POS0815 CLINICAL CHARACTERISTICS, IMAGING PHENOTYPE, AND LONG-TERM OUTCOMES OF TAKAYASU ARTERITIS PATIENTS WITH HYPERTENSION

Background:Hypertension occurred in 30-80% of TAK patients around the world. The occurrence of hypertension might severely worsen TAK prognosis. Nevertheless, data describing the specific imaging features in hypertensive TAK patients and the associations between hypertensive severity, blood pressure control status and long-term outcome were still lacking.Objectives:To investigate the characteristics and associations of hypertensive characteristics with adverse events-free survival in Takayasu arteritis (TAK) patients with hypertension.Methods:This research was based on a prospectively on-going observational cohort-East China Takayasu Arteritis (ECTA) cohort. In all, 618 TAK patients, who registered in the ECTA cohort up to December 2019, were enrolled. The main outcome was the adverse-events-free survival among hypertensive TAK patients during the follow-up ended on August 2020.Results:Totally, 204 (33.0%) patients suffered from hypertension, with 48 (23.5%), 62 (30.4%), and 94 (46.1%) mild, moderate, and severe hypertension, respectively. Cluster analysis indicated three imaging phenotypes for hypertensive TAK patients: Cluster 1: involvement of the abdominal aorta and/or renal artery (n=56, 27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, and the aortic arch and its branches (n=38, 18.6%); Cluster 3: combined involvement of Cluster 1 and Cluster 2 (n=111, 54.4%). By the end of the follow-up, the blood pressure control rate was 50.8%, while the adverse-events-free survival was 67.9% in the entire hypertensive population. Multivariate Cox regression analysis indicated that well-controlled blood pressure (HR=2.13, 95%CI 1.32–3.78, p=0.047), co-existence of severe aortic valve regurgitation (HR=0.87, 95%CI 0.64–0.95, p=0.043), Cluster 1 (HR=0.69, 95%CI 0.48–0.92, p=0.017) and Cluster 3 (HR=0.72, 95%CI 0.43–0.94, p=0.048) imaging phenotype was associated with the adverse-events-free survival.Conclusion:Patients with controlled hypertension showed better adverse-events-free survival, while those with the Cluster 1 imaging phenotype were more likely to suffer from worse adverse-events-free survival. Hypertension occurred in 30-80% of TAK patients around the world. The occurrence of hypertension might severely worsen TAK prognosis.References:[1]Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol 2002; 55:481–6.[2]Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from a cross-country research in Japan: age and sex specificity. Circulation 2015; 132:1701–9.[3]Yilmaz N, Can M, Oner FA, et al. Impaired quality of life, disability and mental health in Takayasu’s arteritis. Rheumatol. (Oxford) 2013; 52:1898–904.[4]Laurent A, Julien H, Nicolas L, et al. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine 2010; 89:1–17.[5]Mwipatayi BP, Jeffery PC, Beningfield SJ, et al. Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg 2005; 75:110–7.Disclosure of Interests:None declared

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Clinical characteristics, imaging phenotypes and events free survival in Takayasu arteritis patients with hypertension

Arthritis Research & Therapy ◽

10.1186/s13075-021-02579-8 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Sun Ying ◽

Wu Sifan ◽

Wang Yujiao ◽

Chen Rongyi ◽

Huang Qingrong ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Takayasu Arteritis ◽

Clinical Characteristics ◽

Cox Regression ◽

Pressure Control ◽

Free Survival ◽

Uncontrolled Blood Pressure ◽

Kaplan Meier ◽

Cluster 2

Abstract Background Hypertension occurred in 30–80% of Takayasu arteritis (TAK) patients around the world and the occurrence of hypertension might worsen the disease prognosis. This study aimed to investigate the clinical characteristics and imaging phenotypes, as well as their associations with events free survival (EFS) in Chinese TAK patients with hypertension. Methods This current research was based on a prospectively ongoing observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 TAK patients with hypertension were enrolled between January 2013 and December 2019. Clinical characteristics and imaging phenotypes of each case were evaluated and their associations with the EFS by the end of August 30, 2020, were analyzed. Results Severe hypertension accounted for 46.1% of the entire population. Three specific imaging phenotypes were identified: Cluster 1: involvement of the abdominal aorta and/or renal artery (27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, the aortic arch, and/or its branches (18.6%); and Cluster 3: combined involvement of Cluster 1 and 2 (53.9%). Clinical characteristics, especially hypertensive severity, differed greatly among the three imaging clusters. In all, 187 patients were followed up for a median of 46 (9–102) months; 72 events were observed in 60 patients (1–3 per person). The overall blood pressure control rate was 50.8%, and the EFS was 67.9% by the end of the follow-up. Multivariate Cox regression indicated that controlled blood pressure (HR = 2.13, 95% CI 1.32–3.74), Cluster 1 (HR = 0.69, 95% CI 0.48–0.92) and Cluster 3 (HR = 0.72, 95% CI 0.43–0.94) imaging phenotype was associated with the EFS. Kaplan–Meier curves showed that patients with controlled blood pressure showed better EFS (p = 0.043). Furthermore, using cases with Cluster 1 imaging phenotype and controlled blood pressure as reference, better EFS was observed in patients with Cluster 2 phenotype and controlled blood pressure (HR = 2.21, 95%CI 1.47–4.32), while the case with Cluster 1 phenotype plus uncontrolled blood pressure (HR = 0.64, 95%CI 0.52–0.89) and those with Cluster 3 phenotype and uncontrolled blood pressure (HR = 0.83, 95%CI 0.76–0.92) suffered worse EFS. Conclusion Blood pressure control status and imaging phenotypes showed significant effects on the EFS for TAK patients with hypertension.

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Clinical characteristics, imaging phenotypes and events free survival in hypertensive Takayasu arteritis population

10.21203/rs.3.rs-525884/v1 ◽

2021 ◽

Author(s):

Ying Sun ◽

Sifan Wu ◽

Yujiao Wang ◽

Rongyi Chen ◽

Qingrong Huang ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Takayasu Arteritis ◽

Clinical Characteristics ◽

Cox Regression ◽

Pressure Control ◽

Free Survival ◽

Uncontrolled Blood Pressure ◽

Kaplan Meier ◽

Cluster 2

Abstract Background Hypertension occurred in 30–80% of Takayasu arteritis (TAK) patients around the world and the occurrence of hypertension might worsen the disease prognosis. This study aimed to investigate the clinical characteristics and imaging phenotypes, as well as their associations with events free survival (EFS) in hypertensive TAK population. Methods This current research was based on a prospectively on-going observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 hypertensive TAK patients were enrolled between January 2013 and December 2019. Clinical characteristics and imaging phenotypes of each case were evaluated and their associations with the EFS by the end of August 30, 2020 were analyzed. Results Severe hypertension accounted for 46.1% of the entire population. Three specific imaging phenotypes were identified: Cluster 1: involvement of the abdominal aorta and/or renal artery (27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, and the aortic arch and/or its branches (18.6%); and Cluster 3: combined involvement of Cluster 1 and 2 (53.9%). Clinical characteristics, especially hypertensive severity, differed greatly among three imaging clusters. In all, 187 patients were followed-up for a median of 46 (9-102) months; 127 (67.9%) cases did not experience any events, while 72 events were observed in 60 patients. The overall blood pressure control rate was 50.8%, and the EFS was 67.9% by the end of the follow-up. Multivariate Cox regression indicated that controlled blood pressure (HR = 2.13, 95% CI 1.32–3.74), Cluster 1 (HR = 0.69, 95% CI 0.48–0.92) and Cluster 3 (HR = 0.72, 95% CI 0.43–0.94) imaging phenotype was associated with the EFS. Kaplan–Meier curves showed that patients with controlled blood pressure showed better EFS (p = 0.043). Furthermore, patients had controlled blood pressure and Cluster 1 phenotype was set as reference, better EFS was observed in patients with controlled blood pressure and Cluster 2 phenotype (HR = 2.21, 95%CI 1.47–4.32), while those had uncontrolled blood pressure and Cluster 1 phenotype (HR = 0.64, 95%CI: 0.52–0.89) and those had uncontrolled blood pressure and Cluster 3 phenotype (HR = 0.83, 95%CI: 0.76–0.92) suffered worse EFS. Conclusion Blood pressure control status and imaging phenotypes showed significant effects on the EFS for hypertensive TAK.

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AB0509 SUSPENSIVE EFFICACY OF TOCILIZUMAB IN TREATMENT-NAÏVE PATIENTS WITH TAKAYASU ARTERITIS: TOCITAKA FRENCH PROSPECTIVE MULTICENTER OPEN-LABELLED TRIAL.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4592 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1552.3-1552

Author(s):

A. Mekinian ◽

D. Saadoun ◽

J. C. N. F. [email protected] ◽

I. Q. M. F. [email protected] ◽

P. Jégo ◽

...

Keyword(s):

Disease Activity ◽

Takayasu Arteritis ◽

Immunosuppressive Drugs ◽

Relapse Free Survival ◽

Research Support ◽

Free Survival ◽

Treatment Naïve ◽

Steroid Sparing

Objectives:To assess long term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK).Methods:In this multicenter, prospective, open-labelled trial, we aim to evaluate the benefit of adding tocilizumab to steroids in treatment-naïve patients with TAK, on discontinuation of steroids after 6 months of tocilizumab treatment, and to assess relapse-free survival following tocilizumab discontinuation.Results:Thirteen patients with TAK were included, with a median age of 32 years [19-45] and 12 (92%) females. Six (54%) patients met the primary end-point. Among 11 (85%) patients which achieved remission at 6 months, 6 (54%) have reached primary endpoint.. Among the 5 remaining patients which continued steroids, 3 had a prednisone-equivalent dosage < 5mg/day. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3-4] at baseline, versus 1 [0-2] after 6 months; p <0.001), ITAS-2010 score (5 [2-7] versus 3 [0-8]; p = 0.002), and ITAS-A score (7 [4-10] versus 4 [1-15]; p = 0.0001)]. All patients discontinued tocilizumab after 7 infusions, and no other immunosuppressive drugs was introduced, except for 1 patient which received methotrexate. After 9 and 12 months, respectively 7 (54%) and 6 (50%) patients achieved remission with less than 7.5 mg/day of prednisone, and 9 (69%) and 9 (75%) with doses <10 mg/day. During the 12 months follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab.No severe AEs were considered related to study treatment and none required tocilizumab interruption or dose reduction. No deaths have occurred during the study period.Conclusion:Tocilizumab seems an effective steroid sparing therapy in TAK but its effect appears to be suspensive.Disclosure of Interests:Arsene Mekinian: None declared, david Saadoun: None declared, [email protected] [email protected]: None declared, [email protected] [email protected]: None declared, Patrick Jégo: None declared, [email protected] [email protected]: None declared, wxv wxv: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Mathieu Vautier: None declared, [email protected]>; [email protected]>;: None declared, Patrice cacoub: None declared, olivier fain: None declared

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Adjuvant Letrozole and Tamoxifen Alone or Sequentially for Postmenopausal Women With Hormone Receptor–Positive Breast Cancer: Long-Term Follow-Up of the BIG 1-98 Trial

Journal of Clinical Oncology ◽

10.1200/jco.18.00440 ◽

2019 ◽

Vol 37 (2) ◽

pp. 105-114 ◽

Cited By ~ 21

Author(s):

Thomas Ruhstaller ◽

Anita Giobbie-Hurder ◽

Marco Colleoni ◽

Maj-Britt Jensen ◽

Bent Ejlertsen ◽

...

Keyword(s):

Breast Cancer ◽

Adverse Events ◽

Contralateral Breast Cancer ◽

Disease Free Survival ◽

Luminal Breast Cancer ◽

Free Survival ◽

Long Term Follow Up ◽

Disease Free

Purpose Luminal breast cancer has a long natural history, with recurrences continuing beyond 10 years after diagnosis. We analyzed long-term follow-up (LTFU) of efficacy outcomes and adverse events in the Breast International Group (BIG) 1-98 study reported after a median follow-up of 12.6 years. Patients and Methods BIG 1-98 is a four-arm, phase III, double-blind, randomized trial comparing adjuvant letrozole versus tamoxifen (either treatment received for 5 years) and their sequences (2 years of one treatment plus 3 years of the other) for postmenopausal women with endocrine-responsive early breast cancer. When pharmaceutical company sponsorship ended at 8.4 years of median follow-up, academic partners initiated an observational, LTFU extension collecting annual data on survival, disease status, and adverse events. Information from Denmark was from the Danish Breast Cancer Cooperative Group Registry. Intention-to-treat analyses are reported. Results Of 8,010 enrolled patients, 4,433 were alive and not withdrawn at an LTFU participating center, and 3,833 (86%) had at least one LTFU report. For the monotherapy comparison of letrozole versus tamoxifen, we found a 9% relative reduction in the hazard of a disease-free survival event with letrozole (hazard ratio [HR], 0.91; 95% CI, 0.81 to 1.01). HRs for other efficacy end points were similar to those for disease-free survival. Efficacy of letrozole versus tamoxifen for contralateral breast cancer varied significantly over time (0- to 5-, 5- to 10-, and > 10-year HRs, 0.62, 0.47, and 1.35, respectively; treatment-by-time interaction P = .005), perhaps reflecting a longer carryover effect of tamoxifen. Reporting of specific long-term adverse events seemed more effective with national registry than with case-record reporting of clinical follow-up. Conclusion Efficacy end points continued to show trends favoring letrozole. Letrozole reduced contralateral breast cancer frequency in the first 10 years, but this reversed beyond 10 years. This study illustrates the value of extended follow-up in trials of luminal breast cancer.

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Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

SAGE Open Medical Case Reports ◽

10.1177/2050313x19870972 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1987097

Author(s):

Francesco Versaci ◽

Giuseppe Andò ◽

Marcello Chiocchi ◽

Francesco Romeo

Keyword(s):

Blood Pressure ◽

Renal Denervation ◽

Hemorrhagic Stroke ◽

Blood Pressure Reduction ◽

Pressure Control ◽

Refractory Hypertension ◽

Sustained Efficacy ◽

Term Benefit

A 49-year-old man with malignant hypertension had been admitted with hemorrhagic stroke. Refractory hypertension had been observed during hospitalization and the decision had been made to perform renal denervation. A significant blood pressure reduction was obtained immediately after renal denervation and persists at 2-year follow-up. This case demonstrates the long-term sustained efficacy of renal denervation performed in the acute phase of hemorrhagic stroke. In addition, it supports the notion that renal denervation–induced normalization of blood pressure may contribute to better outcomes in a challenging setting such as intracranial bleeding.

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P1806OUTCOMES OF PEDIATRIC RENOVASCULAR HYPERTENSON: A SINGLE-CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1806 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jiwon Jung ◽

Joo Hoon Lee ◽

Kun suk Kim ◽

Young Seo Park

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Blood Pressure Control ◽

Antihypertensive Agents ◽

Good Control ◽

Pressure Control ◽

Renovascular Disease ◽

Antihypertensive Medications

Abstract Background and Aims Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH). Method We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated. Results 20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB. All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up. Conclusion Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.

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Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Kidney & Blood Pressure Research ◽

10.1159/000443423 ◽

2016 ◽

Vol 41 (3) ◽

pp. 278-287 ◽

Cited By ~ 2

Author(s):

Krzysztof Milewski ◽

Wojciech Fil ◽

Piotr Buszman ◽

Małgorzata Janik ◽

Wojciech Wanha ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Blood Pressure Control ◽

Pressure Control ◽

Renal Artery Stenting ◽

Long Term Follow Up

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Is Tight Blood Pressure Control in Hypertensive Long-Term Care Patients Associated with Adverse Events?

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.01.060 ◽

2015 ◽

Vol 16 (3) ◽

pp. B27

Author(s):

Ahlam Alsomali ◽

Gisele P. Wolf-Klein ◽

Judith Beizer ◽

Lisa Rosen ◽

...

Keyword(s):

Blood Pressure ◽

Adverse Events ◽

Blood Pressure Control ◽

Long Term Care ◽

Pressure Control ◽

Term Care ◽

Tight Blood Pressure Control

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DYNAMICS OF FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE ACCORDING TO LONG-TERM FOLLOW-UP

International Medical Journal ◽

10.37436/2308-5274-2020-4-1 ◽

2020 ◽

pp. 5-11

Author(s):

O. O. Matova ◽

K. I. Serbeniuk ◽

L. V. Bezrodna ◽

V. B. Bezrodnyi ◽

V. V. Radchenko

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Antihypertensive Therapy ◽

Functional State ◽

Resistant Hypertension ◽

Pressure Control

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium. Key words: resistant arterial hypertension, chronic kidney disease, functional state of kidneys, antihypertensive therapy.

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Effect of renal denervation on long-term outcomes in patients with resistant hypertension

Cardiovascular Diabetology ◽

10.1186/s12933-021-01309-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Bo Liang ◽

Yi Liang ◽

Rui Li ◽

Ning Gu

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Pressure Control ◽

Treatment Method ◽

Control Effect ◽

First Choice ◽

Long Term Follow Up

AbstractIncreasing studies strongly prove that renal denervation, a minimally invasive surgery, is a promising new non-drug treatment method that can effectively control blood pressure in patients with resistant hypertension, but the evaluation of the long-term blood pressure control effect of renal denervation for resistant hypertension is still lacking. Here, we critically review current long-term follow-up data about the use of renal denervation for RH to comprehensively evaluate the effectiveness of renal denervation for RH, and to provide practical guidance for practitioners who are establishing a renal denervation service. Limited by the current research, many problems need to be solved before renal denervation is applied to RH. In addition, ambulatory blood pressure should be the first choice for the evaluation of blood pressure. Finally, the continuous antihypertensive effect of renal denervation in different renal denervation systems also needs to be strictly compared.

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