective assessments of 24-hour ambulatory blood pressure monitoring and urinary albumin excretion were performed in 377 adult patients. Multivariate-adjusted Cox regression models were used to assess hazard ratios (HRs) between baseline and changes over follow-up in MBPS and the risk of microalbuminuria. The MBPS was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP.Results. After a mean follow-up of 6.5 years, microalbuminuria developed in 102 patients. An increase in MBPB during follow-up was associated with an increased risk of microalbuminuria. Compared to individuals in the lowest tertile (−0.67±1.10 mmHg), the HR and 95% CI for microalbuminuria in those in the highest tertile of change (24.86±6.92 mmHg) during follow-up were 17.41 (95% CI 6.26–48.42);pfor trend <0.001. Mean SD MBPS significantly increased in those who developed microalbuminuria from a mean [SD] of 10.6[1.4]to 36.8[7.1],p<0.001.Conclusion. An increase in MBPS is associated with the risk of microalbuminuria in normotensive adult patients with type 2 diabetes.

scholarly journals Diabetic Retinopathy and Risk of Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3733-3736
Author(s):  
Ka-Ho Wong ◽  
Katherine Hu ◽  
Cecilia Peterson ◽  
Nazanin Sheibani ◽  
Georgios Tsivgoulis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Retinopathy ◽  
Primary Outcome ◽  
Vision Loss ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Increased Risk

Background and Purpose: Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events. Methods: This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%; P =0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20]; P =0.026). This association was not affected by randomization arm in the ACCORD glucose ( P =0.300), lipid ( P =0.660), or blood pressure interventions ( P =0.469). Conclusions: DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.

scholarly journals Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1273-1278 ◽  
Author(s):  
Laura Benschop ◽  
Johannes J Duvekot ◽  
Jeanine E Roeters van Lennep
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Hypertensive Disorder ◽  
Cardiovascular Risk Assessment ◽  
Increased Risk

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.

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